Dermatology - A complete Review for your Final Exam and for your USMLE / COMLEX (1)

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There was an equal distribution of males Additionally, Demographic and academic characteristics of the DO — students included in the study.

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Our first objective was to examine pre- or post-admissions student academic performance variables associated with matching into first-choice residency. The only pre-admissions variable associated with matching into first-choice residency was the highest MCAT score, with a 0. Surprisingly, the mean highest MCAT score of those that matched into their first choice was 0.

Pre- and post-admission academic variables affecting matching into first-choice residency for DO — Statistically significant associations are shown in bold. Among the post-admissions performance variables, the mean pre-clinical GPA of students matching into their first choice was slightly higher than that of students that did not 0.

There was a Finally, we identified a small, but statistically significant difference in mean USMLE Step 2 CK scores between students that matched into their first choice and those that did not 3. However, this effect did not persist when including all five performance factors in the analysis. Multivariate analysis of select variables affecting matching into first-choice residency for DO — We also investigated factors that affect matching into specialties of different competitiveness.

Specifically, Similarly, The difference in mean scores between students that matched into specialties of high- versus low-competitiveness was Pre- and post-admission academic factors affecting matching into specialties of different competitiveness for DO — As with the COMLEX exams, we observed a statistically significant difference in mean scores between students that matched into specialties of high- versus low-competitiveness, Finally, we observed a statistically significant difference in the mean pre-clinical GPA between students that matched into specialties of high versus low competitiveness 2.

Although USMLE Step 1 and 2 CK scores were associated with matching into highly competitive specialties we did not include them in this analysis for the same reasons as described above. Multivariate analysis of select variables affecting matching into highly competitive specialties for DO — We examined 13 pre- and post-admissions academic performance variables to identify associations with matching into first-choice residency and into highly competitive specialties. Due to differences in selection criteria used for and the process of entering into postgraduate medical education between the United States and other countries such as the United Kingdom and Canada, our findings can only be generalized to other institutions in the United States rather than globally [ 17 , 18 ].

We found that When examining factors associated with matching into first choice, we identified an association between pre-clinical GPA and matching into first choice. This may be due to the fact that, unlike standardized licensing exams which allow the comparison of applicants from different institutions, grades can have different meanings at different institutions and, therefore, are not an important selection criterion for residency. We observed a similar effect of pre-clinical GPA using multivariate analysis. It is also consistent with residency program directors not citing pre-clinical grades as a criterion for selecting applicants to interview and to rank them post-interview [ 2 ].

This is not surprising, since this exam is utilized by program directors to select applicants for interview as well as to rank them post-interview relative importance 4. Surprisingly, we did not identify a similar effect for Level 1 or Step 1 scores. This may be explained by the fact that passing this exam is not a graduation requirement for our students, rather they opt to take it to increase their competitiveness in the matching process.

Among the pre-admissions academic performance factors tested, we found a statistically significant association of highest MCAT score with matching into first choice.

Dustyn Williams, MD

Interestingly, the mean score of students that did not match into their first choice was 0. We observed the same effect in multivariate analysis. This further confirms the results of our univariate analysis. A previous study has shown that taking the MCAT several times reduces the predictive value of the exam [ 19 ]. This, taken together with the fact that the majority of our students have taken the MCAT more than once could account for our observation that the effect is in the opposite direction one would expect. Matching into a highly competitive specialty is a different question.

Our findings are consistent with these studies. Specifically, we observed a Specifically, it was approximately 3. The fact that COMLEX Level 1 score is the single most important predictor of matching into highly competitive specialties is supported by several lines of evidence. First, it is the only licensing exam score that students are required to submit with their initial residency applications, and since our institutional deadline for taking the exam is September 1st of the fourth year of studies, scores are not available by the September 15th deadline for submission of initial residency applications.

Furthermore, passing licensing exams on the first attempt was a critical factor for matching into highly competitive specialties.

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In comparison, In addition, A likely reason for this observation is that Level 2 PE is considered as a minimum competency exam by program directors of highly competitive specialties. In addition to licensing exams, we identified a statistically significant association of pre-clinical GPA with matching into highly competitive specialties. However, the effect size was small with a 2. The fact that the effect size of pre-clinical GPA was small compared to that of licensing exam scores suggests that, since grades are not standardized among different medical schools, they are not as useful in comparing applicants to residency programs.

In contrast, scores on standardized licensing exams allow program directors to compare diverse applicants from across the country. Finally, using univariate analysis, we did not observe an association between any pre-admissions academic performance variables, such as highest MCAT score or science GPA, with matching into highly competitive specialties. This is not surprising, since, although undergraduate GPA and MCAT scores allow for successful admission to medical school, they are not part of residency applications and thus are not available to program directors.


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A large body of work has demonstrated a small to medium predictive validity of MCAT scores for licensing exam performance, particularly for USMLE Step 1 [ 22 , 23 ], and since USMLE Step 1 is a key determinant for matching into highly competitive specialties as is COMLEX Level 1 according to the present study [ 2 , 7 , 9 , 24 ], this may account for the observed association of MCAT score with the increased unadjusted odds of matching into highly competitive specialties. This study has a number of limitations.

First, the relative competitiveness of specialties may slightly change from year to year, in part due to the variability in the number of applicants and positions available [ 25 ]. To estimate the effect of this limitation, publicly available match data from the National Resident Matching Program NRMP annual residency match reports —, as well as Electronic Resident Application Service ERAS data, that provide detailed information for each specialty on the number of available positions, number of applicants, number of positions filled and number of positions filled by US seniors, was used to determine the specialty fill rate by US seniors, which is a measure of its competitiveness [ 26 ].

This analysis revealed small year-to-year fluctuations in fill rate for the specialties included in this study during the eight-year study period.

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However, these fluctuations were not sufficient to result in any changes in competitiveness levels for any of these specialties during the study period. A second limitation is that our students can apply for, and thus, match into either AOA- or ACGME-accredited residency programs, which may differ in competitiveness within the same specialty.

However, this difference is not sufficient to cause a given specialty to move from one competitiveness category to another depending on whether the program is AOA- or ACGME-accredited. Since licensing exam scores are a key determinant in matching [ 2 ], if ACGME-accredited programs are more competitive than AOA programs within the same specialty, one would expect licensing exam scores of students matching into the former to be higher than those matching into the latter.


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This will result in an increase in mean exam scores than if it were the other way around. Since approximately the same percentage of students matched into ACGME versus AOA-accredited programs in the high and medium competitiveness categories high: Therefore, mean licensing exam scores in this group will be higher and this will attenuate the magnitude of the difference we observed between the high and low competitiveness, as well as between the medium and low competitiveness groups. Third, whether students matched into their first-choice residency program is self-reported and has not been independently validated.

However, students have no incentive or reward to falsify this data. The Electronic Residency Application System ERAS which holds the information on first, second or third choice match, does not officially release this information, thus all medical schools in the United States must rely on self-reported data [ 27 ]. Additionally, in the present study, data on the specific specialty and residency program that students matched into was also self-reported. However, this was also officially validated by the Office of the Registrar at our institution, and we did not identify any inconsistencies between the self-reported and Registrar data.

Thus, there is also no reason to doubt the validity of the self-reported data on first-choice match. An additional limitation consists of the fact that students may revise their original first-choice residency selection using their COMLEX Level 1 or USMLE Step 1 score as a measure of their competitiveness, in order to maximize their chances of a successful match. This would result in an increased number of students matching into their first-choice program. However, this would not be unique to our institution, rather it would likely occur in osteopathic and allopathic institutions throughout the U.

The fact that there is significant heterogeneity in the pre-clinical grading systems currently employed in U. However, since there is no national standard for grading systems, this limitation applies to any study examining pre-clinical GPA and is not exclusive to our study. Since this study focuses exclusively on students from one institution, the effect of medical school quality or competitiveness on matching into residency could not be assessed.

Furthermore, less competitive medical schools tend to attract and admit applicants with lower MCAT scores. Since MCAT scores have been shown to possess a small to moderate predictive validity for licensing exam scores, particularly for USMLE Step 1, students in less competitive medical schools are more likely to score lower on their licensing exams, which will in turn decrease their likelihood of matching into highly competitive specialties [ 22 , 23 ]. A study from the University of Minnesota Medical School, which is a top 50 ranked institution, identified an association of licensing exam scores and residency specialty match, with students matching into specialties such as dermatology highly competitive having the highest mean scores and students matching into family medicine low competitiveness having the lowest mean scores, which is consistent with our findings [ 24 ].

This study demonstrated the importance of passing licensing exams on the first attempt, as well as of exam scores, for matching both into first-choice residency and into highly competitive specialties. However, the difference in scores was more pronounced for matching into highly competitive specialties than it was for matching into first-choice residency. Our findings are in agreement with existing literature and supported by the fact that these exams are universally used by program directors for selecting applicants for interview and for post-interview ranking.

Our results can help faculty better advise students, inform curricular design to optimize matching, as well as understand student risk factors for not matching. The authors wish to thank Dr. KM wrote the manuscript.