Getting Podiatric Physicians Access To USMLE Testing

Editor’s note: This DPM Blog was written by guest author James R. Christina, DPM, Executive Director and CEO of the American Podiatric Medical Association (APMA).

Earlier this year, the 2019 APMA House of Delegates passed Resolution 4-19, establishing that a national joint task force will work with the American Medical Association (AMA) to start discussions with the National Board of Medical Examiners about allowing podiatric medical students to take the United States Medical Licensing Examination (USMLE).

What exactly does this mean for our profession and what is the anticipated path forward?

Currently, only students at allopathic and osteopathic medical schools and foreign medical school graduates have access to taking the USMLE. The USMLE mirrors the American Podiatric Medical Licensing Examination (APMLE) administered by the National Board of Podiatric Medical Examiners (NBPME) in that it has Step 1, Step 2, Step 2 Clinical Skills Examination and Step 3. APMLE has Part 1, Part 2, Part 2 Clinical Skills Examination, and Part 3. The curriculum and competencies of podiatric medical schools is comparable to allopathic and osteopathic medical schools.

As an aside, osteopathic medical students can take either the USMLE or the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) for licensing purposes. We have heard the message from our allopathic and osteopathic colleagues that the best way to demonstrate that our education and training is comparable is to pass their examination(s). The catch 22 is that our students and graduates do not have access to take either the USMLE or the COMLEX-USA examinations.

Resolution 4-19 represents the first step in the process by working to get the National Board of Medical Examiners (NBME) to allow podiatric students and graduates to have access to taking the examinations. If we are successful in gaining access, then we will need to start to prepare our students to be able to take and pass the examination. This may require some curriculum changes at our podiatric medical schools and different methods of preparation. However, we are talking about a licensing examination, something that in no way changes the degree deferred upon graduates of podiatric medical schools. We will still be DPMs.

Also, there has been a lot of misinformation about this process. No podiatric medical students have taken the USMLE. They are not eligible. What has occurred is that in 2017, second-year students at the California School of Podiatric Medicine (CSPM) at Samuel Merritt University took the Comprehensive Basic Science Examination (CBSE) administered by the NBME. This exam is open for anyone to register and take. It gives a good picture of how students will do on Step 1 of the USMLE and helps them identify areas where they may be deficient. The CSPM students took this exam without any preparation. By agreement, the results were kept confidential as the exam, in this instance, was being used to assess strengths and weaknesses, and what areas might need to be better emphasized in preparation for the USMLE should access eventually be granted.

The College of Podiatric Medicine at the Western University of Health Sciences has embarked on a three-year project regarding the Comprehensive Basic Science Examination. Their students are taking the same prep classes as their osteopathic colleagues for the USMLE. In 2018, they had limited prep. In 2019, they will have more preparation. In 2020, they will have had the full prep for the exam. The CBSE has a crosswalk to translate the score on the CBSE to the predicted score on Step 1 of the USMLE. This will give a good indication of potential performance by podiatric medical students on the USMLE and identify areas where there may be educational deficiencies that must be addressed.

What are the ultimate goals if podiatric physicians have access to taking the USMLE and/or COMLEX?

•    This should improve recognition that the education and training of DPMs is comparable to MDs and DOs. Therefore, podiatrists should be recognized as physicians, and have parity with our allopathic and osteopathic colleagues.

•    If and when states establish a plenary license for doctors of podiatric medicine to practice to the full extent of their education and training within their scope, obtaining this license will require passage of either the USMLE and/or COMLEX exams.

This will be a long and evolutionary process. Resolution 4-19 just represents the first step in a long journey: gaining access to taking the test.

Editor’s note: This guest DPM Blog has been adapted with permission from an article originally published in the APMA News.