There are two types of physicians, allopathic and osteopathic. Each practices in an important area of medicine, and both have noticeable overlapping functions. There are major misconceptions about the quality of the American osteopathic medical schools among international medical students, and in particular among students of the Caribbean schools. These commonly stem from two unqualified assumptions that firstly, entry into osteopathic schools is easier than the allopathic schools, and secondly, osteopathic students do not do as well as the allopathic students on the USMLE exams.

In addition to GPA and MCAT scores, criteria for entry into osteopathic schools stress the well-roundedness of each applicant as a measure of their aptitude for appreciating holistic aspects of health and disease. Despite the fact that curricula of allopathic and osteopathic schools cover much of the same material, they have noticeable contrasts with each other. To make use of an analogy, allopathic medicine and osteopathic medicine are like a lion and a tiger: both are classified as large felines despite having noticeable differences.

A key difference between osteopathic and allopathic students is that an osteopathic student has to master the art of osteopathic manipulative medicine and techniques, and an allopathic student does not. In addition to self-evident areas such as osteopathic manipulative medicine, other curricular differences cover a wide spectrum of quantitative differences between concepts deemed to be common to both branches of medicine.  An example of this would be how the osteopathic curriculum places a heavier stress on musculoskeletal health and disease compared to allopathic medicine.

Accordingly, the COMLEX and USMLE exams are designed to address not only the shared grounds between allopathic and osteopathic medicine, but also the concepts that are qualitatively and quantitatively more important for each. This means that osteopathic students are better equipped to take the COMLEX exam, and allopathic students are better equipped to take the USMLE. Hence, interpretation of the average score of osteopathic students on the USMLE exam must take into account the fact that these students are attempting an exam that is designed to address the requirements of the other branch of medicine. By the same token, if allopathic students were to take the COMLEX, they would likely perform worse than osteopathic students. Asking allopathic students to take the COMLEX exam is like forcing a lion to swim across a river, even though a tiger is a much better swimmer!