Passed COMLEX with 626 but failed USMLE

[DoctorVuitton]

I'm pretty active on these forums but decided to open a new account for privacy purposes.

Like the title says, I passed my COMLEX Level 1 with a 626 (upper 15-12%) while failing Step 1. I found out that I failed Step 1 two months ago but have been too busy with rotations to really sit down and think about my options and next steps.
I was initially interested in going into EM or GSurg or OB and thought my COMLEX was high enough to get me into some old AOA programs. As I'm reading through some of the current interview threads, it's looking significantly more competitive than I thought. I don't know if it is worth preparing for and sitting through Step 1 again or if I should just count on my COMLEX being sufficient.

My prep:
I went through Pathoma probably 3-4 times and went through UWorld once (~70%). I even took 3 NBMEs, which I passed and did fairly well on.
I took the COMLEX first. I thought it went horribly. I remember flagging every other question and being really confused by what the questions were asking. I left the site feeling seriously depressed and thought I definitely failed.
I went home and started "reviewing" for the USMLE, which was scheduled in 1 week. I re-watched some high-yield Pathoma videos, went through my UWorld Anki cards, and flipped through some FA chapters I was rusty on.
Step 1 was definitely more challenging but I thought that I atleast understood the questions. There was a ton of pharm that I had never seen and the pathology was on a different world. I left feeling that I passed but I knew I probably did worse than my NBMEs.

At this point, I really don't know what to do.

Looking back I should have never taken Step 1 without being 100% confident from NBME scores that I could've passed but it is what it is. I just want to move on and never want to think about this exam again but am worried about the consequences it may have next year during auditions.

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[Rekt]

I'm pretty active on these forums but decided to open a new account for privacy purposes.

Like the title says, I passed my COMLEX Level 1 with a 626 (upper 15-12%) while failing Step 1. I found out that I failed Step 1 two months ago but have been too busy with rotations to really sit down and think about my options and next steps.
I was initially interested in going into EM or GSurg or OB and thought my COMLEX was high enough to get me into some old AOA programs. As I'm reading through some of the current interview threads, it's looking significantly more competitive than I thought. I don't know if it is worth preparing for and sitting through Step 1 again or if I should just count on my COMLEX being sufficient.

My prep:
I went through Pathoma probably 3-4 times and went through UWorld once (~70%). I even took 3 NBMEs, which I passed and did fairly well on.
I took the COMLEX first. I thought it went horribly. I remember flagging every other question and being really confused by what the questions were asking. I left the site feeling seriously depressed and thought I definitely failed.
I went home and started "reviewing" for the USMLE, which was scheduled in 1 week. I re-watched some high-yield Pathoma videos, went through my UWorld Anki cards, and flipped through some FA chapters I was rusty on.
Step 1 was definitely more challenging but I thought that I atleast understood the questions. There was a ton of pharm that I had never seen and the pathology was on a different world. I left feeling that I passed but I knew I probably did worse than my NBMEs.

At this point, I really don't know what to do.

Looking back I should have never taken Step 1 without being 100% confident from NBME scores that I could've passed but it is what it is. I just want to move on and never want to think about this exam again but am worried about the consequences it may have next year during auditions.

Pretty unique situation here. What were your NBME scores? I see most often a correlation of upper 500s to low 600s to 220s to 230s respectively. At this point you're likely dead for EM or GS ACGME, no idea about Ob/gyn. I'd focus 100% on AOA match if I were you to be honest. I know people do it, but I can't imagine studying for Step 1 while on rotations unless you have some truly terrible/easy rotations.

 

[Peach Newport]

Some notes on OPs study method compared to wisdom I’ve been handed...

1) pathoma and FA are very broad-stroke review material. They will not necessarily carry you through step 1.

2) only 70% of UW. Everyone DO I know who did well on step one went throug UW at least once (not finishing UW always seemed to correlate with poor scoring) but usually 1.5 times or twice.

3) Not doing enough practice Qs. As a certain board prep guru at my school is fond of saying, “those who failed step 1 are usually those who thought FA, pathoma, and UW were enough.”

For some people they are. But reviewing the material is different from thinking critically about it - which is why you gotta squeeze every bit of knowledge out of UW as you can, and pound every qbank possible.

Then again I’m just oms2.

 

[Mad Jack]

Pretty unique situation here. What were your NBME scores? I see most often a correlation of upper 500s to low 600s to 220s to 230s respectively. At this point you're likely dead for EM or GS ACGME, no idea about Ob/gyn. I'd focus 100% on AOA match if I were you to be honest. I know people do it, but I can't imagine studying for Step 1 while on rotations unless you have some truly terrible/easy rotations.

AOA match won't exist when OP is matching

 

[Rekt]

AOA match won't exist when OP is matching

He's 2019 like me, from my understanding and what I've been seeing, the AOA match will still be around. Is this not correct?

 

[DoctorVuitton]

2) only 70% of UW. Everyone DO I know who did well on step one went throug UW at least once (not finishing UW always seemed to correlate with poor scoring) but usually 1.5 times or twice.

I DID go through UW once. When I said "~70%" I meant that my final score on UWorld was 70% on timed,random mode.

What were your NBME scores?

NBME 17 was the only one I didn't pass. The rest were between mid 220s and mid 230s

 

[Peach Newport]

AOA match won't exist when OP is matching

You sure? I think OP is OMS3. I think s/he’s the last year with an AOA match.

 

[Mad Jack]

You sure? I think OP is OMS3. I think s/he’s the last year with an AOA match.

Most programs are dropping the AOA match after initial accreditation. I would be shocked if even a third of programs still participated in the 2019 match.

 

[JamesPotterMS-3]

Some notes on OPs study method compared to wisdom I’ve been handed...

1) pathoma and FA are very broad-stroke review material. They will not necessarily carry you through step 1.
.....
Then again I’m just oms2.

amazing how someone who hasn't even taken boards yet can make such a broad comment on OPs prep or board prep in general. This is why people think this site is garbage.

 

[Mad Jack]

D.O.'s releasing USMLE to programs, PD's please help!

It also appears to be a possibility that you can request but not release scores. It's a dirty trick, can't say whether it still works.

 

[68PGunner]

amazing how someone who hasn't even taken boards yet can make such a broad comment on OPs prep or board prep in general. This is why people think this site is garbage.

For some reason, there are a lot of loud mouthed second year medical students thinking that they know everything about board prep. I also see the same bs with the students in my classroom.

 

[Peach Newport]

amazing how someone who hasn't even taken boards yet can make such a broad comment on OPs prep or board prep in general. This is why people think this site is garbage.

For some reason, there are a lot of loud mouthed second year medical students thinking that they know everything about board prep. I also see the same bs with the students in my classroom.

Which is why I made it clear who I was, what my qualifications were, and what my sources were.

Do I really need to take the test to pass on the advice of others? Is anything I mentioned even particularly bad advice?

Plus, a lot of what I said is literally written out in first aid’s Test taking strategies.

 

[Mad Jack]

Which is why I made it clear who I was, what my qualifications were, and what my sources were.

Do I really need to take the test to pass on the advice of others? Is anything I mentioned even particularly bad advice?

Plus, a lot of what I said is literally written out in first aid’s Test taking strategies.

Annotate all of UW into FA. Do Pathoma. Do Sketchy. Congrats, you passed the boards. Between them, there is very little that isn't covered, it's all about hitting them all hard enough.

I think OP's issue was likely that they were so shook by the COMLEX that their brain melted during the USMLE.

 

[68PGunner]

Annotate all of UW into FA. Do Pathoma. Do Sketchy. Congrats, you passed the boards. Between them, there is very little that isn't covered, it's all about hitting them all hard enough.

I think OP's issue was likely that they were so shook by the COMLEX that their brain melted during the USMLE.

I agree. I think OP got mind blown by the Comlex and started second guessing himself or herself on the real thing. 70% on Uworld on the first go means a 240s-250s on Step 1.

 

[Peach Newport]

Annotate all of UW into FA. Do Pathoma. Do Sketchy. Congrats, you passed the boards. Between them, there is very little that isn't covered, it's all about hitting them all hard enough.

I think OP's issue was likely that they were so shook by the COMLEX that their brain melted during the USMLE.

OP also said “there was a ton of pharm I’d never seen, and pathology was a whole different world.” This was what stuck out to me.

 

[W19]

Is there a point in taking step1 again in OP's case? Not sure it will help that much... unless you can get 250+.

 

[Mad Jack]

OP also said “there was a ton of pharm I’d never seen, and pathology was a whole different world.” This was what stuck out to me.

I thought the same thing when I took it, but it was largely just in my head. You can't let fancy words cloud your vision during the exam, and I have a feeling OP cracked and couldn't see the forest for the trees.

 

[Mad Jack]

Is there a point of taking step1 again in OP's case? Not sure it will help that much... unless you can get 250+.

I mean, if they're looking for something competitive, I dunno. It's tough. I'd probably just try and hide my scores if I were OP, should that remain an option (and I'm still not 100% sure it is, you'd have to check with PDs to make sure you can still hide your scores).

 

[JamesPotterMS-3]

Something else to keep in mind: the NBOME inflated scores this year. So the OP's 626 may actually be ~550-580 with last year's scoring.

 

[W19]

I mean, if they're looking for something competitive, I dunno. It's tough. I'd probably just try and hide my scores if I were OP, should that remain an option (and I'm still not 100% sure it is, you'd have to check with PDs to make sure you can still hide your scores).

I think letting that 80+ percentile on COMLEX stand is better for any competitive program than a fail USMLE (I am assuming OP will not submit that USMLE transcript).

 

[Mad Jack]

I think letting that 80+ percentile on COMLEX stand is better for any competitive program than a fail USMLE (I am assuming OP will not submit that USMLE transcript).

Yeah, you're right. A 260 after a fail is still going to look worse than a 600+ with no USMLE.

 

[kenjixshadow]

Is there a point in taking step1 again in OP's case? Not sure it will help that much... unless you can get 250+.

This! OP will likely get screened out in most EM/Surgery due to first time failure regardless of the retake. Can't speak about Obgyn.

I mean, if they're looking for something competitive, I dunno. It's tough. I'd probably just try and hide my scores if I were OP, should that remain an option (and I'm still not 100% sure it is, you'd have to check with PDs to make sure you can still hide your scores).

Even if OP chooses to hide USMLE score, his or her comlex scores don't mean much in ACGME EM/Surgery. The best chance to match in these specialties lie with ex-AOA or dual programs.

Something else to keep in mind: the NBOME inflated scores this year. So the OP's 626 may actually be ~550-580 with last year's scoring.

Your school didn't tell you or didn't know that there are students who did not pass the cut off on the COMSAEs cannot take the COMLEX. There are more schools now reinforcing this method to ensure more students are able to pass the boards and are inflating their first time pass rate. The bottom 5% are wipe out, which lead to inflated average score.

 

[68PGunner]

This! OP will likely get screened out in most EM/Surgery due to first time failure regardless of the retake. Can't speak about Obgyn.


Even if OP chooses to hide USMLE score, his or her comlex scores don't mean much in ACGME EM/Surgery. The best chance to match in these specialties lie with ex-AOA or dual programs.


Your school didn't tell you or didn't know that there are students who did not pass the cut off on the COMSAEs cannot take the COMLEX. There are more schools now reinforcing this method to ensure more students are able to pass the boards and are inflating their first time pass rate. The bottom 5% are wipe out, which lead to inflated average score.

What happened to the bottom 5%? Do the schools just kick them out?

 

[kenjixshadow]

What happened to the bottom 5%? Do the schools just kick them out?

No, they either 1) delay the exam and retake the COMSAEs until they pass then take the COMLEX, then start clerkship later with them missing out the elective months or 2) take the whole year off and pass the COMSAEs the following year, then take COMLEX, then start clerkship.

 

[JamesPotterMS-3]

Your school didn't tell you or didn't know that there are students who did not pass the cut off on the COMSAEs cannot take the COMLEX. There are more schools now reinforcing this method to ensure more students are able to pass the boards and are inflating their first time pass rate. The bottom 5% are wipe out, which lead to inflated average score.

This has been the case for years. This was discussed on a different thread. The NBOME did inflate scores this year by as much as .75-1 standard deviation from last year's scores. We will not know for sure until next February-March when the official reports come out.

 

[Mad Jack]

This! OP will likely get screened out in most EM/Surgery due to first time failure regardless of the retake. Can't speak about Obgyn.


Even if OP chooses to hide USMLE score, his or her comlex scores don't mean much in ACGME EM/Surgery. The best chance to match in these specialties lie with ex-AOA or dual programs.


Your school didn't tell you or didn't know that there are students who did not pass the cut off on the COMSAEs cannot take the COMLEX. There are more schools now reinforcing this method to ensure more students are able to pass the boards and are inflating their first time pass rate. The bottom 5% are wipe out, which lead to inflated average score.

I don't know a single person in my school that was eliminated due to failure to pass COMSAEs. Some had third year delayed so they could study longer for the boards, but that was it.

 

[hallowmann]

I DID go through UW once. When I said "~70%" I meant that my final score on UWorld was 70% on timed,random mode.



NBME 17 was the only one I didn't pass. The rest were between mid 220s and mid 230s

I don't think it's worth taking it again. It won't make an appreciable difference for you, even if you do pass, and if you don't, it'll just look worse.

Your best bet is applying AOA, if there are sufficient programs. I would also look into a backup field, just in case, because all the ones you mentioned are relatively competitive.

If you can apply ACGME without releasing your USMLE score, that would be worth it for EM (I know plenty of people that matched ACGME EM with COMLEX only). I don't think OB and GS would be as likely.

That said, I would still participate in the AOA match, even if you get EM interviews, because it wouldn't be worth risking not matching.

I think you got burned out. A week between exams is a long time, and you can really lose a lot in that time. Also, the failed NBME 17 (which I believe is the newest one) should have been a redflag. I'm not sure when you took it, but if it was close to the end of studying, it probably pointed to some deficiencies or gaps in knowledge/application. The USMLE is a much more comprehensive exam, so if you're week on a specific area, it'll show, whereas with the COMLEX of might not depending on what your exam covers (COMLEXs tend to have themes).

Either way, put it behind you and just focus on researching programs to apply to, doing well on Level 2, rotations, and ultimately having a competitive app otherwise. I would put in a lot of effort figuring out which ACGME programs are OK with COMLEX-only, and more importantly, which AOA programs are using the NMS match next year.

I don't know a single person in my school that was eliminated due to failure to pass COMSAEs. Some had third year delayed so they could study longer for the boards, but that was it.

This. That rule does more good than harm. It's much worse for the individual student if they fail boards than it is for a school having 1 extra person out of 270 fail.

 

[AnatomyGrey12]

You need to start contacting every AOA program in the fields you are interested in and figuring out how many will remain in the AOA match until the very end. I know some of the competitive fields, i.e surgery, and some number of EM are staying in the AOA match until they have to switch over. You need to figure out which program these are and if there will be enough for you to focus on that route.

 

[ortnakas]

You need to start contacting every AOA program in the fields you are interested in and figuring out how many will remain in the AOA match until the very end. I know some of the competitive fields, i.e surgery, and some number of EM are staying in the AOA match until they have to switch over. You need to figure out which program these are and if there will be enough for you to focus on that route.

I’d agree, except for that even this year, a lot of programs are playing it by ear and aren’t sure yet which Match they’ll primarily be doing. I’ve interviewed at former-AOA-now-also-ACGME programs that are accepting applications in both systems, and are waiting to see how interview season pans out to determine how to allocate their spots.

 

[ThreeCheers]

Most programs are dropping the AOA match after initial accreditation. I would be shocked if even a third of programs still participated in the 2019 match.

Where are you getting this information? If the 2018 match is any indication, I definitely don't think it's accurate to say that programs are abandoning the AOA match the second they receive initial accreditation, although applying to EM has apparently been quite the headache this year.

OP: ACGME surgery and OB are essentially not an option without a USMLE score. Focus on AOA and historically AOA programs. DO PDs that have been looking at DO applicants for years aren't suddenly going to turn their noses up at COMLEX only applications this early in the merger. I do think this could change a few years down the line, though.

 

[Goro]

amazing how someone who hasn't even taken boards yet can make such a broad comment on OPs prep or board prep in general. This is why people think this site is garbage.

For some reason, there are a lot of loud mouthed second year medical students thinking that they know everything about board prep. I also see the same bs with the students in my classroom.

Believe me, I have first year students who tell us that the material we teach isn't Board relevant, when we actually write questions for COMLEX. I call it the First Aid poisoning. Then again, there are pre-meds in pre-Allo who think that they know more than residents and attendings.

OP also said “there was a ton of pharm I’d never seen, and pathology was a whole different world.” This was what stuck out to me.

I suspect that the OP had seen the Pharm before, but forgot about it, or brushed it off in Boards prep. Some of my weak students tend to do well with diseases and diagnosing them, but are terrible at the Rx part.

What happened to the bottom 5%? Do the schools just kick them out?

What?? And lose all that tuition???🤣🤣🤣

 

[AlbinoHawk DO]

I keep hearing rumors of being able to hide your USMLE. If that's the case, that's your only hope at this turn of events. Otherwise, anything aside from FM/Path has pretty much sailed for you. It doesn't matter if they saw 800 on your COMLEX because failed step 1 tells the entire story they want to hear.

My recommendation is to rotate in places that have been AOA if you want something outside FM/Path. Otherwise, you need to build your application for FM/Path. I would not risk a second failure on step 1, especially now considering you are months out of studying actively and your time is probably spent on rotations and COMATs.

 

[W19]

I keep hearing rumors of being able to hide your USMLE. If that's the case, that's your only hope at this turn of events. Otherwise, anything aside from FM/Path has pretty much sailed for you. It doesn't matter if they saw 800 on your COMLEX because failed step 1 tells the entire story they want to hear.

My recommendation is to rotate in places that have been AOA if you want something outside FM/Path. Otherwise, you need to build your application for FM/Path. I would not risk a second failure on step 1, especially now considering you are months out of studying actively and your time is probably spent on rotations and COMATs.

I think IM is still in play...

 

[jrlob91]

FWIW, fourth year applying ob this year, it has proven to be very competitive. A USMLE fail would definitely keep you out of most ACGME residencies. AOA PDs that I have talked to will still be primarily caring about COMLEX even in the merged match, so you would theoretically have a shot at those programs.

 

[zero0]

An absolutely terrifying story. OP, in your honest opinion, what do you think happened?

 

[DoctorVuitton]

An absolutely terrifying story. OP, in your honest opinion, what do you think happened?

Taking two exams of this nature and of this length within one week was too much and I got burnt out I guess. I'm in the top half of my class and did pretty much the standard UFAP to prepare.
Like I said, failing NBME 17 was a red flag that I ignored. I probably wasn't as prepared for Step 1 as I thought.

 

[Neopolymath]

I just want to say that I appreciate OP for posting his experiences so others may learn from them. I know it was probably embarassing and hard to do so. It showcases the importance of studying for USMLE first and foremost and then cramming OMM I guess.

 

[AlbinoHawk DO]

I think IM is still in play...

I don't know, man. I know someone in a similar boat that applied 50 AOA IM programs and got 1 interview.

 

[68PGunner]

I just want to say that I appreciate OP for posting his experiences so others may learn from them. I know it was probably embarassing and hard to do so. It showcases the importance of studying for USMLE first and foremost and then cramming OMM I guess.

If you go to a DO school where you spend about 4 hrs in the OMM lab per week, you will be prepared for the OMM portion of the exam. I literally crammed 18 months of OMM stuff last week on my semester OMM exam and did fine.

 

[Preston Garvey]

I mean, if they're looking for something competitive, I dunno. It's tough. I'd probably just try and hide my scores if I were OP, should that remain an option (and I'm still not 100% sure it is, you'd have to check with PDs to make sure you can still hide your scores).

If you apply to programs through ERAS using the D.O filter you literally cannot submit USMLE scores to them. I took USMLE 1 and 2 and was hoping to submit them to the program's I applied to but could not. So OP might have a solid shot at programs that have not yet attained initial accreditation.

 

[surfguy84]

Some notes on OPs study method compared to wisdom I’ve been handed...

1) pathoma and FA are very broad-stroke review material. They will not necessarily carry you through step 1.

2) only 70% of UW. Everyone DO I know who did well on step one went throug UW at least once (not finishing UW always seemed to correlate with poor scoring) but usually 1.5 times or twice.

3) Not doing enough practice Qs. As a certain board prep guru at my school is fond of saying, “those who failed step 1 are usually those who thought FA, pathoma, and UW were enough.”

For some people they are. But reviewing the material is different from thinking critically about it - which is why you gotta squeeze every bit of knowledge out of UW as you can, and pound every qbank possible.

Then again I’m just oms2.

Just going to throw out a differing opinion...

Felt knowing FA cold was more than enough (plus pathoma). I def did not know fa cold and felt i got too bogged down in details during my studying in retrospect. Takinga higher level overview would have helped me i think.

Agree on uw and practice qs. For reference low 240s score.

 

[QueenJames]

Currently know somebody with a 450-something that matched AOA IM.

Then again, I don't recall the specifics of their application.

I'd say move on focus on part 2. I'm sure if you don't care about prestige you will get somewhere.

Hell... I'd say apply and rotate at wherever there are IMGs on the residency roster (mostly in the east coast... that is if they accept COMLEX)

Your US graduate status has got to hold some weight after all.

 

[Rekt]

I don't know, man. I know someone in a similar boat that applied 50 AOA IM programs and got 1 interview.

Lmao calm down. He can match AOA IM.

 

[DocWinter]

Lmao calm down. He can match AOA IM.

Absolutely agree. IM, family, peds, psych are all very attainable. I really don't see how AOA ER or GS is out of the question either.

 

[AlbinoHawk DO]

Lmao calm down. He can match AOA IM.

eh, you're probably right.

 

[TheBoneDoctah]

This has been the case for years. This was discussed on a different thread. The NBOME did inflate scores this year by as much as .75-1 standard deviation from last year's scores. We will not know for sure until next February-March when the official reports come out.

You say that the NBOME did inflate scores, but then say that we won't know for sure until next February-March? Where did you hear about this inflation/what good would inflating scores do?

 

[ProfAnon]

You say that the NBOME did inflate scores, but then say that we won't know for sure until next February-March? Where did you hear about this inflation/what good would inflating scores do?

There is a thread discussing this elsewhere in this same subforum, but so far this year the mean COMLEX score is 558.61 (and the pass rate is 96.08%). We won't know the absolute final number until after April 30, 2018 when the "COMLEX year" is up. However, it is not going to move much (they are not many people left to take it) and I know, for my school, with all students having taken the exam, the scores were far higher than ever before (both total and each discipline). Anyone taking the exam this past year should be aware of that so they are not surprised when applying for residencies. If you want to compare your score to past years, you should subtract 40-50 points, and this will give you an idea of where you sit competitively.

 

[JamesPotterMS-3]

You say that the NBOME did inflate scores, but then say that we won't know for sure until next February-March? Where did you hear about this inflation/what good would inflating scores do?

Similar to what the previous poster mentioned, my school's numbers were significantly higher this year than previous years. My school has relationships with other COMs and the mean and median score for those schools has also increased this year.

 

[TheBoneDoctah]

There is a thread discussing this elsewhere in this same subforum, but so far this year the mean COMLEX score is 558.61 (and the pass rate is 96.08%). We won't know the absolute final number until after April 30, 2018 when the "COMLEX year" is up. However, it is not going to move much (they are not many people left to take it) and I know, for my school, with all students having taken the exam, the scores were far higher than ever before (both total and each discipline). Anyone taking the exam this past year should be aware of that so they are not surprised when applying for residencies. If you want to compare your score to past years, you should subtract 40-50 points, and this will give you an idea of where you sit competitively.

I wonder if C/O 2020 will go back down to "normal?"

 

[JamesPotterMS-3]

I wonder if C/O 2020 will go back down to "normal?"

Not sure.
I know that in 2018 (c/o 2021) there will be a new Level 1 because of the standards and content outline overhaul that happened last year.