1. 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

2. 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

3. East Carolina University Division of Surgical Education Turning Knowledge into Action Background  419% increase in DOs in allopathic residencies, 1985 - 2006  DOs entering allopathic general surgery residency 3%, up from 1.2% mid 1990s  Bias against DO applicants

4. 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

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

6. 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

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

8. East Carolina University Division of Surgical Education Turning Knowledge into Action AllopathicOsteopathicp-value Age in Years28.9 ± 3.629.3 ± 2.70.221 Male Gender65.1%63.0%0.621 Caucasian65.5%78.5%0.002 US Citizenship 96.5%98.5%0.220 Demographics

9. East Carolina University Division of Surgical Education Turning Knowledge into Action AllopathicOsteopathicp-value Years after Graduation 0.3 ± 0.90.3 ± 0.80.884 Jobs after Graduation 0.2 ± 0.50.3 ± 0.60.061 Couples Match 3.6%5.9%0.192 Other Demographics

10. East Carolina University Division of Surgical Education Turning Knowledge into Action AllopathicOsteopathicp-value Letters of Recommendation 3.5 ± 0.73.6 ± 0.80.065 Volunteer Activities5.8 ± 4.86.0 ± 5.20.700 Scholarly Works1.6 ± 3.51.5 ± 4.40.943 Advanced Degrees15.1%21.5%0.057 Common Selection Variables

11. East Carolina University Division of Surgical Education Turning Knowledge into Action AllopathicOsteopathicp-value Reported99.0%54.8%0.0001 Score207.7 ± 20.0212.9 ± 14.70.030 Attempts at Passing 1.1 ± 0.51.0 ± 0.20.050 USMLE Step 1

12. East Carolina University Division of Surgical Education Turning Knowledge into Action AllopathicOsteopathicp-value Score217.4 ± 22.0218.5 ± 18.00.699 Attempts at Passing 1.1 ± 0.31.0 ± 0.00.162 Reported77.1%43.0%0.0001 USMLE Step 2

13. East Carolina University Division of Surgical Education Turning Knowledge into Action COMLEX 1COMLEX 2 Score512.5 ± 70.3518.4 ± 91.8 Attempts at Passing 1.1 ± 0.31.1 ± 0.2 Reported88.9%77.8% Reported USMLE equivalent 54.8%43.0% COMLEX Performance

14. 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

15. 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

16. 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.

17. East Carolina University Division of Surgical Education Turning Knowledge into Action