COMLEX/USMLE choices

[Hayduke]

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HI-
Long time lurker, infrequent poster in need of some decent advising. Yep-I need the kind one can only find on an anonymous messageboard at 2am.

The Guy- Late 30s, brown & brown, went to medical school to be an EP w/FACEP behind his name. For reasons outside the scope of this thread, got gunned down at state school and took first acceptance at a DO program. (lurid details on request)


The Package- FF/EMT-P x ten years, RN x5 (all ED), hanging by fingernails in top 1/3 class after first two years, two papers this summer in journals no one will read, other project in the oven and possible poster at ACEP in Sept., officer in EM group both years and membership in ACEP/EMRA, SAEM and AAEM


The Quandry- I have been studying since March for boards. The last 4 weeks have seen the whole pathetic 16 hour day First Aid as a coloring book mess. I have taken practice tests for both COMLEX and the USMLE. I didn't set either one on fire. My COMLEX score probably won't be in the upper 90s, but it will hopefully put me in a top quarter to 15% kinda place.

I took the NBME self-assessment yesterday and passed, but barely. Lots of stupid errors, but then some things that I flat don't know.

Paralleling these two exams has been pretty interesting for a view of the difference in education. Neither is "harder" or more applicable, but they have very different emphases. E.G. In my practice, I plan on using RFLP techniques about as often as I'll use a sphenobasilar compression dx. The difference is that I have been forced to learn one and not the other.

With the recent and probable future competitiveness of EM I have been thinking the USMLE would keep some doors open that might have been closed with only the COMLEX. Additionally, I have the perception that the USMLE will give me the added benefit of smoothing paths for international practice. There is also a personal "I can do that" asthetic about this as well.

I am 3 days away from the COMLEX and 10 useable days away from my USMLE date.


The Questions-
1. Does my USMLE score have to be reported on ERAS? I have received conflicting reports on this. I am a terrible liar and couldn't really do an ethical switch-up.
2. Will passing below the mean be the kiss-of-death and prevent my getting interviews for most SE/SW/West coast EM?
3. Regardless of the possible real or perceived dangers to me, does it "mean" anything to have passed both exams?
4. Any other advice?

Thanks

 

[pushinepi2]

HI-
Long time lurker, infrequent poster in need of some decent advising. Yep-I need the kind one can only find on an anonymous messageboard at 2am.

The Guy- Late 30s, brown & brown, went to medical school to be an EP w/FACEP behind his name. For reasons outside the scope of this thread, got gunned down at state school and took first acceptance at a DO program. (lurid details on request)


The Package- FF/EMT-P x ten years, RN x5 (all ED), hanging by fingernails in top 1/3 class after first two years, two papers this summer in journals no one will read, other project in the oven and possible poster at ACEP in Sept., officer in EM group both years and membership in ACEP/EMRA, SAEM and AAEM


The Quandry- I have been studying since March for boards. The last 4 weeks have seen the whole pathetic 16 hour day First Aid as a coloring book mess. I have taken practice tests for both COMLEX and the USMLE. I didn't set either one on fire. My COMLEX score probably won't be in the upper 90s, but it will hopefully put me in a top quarter to 15% kinda place.

I took the NBME self-assessment yesterday and passed, but barely. Lots of stupid errors, but then some things that I flat don't know.

Paralleling these two exams has been pretty interesting for a view of the difference in education. Neither is "harder" or more applicable, but they have very different emphases. E.G. In my practice, I plan on using RFLP techniques about as often as I'll use a sphenobasilar compression dx. The difference is that I have been forced to learn one and not the other.

With the recent and probable future competitiveness of EM I have been thinking the USMLE would keep some doors open that might have been closed with only the COMLEX. Additionally, I have the perception that the USMLE will give me the added benefit of smoothing paths for international practice. There is also a personal "I can do that" asthetic about this as well. ...

The Questions-
1. Does my USMLE score have to be reported on ERAS? I have received conflicting reports on this. I am a terrible liar and couldn't really do an ethical switch-up.
2. Will passing below the mean be the kiss-of-death and prevent my getting interviews for most SE/SW/West coast EM?
3. Regardless of the possible real or perceived dangers to me, does it "mean" anything to have passed both exams?
4. Any other advice?

Thanks

First of all, good luck.

1. You DO NOT have to report the USMLE score to ERAS. As I recall, there is a check box/section with specific instructions on sending examination scores to your, "applied to" programs.

2. ?? Don't know. The board score question is a common one here at SDN, and the responses are anything but consistent. I talked to one PD at a self described, "very competitive" east coast program who said that he considered an 80th percentile COMLEX score as competitive. In your desire to take the USMLE, you run the risk of having a lower USMLE score detract from a superior performance on COMLEX. Considering that the current ACEP president is a DO, this issue will hopefully fade into the background. There are still programs, however, (i.e. NYC) that view the USMLE score as some type of a standardizing touchstone.

3. I'd say absolutely not. I can't think of any situation in which the completion of both board examinations is required. With the exception of establishing a formal practice in a foreign country, you are only REQUIRED to complete COMLEX I-III prior to obtaining an unrestricted physician's license. The NBOME is far from perfect, but it has labored hard to make sure that COMLEX is standardized and recognized in all fifty states (including Louisiana!) I'd love to hear other opinions on this issue, but I do not associate the passage of USMLE and COMLEX exams with additional prestige. When was the last time anyone asked an attending or established EM professor for board scores? Clearly, the exam that DOES matter is the one administered by ABEM / AOBEM. That, in addition to distinguishing yourself in the practice of emergency medicine, will help you to secure those, "FACEP" letters you so desire.

4. Other advice? Keep talking to current residents and PDs. The program directors are obviously involved in the resident selection process and can give you details about how much board scores/interviews/personal statements/etc weigh into the formulation of the ROL. When doing away rotations, ask for some time with the designated medical student coordinator or program director. Those individuals are in the best position to give you direct answers. Indeed, doing well at an audition EM rotation goes a long way to securing yourself an eventual interview. Scheduling electives and being recognized as a hard working/knowledgeable student is something that is much more important than debating between COMLEX and USMLE. I learned a lot through interaction with residents from several programs. IMHO, it is difficult to divorce yourself from the perspective of a former RN/EMT/FF. Some residents won't appreciate your comments about faster ways to secure a tube. Just remember that you will be judged as a future physician and not ranked according to your speed at initiating an IV. Simply put, many programs and chief residents do not want someone who is too aggressive or someone who is perceived as, 'unteachable.'

Best wishes for success on your exams!

-Push

 

[Apollyon]

Your post is written in an entertaining style, and, if that is indicative of how you are, hopefully, the "powers that be" will also see it. There's more to a person than a board score.

 

[Hayduke]

Thanks for the replies and advice.

Push-
With your answer to #1, it looks like I could take the USMLE, screw-tha-pooch and still apply with integrity intact. That's what I needed to hear.

If there are different opinions about this I would appreciate hearing them.

Your closing advice is a loud echo of the attending that talked me into applying. Regarding my past lives/career, "lose the 'tude, keep the skill, be a sponge". Keeping this mantra in mind, I have consciously worked to divorce myself from an allied health mindset. I hope this will keep me in good stead this August. Thanks again.

Apollyon-
Thanks. I just need the numbers so that folks can see how pretty I am.

 

[kungfufishing]

There's more to a person than a board score.

especially if they have good board scores....kidding.

as a DO who went through the process with good comlex scores alone, I kind of wished Id had the usmle, too. I would take it if I were you - you dont have to report it if you dont like it. Make sure to beat the mean on the comlex. If you can throw in a good usmle score (it is so easy to say stuff like that on this side of the fence!) it will only enhance your application, which sounds like it is fairly strong otherwise.

 

[VentdependenT]

Pound that first aid in deep during those 10 days with the last day focusing on biostats. You'll do fine!

 

[old blue]

Take the USMLE. There are a few programs out there that don't accept COMLEX (although, you could call every program that you would consider and confirm it w/ each). You never know when a new program director might come in and elect not to accept it (TX A&M). Louisiana, I believe, just passed state law this spring to accept it for residency. Those programs might still be a little sketchy about accepting it this year. Other than this, it means nothing to have passed both.

I got burned by this. Everyone (upperclassmen, profs, directors, DO EM graduates) told me not to waste my time and money on USMLE because EM programs typically accept COMLEX.

If you do crappily on it, only report it to the programs that require it. I think you can do that. The match was very competitive this year but you sound like a strong candidate. If you do well on the COMLEX you will get in somwhere as long as you are not stringently geographically restricted.

Peace

 

[MasterintuBater]

Anecdotally, I usually offer up my "stats & numbers" in responses to posts like these.

I'm a D.O. student, barely top half of my class, with step one COMLEX scores barely above 50th percentile. (Didn't report USMLE score). Applied to 30 allo programs, interviewed at 10, matched #1. Maybe I just lucked out, but the more likely lesson from my experience is to NOT obsess over board scores and class ranking too much. I picked up the slack in the more intangible areas, and I think anyone else can do the same in the field of EM.

 

[DrQuinn]

Anecdotally, I usually offer up my "stats & numbers" in responses to posts like these.

I'm a D.O. student, barely top half of my class, with step one COMLEX scores barely above 50th percentile. (Didn't report USMLE score). Applied to 30 allo programs, interviewed at 10, matched #1. Maybe I just lucked out, but the more likely lesson from my experience is to NOT obsess over board scores and class ranking too much. I picked up the slack in the more intangible areas, and I think anyone else can do the same in the field of EM.

I agree with above. Its ok, its normal for an M2 to be obsessed... and stressed... about the decision to take the USMLE vs. COMLEX.

OH WOW I found this great article on the internet... check it out:
http://www.aaemrsa.org/resources/osteopaths/index.php?topic=opinions

It basically parallels what's been said here... but dont' forget, if you bomb the USMLE, you don't have to tell the programs, you can just submit your COMLEX.

Also, I agree with Apollyon... there is more to your application than #s. Your other experiences will help a helluva lot more than a 230 on the USMLE (paramedic, RN, came back to med school).

Q