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Mar 26, 2024

Practice Perfect 905
Are Podiatrists Eating Their Young
With the Board Examinations?

  Jarrod Shapiro, DPM, FACFAS, FACPM

PRACTICE PERFECT   March 26, 2024

One of the most significant hurdles for a young podiatric medical student is passage of the first board exam, part 1 of the NBPME examination process. This difficult examination requires our students to have a strong knowledge of the basic biological sciences in addition to lower extremity anatomy. Now, it makes sense that we would test this material; it’s what was covered during the first two years of podiatric medical school. For our students to pass this pass/fail examination, they have to receive a 75% or higher. This is a slightly simplistic definition since it’s actually a scaled percentile score, but I think it’s overall a fair statement.

Here's my question: when compared with the MD and DO examinations, why is our test requirement so high? Let’s see what the requirements are for those other professions.

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According to the Gold USMLE review, the examination is pass/fail, not numerical. As per the directives of the USMLE program, to secure a “pass” status, candidates are expected to accurately respond to roughly 60% of the questions presented in this Step . So, you need 60% to pass the USMLE.


The COMLEX examination is the board examination that osteopathic doctors take. From the COMLEX Level 1 score report: “The result indicates the pass/fail decision based on your examination performance. Passing COMLEX-USA Level 1 is solely based on achieving an overall standard score of 400 or higher. The standard score of 400 reflects the minimum passing level recommended by the NBOME for COMLEX-USA Level 1.” If the maximum score on this exam is 800, then that means a DO student needs a 50% to pass.

Let’s sum this up. Podiatry students have to pass with a 75% while MDs need 60% and DOs need 50%. This sounds pretty bad, I know.

Let’s make a few qualifying comments. First, I’m an outsider to much of this, and my figures can’t be the whole story (I hope). Second, the USMLE is known to be a brutally difficult test, while the COMLEX is slightly easier but harder than the APMLE exam which tests more first order basic information rather than convoluted higher order questions.

Assuming this is true, why are we doing this to our students? Why is our pass requirement so high? One reason might simply be that we’re holding our students to a higher standard. Given the quality of physicians in the MD and DO world, I have trouble believing that. Could it be that podiatry continues to suffer from the “little man” disorder? Being a small profession in the medicine world, podiatry has spent much effort trying to be accepted as physicians and surgeons on par with the rest of the doctors. Perhaps this is another example of our Napoleon complex working against us. Perhaps this is yet another example of podiatrists eating their young.

I’d like to invite the APMLE or other responsible parties within podiatry to respond to my accusations. Maybe I have it completely wrong, and a simple clarification by our leaders will close the book on this question. Or perhaps we’ll see signs that our profession could do better by our students.

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My questions to the APMLE are:

  1. Are these numbers true?
  2. Where does the 75% number come from? Is there a reasonable justification for this number?
  3. Why not drop the number to at least 70%? What effect would this have on the integrity of the examination?

We’ll watch for an answer and publish the results for our community to consider.

Best wishes.

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]

  1. https://www.goldusmlereview.com/blog/usmle-passing-scores/. Last accessed 3/21/24.
    Follow this link

  2. https://www.nbome.org/assessments/comlex-usa/comlex-usa-level-1/scores-transcripts/. Last accessed 3/21/24.
    Follow this link

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