When applying to medical residency programs, you want your application to be as impressive as possible. If you’re an osteopathic medical student, you may be wondering which exam scores will set you apart.

Deciding which exams you should take will help you best represent your knowledge and skills to residency program directors. Whether you’ve already taken the USMLE or the COMLEX or are looking to take one for the first time, you may find that taking both the USMLE and the COMLEX can give you a competitive edge.

USMLE Steps vs. COMLEX Levels

The United States Medical Licensing Examination (USMLE) is a mandatory three-step standardized exam for all students planning to practice allopathic medicine in the United States.

  • Step 1: USMLE Step 1 is taken in the second or third year of medical school and tests medical applications of the foundational sciences.
  • Step 2: USMLE Step 2 is taken in the third or fourth year of medical school and tests and is comprised of two parts — Clinical Knowledge (Step 2 CK) and Clinical Skills (Step 2 CS).
  • Step 3: USMLE Step 3 is usually taken during the first year of residency and tests advanced subjects such as medical ethics, interpretation of medical literature and patient diagnosis skills.

The Comprehensive Osteopathic Medical Licensing Examination (COMLEX) is a national, standardized exam made up of three levels specifically for students looking to become licensed osteopaths.

  • Level 1: COMLEX Level 1 is taken after the second year of medical school, and tests your knowledge of foundational sciences and osteopathic care.
  • Level 2: COMLEX Level 2 is taken during the third or fourth year of medical school and tests Cognitive Evaluation (Level 2-CE) and Performance Evaluation (Level 2-PE). Note that Level 2-PE was suspended indefinitely beginning in 2020, and the National Board of Osteopathic Medical Examiners (NBOME) is currently exploring viable alternatives.
  • Level 3: COMLEX Level 3 is taken during the first year of residency and tests how well you can administer safe and effective osteopathic care in a variety of medical settings.

As these two sets of exams have some similarities, you may be wondering whether taking USMLE Step 1 is worth your time, energy and money when you’ve already taken COMLEX Step 1.

In any case, you have to take at least one of the exams to be qualified to practice medicine in the U.S. Medical doctors (MDs) only need to take the USMLE to meet their testing qualifications.

Many aspiring doctors of osteopathy (DOs) take the COMLEX, as it’s the only medical exam that includes questions about that specialized branch of medicine. In most states, it’s possible to become a licensed DO by only taking the USMLE. However, also taking the COMLEX shows DO programs you’re committed to osteopathy.

Additionally, while you may be able to match into a residency with only COMLEX scores, adding USMLE scores to your application can increase your chances of matching with your chosen specialty.

Which Score Is Used More to Apply for Residencies?

Which Score Is Used More to Apply for Residencies?

In 2020, the Accreditation Council for Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA) moved toward a single system for accrediting residency programs. This merger combined all MD and DO residency opportunities, giving medical students equal access to programs previously limited to just allopathic or osteopathic applicants.

Though this merger broadened the opportunities for medical students, there are still more MD students than DO students, meaning more people apply to residencies using USMLE scores than COMLEX scores. There are also more original ACGME programs than AOA programs, meaning that out of all the residencies you could apply to, you may find more opportunities with programs that originally only accepted USMLE scores.

For these reasons, most students choose to submit USMLE scores in their residency applications. Many program directors are used to the USMLE grading scale and may feel more confident accepting an applicant with a USMLE score alone or in addition to a COMLEX score, instead of only a COMLEX score.

However, as more people apply to residencies using COMLEX scores, directors will become increasingly familiar with that exam and scoring system. In addition, the NBOME provides extensive resources for directors looking to better understand COMLEX scores so they can make well-informed application decisions.

Taking both tests can increase your chances of being accepted to your dream programs. Additionally, even if you’re an aspiring DO and have already taken the COMLEX, you may want to take the USMLE to keep your options open in case you decide, before or during your residency, to pursue an allopathic medical career.

Convert COMLEX Scores to USMLE Scores

If you’ve already taken one of these exams and are considering taking the other one, you may want to use your current score to predict whether you’d perform well on the other exam. However, that’s easier said than done.

Passing USMLE Step 1 numeric scores range from 194 to 300. (Note that Step 1 has moved to a pass-fail grading scale.)

Passing numeric scores for COMLEX Level 1 range from 400 to 999. If you received a numeric report and want to convert your COMLEX scores to USMLE scores, equations can only give you approximate answers at best.

Any conversion methods you may find won’t be entirely accurate, as no COMLEX score to USMLE score or USMLE score to COMLEX score three-digit conversion has been widely accepted. Many residency programs have been advised to use caution when using any formula to derive one score from the other.

Inaccurate conversions are likely because the tests vary greatly in their subject matter, scoring systems and number of questions. Additionally, conversion methods often derive equations from small sample sizes, which are already skewed, as far more people take the USMLE than the COMLEX.

Pass/Fail Updates

Pass/Fail Updates

Both exams’ scoring systems have or will eliminate numeric scores and transition to a pass/fail score reporting system — this happened on January 26, 2022, for the USMLE Step 1 and will happen on May 10, 2022, for the COMLEX Level 1. If you take those exams on or after those dates, you’ll receive a passing or failing score without a specified number.

Though the pass/fail method makes it easy for you to determine how well you performed, you’ll no longer know by what margins. However, the correlation suggests students who perform well on one exam are more likely to perform well on the other. If your hard work paid off the first time, taking the other test can show residency programs your full potential.

Prepare for Success With Medlearnity Expert Tutors

If you’d like help preparing for the USMLE, COMLEX or any other medical school exam, Medlearnity has you covered. Our tutors have average scores of 260 on the USMLE and 650 on the COMLEX and have gone on to train at some of the top hospitals in the country. In addition to being top scorers, they’re also exceptional educators, working with you to address your specific questions and learning preferences.

Tutoring is a great way to supplement studying on your own. You’ll talk to and learn from experienced doctors who can improve your understanding of allopathic and osteopathic medical concepts so that you can perform your best on exam day.

Sign up for a free tutoring trial and find out how Medlearnity can help you advance your medical career!

Prepare for Success With Medlearnity Expert Tutors

About the author 

Akshay Goel MD

Dr. Goel is a body-trained radiologist and an expert in medical education and imaging informatics. He completed his Radiology Residency at Columbia University Medical Center and his fellowship at Weill Cornell Medicine. Dr. Goel has guided several students and doctors into successful careers over the past decade. He continues to help Medlearnity tutors optimize their educational methodology to drive the highest tutoring and admissions impact possible.

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