East Carolina University Division of Surgical Education Turning Knowledge into Action A Six Year Head-to-Head Comparison of Osteopathic and Allopathic Applicants to a University-Based, Allopathic General Surgery Residency Lisa L Schlitzkus MD, Christopher J Clark MD, Steven C Agle MPH, MD, P.J. Schenarts MD

East Carolina University Division of Surgical Education Turning Knowledge into Action Background  250% increase in DO graduates, 1980 – 2005  1/5 of medical school graduates DO  18,000 MD graduates annually, stable since 1980

East Carolina University Division of Surgical Education Turning Knowledge into Action Background  419% increase in DOs in allopathic residencies,  DOs entering allopathic general surgery residency 3%, up from 1.2% mid 1990s  Bias against DO applicants

East Carolina University Division of Surgical Education Turning Knowledge into Action Hypothesis Applicant characteristics of osteopathic graduates to a university-based, allopathic general surgery residency are no different than those of allopathic graduates

East Carolina University Division of Surgical Education Turning Knowledge into Action Methods  IRB approval  Retrospective  US Graduates only  Electronic Residency Application Service (ERAS)

East Carolina University Division of Surgical Education Turning Knowledge into Action Methods  Database of self-reported data  Demographics  Years and Jobs after graduation  Couples match  Letters of Recommendation  Volunteer experiences  Scholarly works  Advanced degree  USMLE and COMLEX scores  Statistical Analysis  Student t-test and chi-square  Significance set at p<0.05

East Carolina University Division of Surgical Education Turning Knowledge into Action Results 1,155

East Carolina University Division of Surgical Education Turning Knowledge into Action AllopathicOsteopathicp-value Age in Years28.9 ± ± Male Gender65.1%63.0%0.621 Caucasian65.5%78.5%0.002 US Citizenship 96.5%98.5%0.220 Demographics

East Carolina University Division of Surgical Education Turning Knowledge into Action AllopathicOsteopathicp-value Years after Graduation 0.3 ± ± Jobs after Graduation 0.2 ± ± Couples Match 3.6%5.9%0.192 Other Demographics

East Carolina University Division of Surgical Education Turning Knowledge into Action AllopathicOsteopathicp-value Letters of Recommendation 3.5 ± ± Volunteer Activities5.8 ± ± Scholarly Works1.6 ± ± Advanced Degrees15.1%21.5%0.057 Common Selection Variables

East Carolina University Division of Surgical Education Turning Knowledge into Action AllopathicOsteopathicp-value Reported99.0%54.8% Score207.7 ± ± Attempts at Passing 1.1 ± ± USMLE Step 1

East Carolina University Division of Surgical Education Turning Knowledge into Action AllopathicOsteopathicp-value Score217.4 ± ± Attempts at Passing 1.1 ± ± Reported77.1%43.0% USMLE Step 2

East Carolina University Division of Surgical Education Turning Knowledge into Action COMLEX 1COMLEX 2 Score512.5 ± ± 91.8 Attempts at Passing 1.1 ± ± 0.2 Reported88.9%77.8% Reported USMLE equivalent 54.8%43.0% COMLEX Performance

East Carolina University Division of Surgical Education Turning Knowledge into Action Limitations  Retrospective  Self Reported Data  Unable to compare clerkship grades  Single Institution  Few osteopathic applicants

East Carolina University Division of Surgical Education Turning Knowledge into Action Discussion  Increased osteopathic graduates of which 9% enter general surgery residencies  Osteopathic residencies cannot accommodate thus more will enter allopathic  Screening variables not applicable to DOs  Example: AOA membership  Unfamiliarity with specific medical schools  Race may reflect rural focus  Failure to report USMLE scores may be considered red flag

East Carolina University Division of Surgical Education Turning Knowledge into Action Conclusion Essentially no difference exists between allopathic and osteopathic applicants, except for USMLE Step 1 scores, which may be due to self-reporting of favorable data.

East Carolina University Division of Surgical Education Turning Knowledge into Action