ACGME match facts

[DO Anes]

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I am at a mid-tier anesthesiololgy program at an academic medical center in the Northeast with an ACGME-accredited anesthesiology residency. I am dismayed by the poor advice that some osteopathic students are getting from their schools about what is an acceptable/competitive COMLEX score. Here are the facts:
We received over 1000 applications this year for 8 spaces. Many programs no longer look at the COMLEX, but we do. Our cutoff for interview invitation is a COMLEX of 600 on the first attempt. We frequently do not have the COMLEX II score available at the time of invitation. It is distressing to see poeple come with COMLEX scores of 570 and get that blank look when we ask, "What about your USMLE, since you COMLEX II is not competitive"? We are frequently told that their advisors said it was unnecessary to take the USMLE. I can't speak for other specialties, but a COMLEX II below 600 is not making the rank list. When a student has taken both the USMLE and COMLEX, we tend to ignore a poor COMLEX score if the USMLE is good. Our cutoff for interview is a USMLE I of 200 on the first attempt. We frequently see COMLEX scores in the 500's, but USMLE's for the same student of 250-260. When we ask about the disparity, most say they spent all their time studying for the USMLE and ignored the COMLEX. Vice-versa, however, does not work. A stellar COMLEX score will not help someone with a poor USMLE score.
Take home point: for moderately competitive residencies, like anesthesiology, if you only take the COMLEX, score above 620. If you do poorly on the COMLEX, take the USMLE and blow it away. No amount of clinical savvy, experience, EC's, auditions or anything else will get someone with a lousy COMLEX listed. That may not be fair, but those are the facts. The average COMLEX for AOA anesthesiology is about 500 and for radiology, the most competitive AOA residency, it is about 570. That is completely irrelevant in the ACGME match. Considering the ever-increasing enrollment of both DO and MD schools, coupled with the new changes in ACGME policy regarding fellowships and internships, expect this competition to skyrocket in the next few years.

 

[p1acebo]

I am at a mid-tier anesthesiololgy program at an academic medical center in the Northeast with an ACGME-accredited anesthesiology residency. I am dismayed by the poor advice that some osteopathic students are getting from their schools about what is an acceptable/competitive COMLEX score. Here are the facts:
We received over 1000 applications this year for 8 spaces. Many programs no longer look at the COMLEX, but we do. Our cutoff for interview invitation is a COMLEX of 600 on the first attempt. We frequently do not have the COMLEX II score available at the time of invitation. It is distressing to see poeple come with COMLEX scores of 570 and get that blank look when we ask, "What about your USMLE, since you COMLEX II is not competitive"? We are frequently told that their advisors said it was unnecessary to take the USMLE. I can't speak for other specialties, but a COMLEX II below 600 is not making the rank list. When a student has taken both the USMLE and COMLEX, we tend to ignore a poor COMLEX score if the USMLE is good. Our cutoff for interview is a USMLE I of 200 on the first attempt. We frequently see COMLEX scores in the 500's, but USMLE's for the same student of 250-260. When we ask about the disparity, most say they spent all their time studying for the USMLE and ignored the COMLEX. Vice-versa, however, does not work. A stellar COMLEX score will not help someone with a poor COMLEX score.
Take home point: for moderately competitive residencies, like anesthesiology, if you only take the COMLEX, score above 620. If you do poorly on the COMLEX, take the USMLE and blow it away. No amount of clinical savvy, experience, EC's, auditions or anything else will get someone with a lousy COMLEX listed. That may not be fair, but those are the facts. The average COMLEX for AOA anesthesiology is about 500 and for radiology, the most competitive AOA residency, it is about 570. That is completely irrelevant in the ACGME match. Considering the ever-increasing enrollment of both DO and MD schools, coupled with the new changes in ACGME policy regarding fellowships and internships, expect this competition to skyrocket in the next few years.

Did you mean a poor USMLE score at the end of that sentence?

Thank you for the advice, I am planning on applying to ACGME EM programs (I am a second year currently). I already have the ball rolling on setting up my USMLE date, and plan on taking both the COMLEX and the USMLE.

My question is, if you do score poor on the COMLEX but good on the USMLE, is that better than just a stellar COMLEX score? Or maybe I missed your message.

 

[sylvanthus]

I think the take home point was to do awesome on the COMLEX and if you don't, to take the USMLE and do well on that to counteract the poorer COMLEX score.

 

[DO Anes]

Thanks. Edited.
Once you take the USMLE, the COMLEX is largely irrelevant. So you can do poorly on COMLEX and rescue with a good USMLE, although the poor COMLEX will tarnish the file somewhat, especially in DO-friendly programs. There is no rescue, however, for a poor USMLE. A stellar COMLEX is good, although some ACGME programs do not accept the COMLEX

 

[Bacchus]

I find these numbers interesting but am puzzled by what mindset must be going on. Is there a strong DO bias? A 200 on the USMLE seems rather low whereas the average COMLEX is 500 with a stddev. of ~81 putting a 600 rather high from the USMLE minimum. Last test season 600 would have been >85th percentile. Is there an explanation behind the numbers?

 

[DO Anes]

COMLEX seen as less rigorous, credible, whatever, than USMLE.

 

[sylvanthus]

Sadly, this is from the JAOA. They essentially admit the COMLEX is less rigorous.

USMLE Step 1 = 67.97 + 0.24 x COMLEX Level 1, (R^2=0.68)
USMLE Step 2 = 102.2 + 0.18 x COMLEX Level 2, (R^2=0.46)

 

[sylvanthus]

link to the article


http://www.jaoa.org/content/106/9/568.abstract

 

[Bacchus]

Eye opening

 

[sylvanthus]

It was actually pretty accurate when I plugged in both my scores.

 

[IDBasco]

That formula underestimated my score by 21 points. Not useful in my opinion.

 

[DrWBD]

link to the article


http://www.jaoa.org/content/106/9/568.abstract

This came up in a discussion here about a year ago:

 

[Kate6058]

Thanks. Edited.
Once you take the USMLE, the COMLEX is largely irrelevant. So you can do poorly on COMLEX and rescue with a good USMLE, although the poor COMLEX will tarnish the file somewhat, especially in DO-friendly programs. There is no rescue, however, for a poor USMLE. A stellar COMLEX is good, although some ACGME programs do not accept the COMLEX

Thanks for the info. How does your program consider someone with a high USMLE Step 2 score that is reported on the application when you receive it? I've heard conflicting info about whether a good Step 2 can also help rescue a low COMLEX Level 1. Some say yes, that Step 2 is becoming increasingly useful on your app, but some say no.

 

[DO Anes]

Thanks for the info. How does your program consider someone with a high USMLE Step 2 score that is reported on the application when you receive it? I've heard conflicting info about whether a good Step 2 can also help rescue a low COMLEX Level 1. Some say yes, that Step 2 is becoming increasingly useful on your app, but some say no.

Yes, a good USMLE II can mitigate a low (200-210) step I score. Once there is a USMLE score in the packet, either step I or II, we basically ignore/discount the COMLEX, whether it is high or low. (That being said, a high COMLEX, >650, helps the app, but does not rescue a low USMLE). Step II is useful on the app, assuming it is high. So an applicant with a step I of 210 and no step II is at a disadvantage to someone with the same step I and a Step II of 230. Similarly, someone with a step I of 210 only has an advantage over someone with the same step I and a step II of 195. Do not fail any USMLE steps, including the CS. Without significant and compelling reason, no USMLE score will rescue a previous failure. Sometimes we don't see the previous failure until ERAS sends follow-up material and the interview invitations are out; we only see the most recent score initially. If you have failed an exam , please do not waste your time and money by applying without having a personal discussion with someone in the program's leadership to know that your application will be ranked. 999 times out of 1000, someone with a failure will not make the rank list at this program, regardless of the subsequent score.

 

[DocEspana]

That formula underestimated my score by 21 points. Not useful in my opinion.

It underestimated my actual USMLE by ~35 points. which is huge (haha a 221 vs a 256 is a big deal)

 

[docnotsopc]

It underestimated my actual USMLE by ~35 points. which is huge (haha a 221 vs a 256 is a big deal)

You got a 256 .... daaaaaaaaam son

 

[DocEspana]

You got a 256 .... daaaaaaaaam son

ahahahaha i wish. I was simply using the 221 as a mean score and saying 35 points above that. For the actual purpose of not being 100% open about every detail of my personal life and just listing out my 3 digit score. I did do well enough to get that 99 though, so I'll still accept the "daaaaaaamn son" comment.

 

[kazuma]

Thanks for posting these facts. I've been giving similar advice to the current 3rd years at my hospital, but unfortunately many of them are still believing the lies told by their professors and advisers. I'll have to show them this thread.

 

[se20001984]

do you guys recommend USMLE or COMLEX 1st?

 

[fiznat]

I'd be interested to hear if the "cutoff" scores for USMLE are higher, lower, or the same for DO and MD applicants. Are all applicants with similar numbers, LORs, ECs, etc considered equally?

 

[kazuma]

do you guys recommend USMLE or COMLEX 1st?

I always took the COMLEX a week or two before the USMLE. I figured the COMLEX would be a warm up round to get back into standardized testing mode and become familiar with the testing center etc.

 

[Dissected]

do you guys recommend USMLE or COMLEX 1st?

I took USMLE on a monday, studied the green book for a couple days and then COMLEX that same friday. Worked for me.

It probably doesn't matter very much tho..

 

[sylvanthus]

I took USMLE on a monday, studied the green book for a couple days and then COMLEX that same friday. Worked for me.

It probably doesn't matter very much tho..

I did the exact same thing......

 

[cliquesh]

I got in the 250's on USMLE step one. Would you recommend that I take the usmle step 2? I was planning on just taking the COMLEX II and not even reporting my comlex scores.

 

[FrkyBgStok]

This question isn't directly related to the conversation but I am curious. To the DOs applying to moderately competitive and DO friendly MD residencies, are generally feeling comfortable about matching? It seems like skipping the DO match would be dumb unless you felt like you had a decent shot. Stuff like anes. Why skip the match? As a premed I am genuinely asking.

 

[Dissected]

I got in the 250's on USMLE step one. Would you recommend that I take the usmle step 2? I was planning on just taking the COMLEX II and not even reporting my comlex scores.

It ultimately depends on what specialty you are applying to and what the programs you will rank are looking for. I would email some program coordinators if I were you..its good to hear things from the horse's mouth.

After doing a lot of research I decided it was in my best interest to take it for general surgery.

 

[sylvanthus]

DO match is before the MD match. Therefore, if you match into a DO program, you are pulled from the MD profram. So, if your favorite programs are MD, you take a big risk staying in the DO match.

 

[Dissected]

DO match is before the MD match. Therefore, if you match into a DO program, you are pulled from the MD profram. So, if your favorite programs are MD, you take a big risk staying in the DO match.

Agreed.

To add to this and to answer Frkybgstok's question, yes. Many DO applicants feel comfortable when applying to ACGME programs and going strictly with the MD match. Especially in primary care fields (FM, IM, Peds). Anesthesia is a unique bird because there are such a small number of DO spots, and to my knowledge (could be off base here), some of the programs aren't the best...so in a sense, skipping the MD match might be a good decision. Kind of what sylvanthus is saying.

Remember that ~60% of DO's end up at ACGME programs.

 

[FrkyBgStok]

Thanks. That makes sense.

 

[tkim]

This question isn't directly related to the conversation but I am curious. To the DOs applying to moderately competitive and DO friendly MD residencies, are generally feeling comfortable about matching? It seems like skipping the DO match would be dumb unless you felt like you had a decent shot. Stuff like anes. Why skip the match? As a premed I am genuinely asking.

Complicated question but if you interview at a DO program that you would have ranked #1 or #2 if a combined match were offered, you would rank only that one DO program and if you matched you're done. If not, then you move on to the MD match. If all the places you interviewed DO side would be ranked lower and you have a comfortable number of MD interviews, skip DO.

The problem will be the candidate that interviewed at a couple of meh DO places, but didn't interview at enough MD places to comfortably skip the DO match. Tough choices there.

 

[GraceEuphoria]

I took USMLE on a monday, studied the green book for a couple days and then COMLEX that same friday. Worked for me.

It probably doesn't matter very much tho..

I did the exact same thing......

I love that everyone knows what this means.

That said, I have a friend who plans to do just that. I am only now realizing I want to take USMLE in addition to COMLEX and I think I'll be trying to take USMLE afterward. However, with some of the posts here, it seems as though I either need to take USMLE early to ensure I'm fresh and on my game...or else, make sure I wait a little bit after my COMLEX in order to get some rest and be ready for round 2. Decisions, decisions...

 

[tkim]

Maybe that's the case for your program, DO Anes, but I can't believe that it's typical without any further information. Just last year we had residents from ACGME gas programs come in and tell us COMLEX is more than enough. Anyone have links to some cold hard facts? Are average COMLEX scores for anesthesiology listed anywhere?

You won't find any 'facts' listed conveniently in one place. It's program dependant. That said, having a USMLE will make it more convenient for ACGME programs to guage your competitiveness. Simple.

 

[DO Anes]

Maybe that's the case for your program, DO Anes, but I can't believe that it's typical without any further information. Just last year we had residents from ACGME gas programs come in and tell us COMLEX is more than enough. Anyone have links to some cold hard facts? Are average COMLEX scores for anesthesiology listed anywhere?

I would not say it's typical as many programs do not accept the COMLEX, regardless of the score. COMLEX is more than enough IF the program looks at the COMLEX and IF the score is good (>630). Even then, you better hope that some other DO applicant doesn't come in with COMLEX of 610 and USMLE of 215. Here is the cold, hard fact, the COMLEX is viewed as less credible than the USMLE. Wishing it were otherwise does not make it so. Of course, it's a free country; everyone is welcome to gamble with their future.

 

[DO Anes]

You won't find any 'facts' listed conveniently in one place. It's program dependant. That said, having a USMLE will make it more convenient for ACGME programs to guage your competitiveness. Simple.

Trust me, after wading through over 1000 applications and sitting through 200 interviews, no one is going to be interested in trying too hard to gauge an applicant's competitiveness. One other thing to keep in mind, regardless of the number of well-qualified DO applicants, no ACGME program is going to take a chance on matching a majority of DO's. If you don't think there is pressure to keep the resident match group mostly MD (i.e.>70%), especially from the affiliate institution, then you are sadly mistaken. Considering the increase in DO schools and class sizes, coupled with no increases in GME funding, this will not have a happy ending.

 

[fiznat]

appreciate you trying to help us, but someone's word on the internet is not exactly what I meant by cold hard facts.

Come on man, give the guy a break. It isn't so often that people post such detail, so I'm happy for the opportunity to hear it. Even if it is just one program, and on the internet.

 

[tkim]

Come on man, give the guy a break. It isn't so often that people post such detail, so I'm happy for the opportunity to hear it. Even if it is just one program, and on the internet.

You know when you're a pre-med, and some med student/resident/attending posts something and that pre-med says 'hey man post some facts' ...

Same thing, fast forward 4 years.

 

[DocEspana]

When I say more than enough, I mean there was no mention of 600+ being a requirement. I appreciate you trying to help us, but someone's word on the internet is not exactly what I meant by cold hard facts.

 

[p1acebo]

DO match is before the MD match. Therefore, if you match into a DO program, you are pulled from the MD profram. So, if your favorite programs are MD, you take a big risk staying in the DO match.

This is how I am taking my approach. If my number #1 and #2 happen to be MD programs I am not going to take the chance of getting matched at a DO program that I didn't rank as high. Who knows though, maybe I won't even have to run into that issue.

Also, I plan on doing USMLE and then COMLEX a few days after with greenbook. 😛 Seems like several people I know have suggested that.

 

[DO Anes]

As I said, it's a free country.

 

[kazuma]

When I say more than enough, I mean there was no mention of 600+ being a requirement. I appreciate you trying to help us, but someone's word on the internet is not exactly what I meant by cold hard facts.

You can lead a horse to water but you can't make it drink....................🙄


Here's a great plan for everybody questioning the of the OP's advice. Don't worry about the $1000 for USMLE 1&2. Just take COMLEX and see what happens. $1000 is a lot of money, don't go throw it away on some stupid exam. For all we know DO Anes works for the NBME and he's really just trying to line his pockets by taking advantage of DO students.🙄

 

[Dissected]

You can lead a horse to water but you can't make it drink....................🙄


Here's a great plan for everybody questioning the of the OP's advice. Don't worry about the $1000 for USMLE 1&2. Just take COMLEX and see what happens. $1000 is a lot of money, don't go throw it away on some stupid exam.

👍

Take home point in this thread from medical students, residents and attendings who have been there....Suck it up and take the USMLE.