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NBOME Collaborates with Colleagues Across Medical Education to Improve Residency Transition

August 26, 2021

The Coalition for Physician Accountability formed the Undergraduate Medical Education to Graduate Medical Education Transition Review Committee (UGRC)—of which the NBOME is a member—in 2020 to focus on improvements to the current state of transitioning from medical school into residency. Today, the Coalition released a report from the UGRC which laid out 34 recommendations for improvement in several areas such as the application process, career advising resources, competency assessments, processes related to interviewing, ranking and matching, and onboarding into residency.

“The UGRC focused considerable attention on student and other stakeholder wellness, reducing stressors and fostering inclusion for all residency applicants,” said NBOME President and CEO John R. Gimpel, DO, MEd, who served as a member of the UGRC and on the Coalition’s Management Committee. “The ultimate goal was enhancing the transition, reducing systemic biases and stressors in the system, and improving health care for the patients we all have the privilege to serve,” he added.

Numerous recommendations in the report focus on providing accurate, trustworthy advising resources, which currently add considerable misinformation and bias into the system. Important consensus recommendations included attention to the interview process and competencies for all learners. In addition, the URGC recommended that applicants be reviewed in a way that is holistic, mission-based and equitable. This includes a recommendation “to promote equitable treatment of applicants regardless of licensure examination requirements, comparable exams with different scales (COMLEX-USA and USMLE) should be reported within the electronic application system in a single field.”

This recommendation calls for the creation of a combined score field in the Electronic Residency Application Service that allows scores of the two licensing exams to be compared more easily, mitigating structural bias and reducing financial and other stressors for DO applicants.

While COMLEX-USA is accepted in all 50 states (and in many international jurisdictions), the report noted that many residency programs are unclear on the equivalency of the licensure examinations, and do not understand the COMLEX-USA scale. This results in some DO applicants feeling compelled to take the USMLE because they believe it will make them most competitive in certain residency programs.

For these students, that perception leads to increases in time, cost and stress levels. According to the UGRC’s report, “currently, over 4000 students [sit for both]—wasting time, enduring additional stress, and paying over $5 million out of pocket that is not needed.” The UGRC’s recommendation (#18) aims to reduce the perceived need to be tested twice.

According to the report, the UGRC’s first goal was to “envision an idealized future state for the transition from UME to GME.” This ideal state foresees the UME to GME transition as “equitable, coordinated, efficient, transparent, and cohesive,” and the key to its success as a “commitment to the broad inclusion of students, educators, schools, programs, and the public in the design, evaluation, and continuous improvement of the UME-GME transition.”

“Alongside the AOA and AACOM, we have advocated strongly for osteopathic medical education, assessment and the distinctive and valid pathway to osteopathic medical practice,” said Gimpel. “We believe these recommendations will help create better organizational alignment across the transition, address inequities and educate many stakeholders. We also believe they will enhance wellness and produce many additional positive outcomes for applicants from all backgrounds.”

Read the full report from the UGRC here.

The NBOME participated throughout the Coalition’s UGRC Planning Committee process, and joined 16 other Coalition members—along with several public members—in unanimous acceptance of the UGRC Report and its 34 recommendations. Those members include the Accreditation Council for Graduate Medical Education (ACGME), the American Medical Association (AMA), the American Osteopathic Association (AOA), the Educational Commission for Foreign Medical Graduates (ECFMG), the Association of American Medical Colleges (AAMC) and the American Association of Colleges of Osteopathic Medicine (AACOM), the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME).