Abstract
Purpose. This quantitative study examined the impact of the transition from numerical to pass/fail scoring for COMLEX Level 1 and USMLE Step 1 on osteopathic (DO) students’ ability to match into competitive specialties. Specifically, it compared match outcomes and application components among the classes of 2023, 2024, and 2025 at a Southern California osteopathic medical school to determine how the shift influenced residency competitiveness and strategy.
Theoretical Framework. Guided by human capital theory, this study conceptualized board scores, letters of recommendation, and audition rotations as investments contributing to match success. Additionally, the study was framed by the concept of DO bias, which suggests that disparities in residency selection stem from limited understanding and historical stigma associated with osteopathic training.
Methodology. A causal-comparative, quantitative design was used to analyze secondary data from approximately three cohorts (~175 students each) applying to competitive specialties. The class of 2023 served as the control group (numerical scoring), while the classes of 2024 and 2025 represented post–pass/fail cohorts. Analyses examined relationships between match outcomes and variables including Step 2/Level 2 scores, number of letters of recommendation, and audition rotations, as well as trends in Step 2 participation.
Findings and Conclusion. Findings indicated that Step 2/Level 2 scores and letters of recommendation were significant predictors of match success, while audition rotations demonstrated a weaker but notable influence. Step 2 scores showed marginal significance compared with Level 2, suggesting variability in how residency programs interpret these metrics. No consistent, statistically significant differences were observed across class years, indicating that the transition to pass/fail scoring did not substantially alter match outcomes in the short term. However, trends suggested increased reliance on Step 2 and other application components, potentially reinforcing existing disparities for DO applicants in competitive specialties.
Recommendations. Institutions should enhance evidence-based advising that emphasizes strategic Step 2 performance, strong letters of recommendation, and targeted audition rotations. Residency programs should work toward standardizing the evaluation of COMLEX scores to reduce inequities. Further longitudinal research is recommended to assess the long-term effects of pass/fail scoring and to explore additional factors influencing DO match success across institutions.