On USMLE for DOs - and the future of the NBOME

Over the past couple of years, I’ve found myself in the middle of a fight between DO medical students and the National Board of Osteopathic Medical Examiners. At issue is whether DO students should be compelled to take the COMLEX-USA - which creates a de facto requirement for DO students to take two licensing examinations, since residency program directors prefer USMLE.

In this video, I’ll provide a basic overview of this acrimonious dispute; explain why the DO students are right (and will eventually win); review the NBOME’s options; and explain what I would do if I led the NBOME in order to save the organization, help osteopathic medical students, and make medical education and patient care better, too.

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MUSIC CREDIT:
“Clutch,” by Nicolas Major.

[dr.strugglebus]

3rd yr DO student/NBOME hater here. We have a shelf/COMAT that’s specifically over OMT, which honestly is enough in my opinion. Most of the time, the inclusion of osteopathic findings in vignettes isn’t helpful to me at all in actual elucidating the diagnosis or correct treatment. Took step 1 and passed, with step 2 scheduled in a few weeks. We literally can’t keep screaming we’re the same when COMLEX has a lower passing score while testing the same basic science. Something isn’t adding up! Thank you for putting the younger generations thoughts into such an organized and factual supported video!

[mr.medtech]

Well said Dr. Sheriff. I follow you on Twitter. I'm a current OMS-1 and several classmates, including myself, feel the same as you. I appreciate our OMT classes and philosophy don't get me wrong. It's the reason why I decided on D.O. Since I started attending med school, so far OMT and principles make up about 10% of everything I have learned so far. Why do we need to take an exam that acts like they only taught us was osteopathic? Have a single licensing exam and allow D.O.s to be eligible for OMT certification or something. Heck, there are several M.Ds that would probably like to become OMT certified. Open it up to those interested instead of forcing it down our throats. Honestly, this requirement just make students more salty from what I've seen.

[reetombera]

I also wanted to add, but where COMLEX has a lot of emphasis on OMT, USMLE directly substitutes that emphasis with an emphasis on biochem.
In my school, we spent all of 1 week on biochem. Hence, while the OMT emphasis had me prepped for Level easily, the distinct lack of biochem exposure until I was grinding Uworld meant I was woefully unprepared for Step.

[MarinaAli]

Finished Level 1/Step 1 last year and am gearing up for the second set this summer. I felt like Step 1 was a fairer exam. The stems were shorter, the exam as a whole is shorter, and the sections are shorter. Level 1 felt like it was trying to wear me out and test my stamina more than it was testing my knowledge. I wish our COMAT for OMM, which is basically our OMM shelf exam, could count as the test of our OMM competency, while using the USMLE as our main exam. I’ve had this discussion with multiple classmates and both MD and DO med students from other schools. It’s fair while not being time consuming or super expensive. When I’ve studied for boards, I’ve had to account for two sets of exams at each step/level. It’s twice the price for what feels like a temporary part of my medical training.

[beccaburrington]

It's part of the DO oath that we continue to pay AOA dues. To not be an AOA member is literally breaking our oath as an osteopathic physician. I think a lot of DO students feel much of the path to becoming a DO is managed with a heavy hand. There are a lot of ethical binds.

[reetombera]

"Will NBOME do any of this? of course not."
Another reason I can tell you why for this is because you noted strategies that would work out better for Osteopathic Medicine in general in the long run. But if you have a leadership full of old men and women, what do any of them have to benefit from a long term strategy? Kinda the same thing that happens in many C-suites now in corporation. Why play a more universally beneficial strategy to improve everyone's lives in the long run, when we can instead take everything we can in the short term to run away with the greatest profit, and not personally have to worry about the downstream effects?

[Thatguy-mojd]

I would argue against the Step 1 higher minimum score being somehow a good thing. Look at all the hundreds of thousands of Drs who passed when the STEP 1 bar was lower and they turned out fine. Arbitrarily increasing the minimum score doesn’t make MDs better doctors. Stop trying to make the same degree you got harder to achieve. - signed MD student

[tricogustrico]

Average MD students are smarter than DO students thus it is no surprise they can't all pass the USMLE.