Context: The Accreditation Council for Graduate Medical Education (ACGME) and American Osteopathic Association (AOA) endorsed the use of competency-based assessment, with the intention to improve health care administration [1, 2]. High-stakes licensing exams, such as the Comprehensive Osteopathic Medical Licensing Examination -- USA (COMLEX-USA), are used for such assessments. Residency programs, like those certified by the American College of Osteopathic Pediatricians (ACOP), have also developed competency-based assessment tools. The purpose of this study is to summarize ACOP Program Directors' Annual Reports of First-Year Osteopathic Graduate Medical Education (OGME-1) pediatric residents from 2005 to 2009, and to investigate the relationship between the competency ratings of residents as reported on the ACOP Program Director's Annual Report and COMLEX-USA scores. intention to improve health care administration [1, 2]. High-stakes licensing exams, such as the Comprehensive Osteopathic Medical Licensing Examination -- USA (COMLEX-USA), are used for such assessments. Residency programs, like those certified by the American College of Osteopathic Pediatricians (ACOP), have also developed competency-based assessment tools. The purpose of this study is to summarize ACOP Program Directors' Annual Reports of First-Year Osteopathic Graduate Medical Education (OGME-1) pediatric residents from 2005 to 2009, and to investigate the relationship between the competency ratings of residents as reported on the ACOP Program Director's Annual Report and COMLEX-USA scores. Conclusions: For pediatric OGME-1 residents, competency ratings drawn from the ACOP's Program Director's Annual Report are statistically related to COMLEX-USA examination scores. (Contains 8 tables and 2 figures.) [This paper has been published as: Langenau E, Pugliano G, Roberts W, Hostoffer R. Summary of ACOP (American College of Osteopathic Pediatricians) Program Directors' Annual Reports for First-Year Residents and Relationships Between Resident Competency Performance Ratings and COMLEX-USA Test Scores. Electronic Journal of the American College of Osteopathic Physicians. 2010; 2(7).]