Should Students Taking COMLEX Also Take USMLE?

It’s April and there are big decisions to make. In the coming months, every second-year osteopathic medical student in the country will sit for the COMLEX-USA Level 1 exam. In addition to sitting for COMLEX, thousands of the same students will be faced with the important decision of whether or not to also take the USMLE Step 1.

It has been reported consistently that over 70 percent of osteopathic medical students believe taking the USMLE Step 1, in addition to COMLEX, is worth it stating “to keep options open” is the most common reason (Hasty et al., 2012).

Despite the fact that the majority of allopathic programs (77 percent to be exact) state that they are both familiar with and accept COMLEX, many students still feel it’s necessary to take the USMLE.

Administrative perspective on this topic varies by school – some schools leave the decision solely to the discretion of the students, others provide student-by-student recommendations on the matter, and there are a few COMs that now require their students to sit for the USMLE.

Unfortunately, there is no single universal answer that makes sense for all students.

As we move toward a unified single GME system in June of 2020, many questions still remain unanswered. Will certain osteopathic residency programs even apply for ACGME accreditation? Will fellowship program and subspecialties require USMLE scores? Will a mediocre USMLE score hurt or help my chances during The Match? These are all good questions students have.

Risk Verses Rewards

At TrueLearn, we believe the decision to sit for the USMLE Step 1 is a personal one requiring some soul searching, outside faculty perspective, and a touch of strategy. It must take into account factors pertaining to the academic profile of the student, as well as their career goals in medicine. For the student who is heart-bound on Neurosurgery and it at the top of his/her class, the decision is easy and it’s a go. For the student who is barely passing and is shooting for primary care, it’s probably best for them to focus on doing their best on COMLEX. Unfortunately, most students fall in the middle somewhere.

One of the most common questions we get from students is, “If I take the USMLE, do I have to report my score.” The short answer to this is ABSOLUTELY YES.

During the ERAS process, you will be required to submit your USMLE scores (if you have them, of course) and you are contractually obligated to do so. There is no taking the exam for practice as some students may believe.

This places some students in a bit of a quandary – those who have a strong performance on COMLEX, but suffer a below-average performance on the USMLE.

How to Decide

Here are some questions that you may want to consider when deciding whether you should sit for the USMLE Step 1 this year:

• Do I want to enter into a non-primary care specialty?
• Is my specialty generally known as being “Osteopathic friendly?”
• Does my GPA  rank in the top 50 percent of my class?
• Do I have a history of being a strong standardized test taker?
• WIll I be applying to residency programs on the West Coast?
• Do I plan to enter into the NRMP match?

If the majority of your answers here are ‘yes’ then you may strongly want to consider taking the USMLE. If you find yourself answering ‘no,’ then you may want to think long and hard about whether the risks of taking the exam outweigh the rewards for you.

Regardless of your intentions, we highly recommend for you to consult one (or more) of your faculty on this matter.

If after you are still on the fence, take a look at this article written by Dr. Don Sefick and Elizabeth Petsche that includes a decision-making matrix used to help students at Michigan State make the decision for themselves.

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