When assessing medical schools, aspiring physicians should investigate how students at their target schools perform on American national medical licensing exams, experts say.
Licensing exam scores determine whether someone is legally permitted to become a U.S. doctor, experts say. Dr. John R. Gimpel, the president and CEO of the National Board of Osteopathic Medical Examiners, says the purpose behind medical licensing exams is to ensure that everyone who practices medicine is competent to do so. "They're all about protecting patients and protecting the public," Gimpel says.
Gimpel emphasizes that med school hopefuls shouldn't use licensing exam scores as the be-all and end-all deciding factor when choosing a med school, since the exams aren't built to assess the quality of a school. He adds that there are many other considerations beyond licensing exam scores that prospective med students should weigh carefully, such as whether the mission of a school aligns with their career goals and whether the school has a top-notch teaching faculty.
However, when a med school consistently posts licensing exam scores above the national average, that is a reassuring sign, Gimpel says. "That helps to show that their graduates are at least succeeding well in passing their licensing exams and getting high scores, and that's usually going to mean that those doctors are going to be successful in getting into the residency programs that they'd like to and into the career paths that they like," he says.
The most crucial licensing exam statistics for a prospective medical student to know about each of the med schools he or she is considering are the pass rates among first-time test takers for the first two parts of either the allopathic or osteopathic medical licensing exams, experts say. When licensing exam pass rates dip below 90%, that is cause for concern, says Dr. G. Richard Olds, president of St. George's University, an international academic institution that includes a medical school and has a main campus located in the West Indies. Pass rates hovering around or approaching 70% are particularly troubling because med schools with exceptionally low licensing exam pass rates run the risk of losing their eligibility to receive federal student aid funding, he adds.
Why Passing Licensing Exams Is Critical
Students and recent graduates of M.D. programs at allopathic medical schools must pass the United States Medical Licensing Examination, which is commonly known as the USMLE, in order to become licensed doctors who can work independently in the U.S. Similarly, anyone attending a D.O. program at an osteopathic medical school will need to pass the Comprehensive Osteopathic Medical Licensing Examination of the United States, which is commonly known as COMLEX-USA, in order to practice medicine without supervision in America.
Both the USMLE and the COMLEX-USA are three-part exams, and each part is typically completed at a specific moment within a medical trainee's yearslong education in medicine. The first part is usually taken after the first two years of medical school, while the second portion -- which includes both a written knowledge test and a hands-on clinical skills test -- is ordinarily completed during the latter half of medical school, with the third and final part reserved for the first or second year of a medical residency.
The licensing test results that are most relevant for vetting medical schools are the scores and pass rates for first two portions of the USMLE and COMLEX-USA exams, according to experts. Those are the two components of the licensing exams which are designed to judge whether medical students have gained sufficient knowledge and skills through their medical school curriculum, experts explain. Meanwhile, the last part of these exams assesses the competencies of medical residents.
Among the 110 ranked medical schools in the U.S. News Best Medical Schools rankings that reported their USMLE pass rates for first-time test takers during the 2016-17 school year, the average pass rate for Step 1 of the exam was 96.3%, whereas the average pass rate for the Step 2 clinical knowledge test was 96.6%. Meanwhile, according to the National Board of Osteopathic Medical Examiners, which administers the COMLEX-USA exam, the average pass rate among first-time test takers during the 2016-17 academic year was 92.7% for Level 1 of the exam and 93.2% for the Level 2 cognitive evaluation portion of the exam.
How Licensing Exams Factor Into the Residency Match Process
Licensing exam scores influence whether someone is a competitive candidate for a desirable residency in his or her dream medical specialty, physicians say. Exam scores are one factor among many that U.S. residency directors consider during the selection process for their residency programs, according to doctors.
Students with high licensing exam scores have a greater chance of obtaining highly coveted residency placements. Meanwhile, students with low scores may struggle to find a residency match, experts explain.
Some osteopathic medical students opt to take both the USMLE and the COMLEX-USA so they can maximize their competitiveness for selective residency programs, but doing so is not mandatory, experts say. Late last year, the American Medical Association's House of Delegates unanimously approved a resolution which states that the USMLE and the COMLEX-USA should be regarded as equivalent during the residency match process, and neither exam should be favored over the other.
Why You Should Put Licensing Exam Scores in Context
Olds says medical school hopefuls should not automatically assume that schools with slightly higher scores and pass rates on these exams are superior to institutions with marginally lower numbers. There are certain factors that can heavily influence those statistics that have nothing to do with the quality of a school's curriculum, he says.
For instance, if a medical school has a high attrition rate, seemingly impressive licensing exam pass rates may mask problems with their courses and academic support services, Olds says. Prospective med students should also take note if a med school has a policy of flunking out students who appear unlikely to pass licensing exams and, if that's the case, they should view that school's scores and pass rates with more skepticism, he adds.
"The school shouldn't be taking students in that they're not prepared to help be successful, especially because most kids who make it into med schools are highly qualified," he says.
Another important consideration to keep in mind when examining licensing exam results is that these results are at least partially influenced by the type of student a school usually admits, Olds says. If a med school strongly considers MCAT scores and undergraduate GPAs when making admissions decisions and the vast majority of its students have stellar scores and grades, their typical admitted student is predisposed to perform well on the medical licensing exam without requiring much academic assistance. In contrast, he says, a school which enrolls a significant number of students with mediocre or low MCAT scores and average or poor GPAs will likely need to provide significant academic help to its students to ensure that they pass licensing exams.
Olds says prospective med students should see how a school's licensing exam scores compare with the MCAT scores of its incoming students. If a school's average MCAT score is significantly more impressive than its average licensing exam scores, that may indicate that a school's med students aren't reaching their full potential, he says. On the other hand, if a school's average licensing exam score is equally as good or superior to its average MCAT score, that is a positive indication that a school is helping its students grow their knowledge and skill sets. "You want them to help students outperform what would be predicted," he says.
Gina Moses, the director of admissions recruitment at the New York Institute of Technology College of Osteopathic Medicine, says prospective medical students can often find information about how a medical school's students perform on licensing exams in the outcomes section of school websites. Another place to look is in school catalogs, she says.
Moses says med school hopefuls should look up both the average licensing exam scores and the pass rates at the med schools on their short list in order to decide where to apply. Still, she cautions that the more important figures are the pass rates, which are the "better indicator of student success," she wrote in an email. It's important for prospective students to consider these figures alongside other important criteria for picking a med school, such as student support services, cost and accreditation, she says.
"The numbers must be viewed as part of the whole description of the medical school," she says. "The ideal environment will be different for each applicant so an applicant will need to investigate all information about the school so as to best evaluate his or her options and narrow his or her application choices."
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