The Use of COMLEX-USA and USMLE for Residency Applicant Selection

J Grad Med Educ. 2016 Jul;8(3):358-63. doi: 10.4300/JGME-D-15-00246.1.


Background: The Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) and the United States Medical Licensing Examination (USMLE) are recognized by all state medical licensing boards in the United States, and the Federation of State Medical Boards has supported the validity of both examinations for medical licensure. Many osteopathic medical students take both examinations.

Objective: The purpose of this study was to investigate performance on COMLEX-USA Level 1 and USMLE Step 1 of students from colleges of osteopathic medicine where the majority of students took both examinations.

Methods: Data were collected on the entering classes of 2010 and 2011. Relationships between the COMLEX-USA Level 1 and the USMLE Step 1 were quantified using Pearson correlations. The correlation between outcomes on the 2 examinations was evaluated using the phi coefficient. A contingency table was constructed to look at first-attempt outcomes (pass/fail).

Results: Data for 2010 and 2011 were collected from 3 osteopathic medical schools, with 795 of 914 students (87%) taking both examinations. The correlation between first-attempt COMLEX-USA Level 1 and USMLE Step 1 scores was statistically significant across and within all 3 schools. The overall correlation was r(795) = 0.84 (P < .001). Pass/fail status on the 2 examinations was moderately correlated (φ = 0.39, P < .01).

Conclusions: Our study found a strong association between COMLEX Level 1 and USMLE Step 1 performance. Additional studies to accurately compare scores on these examinations are warranted.

MeSH terms

  • Adult
  • Educational Measurement / standards*
  • Female
  • Humans
  • Internship and Residency
  • Licensure, Medical
  • Male
  • Osteopathic Medicine / education*
  • Students, Medical