Thoughts on taking STEP 1 vs STEP 2 as a DO student

[artdr]

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Hello,

I am a 2nd year DO student. I am interested in Internal Medicine and GI. My school has advised us to take COMLEX 1 and skip STEP 1 since its pass/fail anyway. We are told we can take STEP 2 since that is scored. What should I do?

Thank you for your time!

 

[Real McCoy]

Below is a screenshot from the 2022 survey specifically for Internal Medicine. Do take with a grain of salt as percent of directors who respond is not very high and may not be an accurate reflection of the larger IM community.

Source: 2022 NRMP Program Director Survey
Also see: 2024 NRMP Charting Outcomes

 

[Doctoscope]

Ignore everything your DO school tells you lol, like 90% of the "advice" is garbage and I'm always shocked as to how those people got the job in the first place

 

[DO2015CA]

Not worth being hit with the filter if it’s “just pass/fail” so you need a minimum score to pass. You’ll want the best IM program you can get to set you up for GI.

 

[TeddyBoomBoom]

Take both. Filtering by successful exam completion is one of the easiest ways for PDs to start filtering applicants.

You’ll get a lot of anecdotal advice, but my personal experience as a do (also anecdotal) was that having taken both Steps 1&2 evened the application playing field significantly.

Just my 2 cents.

 

[Dr. Pineal Gland]

I always recommend both, you dont want to apply to residency at a disadvantage. If you and another applicant are equal and one has a step 1P and the other doesn't the other candidate is ranked higher. Some programs will have a filter for step1 scores too.

 

[Ho0v-man]

DO schools tend to provide generic advice that will apply to every student with goal of getting them to residency apps with no red flags. That’s why they advise against it. The idea is that you will match into something somewhere without it. It’s not their concern if it’s not a program or specialty you wanted.

You can seek out individual guidance based on your goals, but you’ll honestly get better advice here 99% of the time. You’ll get incorrect/outdated information from some very well-meaning faculty at a DO school. How many DO school faculty have any insight into what a university IM program is looking for in a candidate? Many of them did AOA residencies which don’t even exist anymore. As an example, I was told I had almost no chance of matching radiology (false) and many were told just being an average student would get you into obgyn (very false).

I’m not in IM. But when I was in school it seemed like academic IM without step1 was really tough outside of the Midwest. I can’t imagine things have gotten less competitive.

 

[thumbz]

Interesting perspectives I didn't consider - I think I'm on of those well meaning faculty far enough removed I'm giving bad advice. We don't filter DO's out for not having a pass on Step 1, so I (perhaps foolishly) told a group of DO schools to skip it and focus on Step 2 instead as we use that to rank. I would love to hear from other faculty at residency programs - IM specifically.

Are you guys filtering out DO's entirely for not having a step 1? Would love to hear more anecdotal evidence on this.

To those who already posted in this thread - are any of you on interview/rank committees for your residency programs? Are you filtering out for no step 1?

 

[Ho0v-man]

Interesting perspectives I didn't consider - I think I'm on of those well meaning faculty far enough removed I'm giving bad advice. We don't filter DO's out for not having a pass on Step 1, so I (perhaps foolishly) told a group of DO schools to skip it and focus on Step 2 instead as we use that to rank. I would love to hear from other faculty at residency programs - IM specifically.

Are you guys filtering out DO's entirely for not having a step 1? Would love to hear more anecdotal evidence on this.

To those who already posted in this thread - are any of you on interview/rank committees for your residency programs? Are you filtering out for no step 1?

I was involved for my intern year program and have knowledge regarding the associated categorical program. This was an unopposed community program in a very rural location. Comlex only applicants were interviewed and ranked for both, but below applicants who took both exams unless there were stand out reasons like personal connections or a great audition. The scores themselves didn’t matter much in the categorical program since they were rarely very impressive (undesirable location). But just having passed it did put an applicant at an advantage.

My above comment is based on statements from classmates who applied IM during my academic year. This was in 2020 when it was still scored.

In radiology, those without step 1 are not considered at mine or essentially any programs. But that’s a different can of worms.

Edit: as an aside, I’d always encourage taking everything if you can because you might change your mind. It would really suck to be halfway through third year and fall in love with another specialty that will want both step exams. When I took step 1, I was very confident I was going into FM. My entire career/life would’ve been different if I didn’t take step1&2.

 

[Dr. Robb Bassett]

Hey — really glad you posted this. You’re not the only DO student staring at that COMLEX/STEP fork in the road wondering what actually matters now that STEP 1 is pass/fail.

The short version?
Yes — for Internal Medicine, especially community or DO-friendly programs, skipping STEP 1 and putting all your weight behind COMLEX 1 + a strong STEP 2 score can absolutely work.

But since you mentioned GI — which is competitive — here are a few deeper things to consider:

• How strong are you as a test-taker?
  If you’re solid across the board, even a pass on STEP 1 can quietly check a box for programs that are more USMLE-biased (even if they won’t say it out loud). It signals that you’re “bilingual” — fluent in both exam systems.
  
  
• Where are you aiming?
  If your target list includes big-name academic IM programs, especially ones that rarely take DOs, that STEP 1 pass might be worth having. But if you’re focusing on more DO-friendly institutions or regional programs, you might not need it.
  
  
• How’s the rest of your application shaping up?
  Strong preclinical grades, glowing evals, good research or mentorship in GI — those things can carry a lot of weight. But if anything feels average, having STEP 1 in your corner might help round things out.
  

I’d also talk to upperclassmen from your school who matched into IM or GI. What path did they take? Did any skip STEP 1 and still end up where you want to be? You’ll learn more from their patterns than from generic internet takes.

And one more thing—just as important:
It’s awesome that you already feel drawn to GI. It’s a fascinating specialty — no question. But don’t stop testing the hypothesis just because it feels right now.

Yes, clinical rotations will give you exposure to the patients, the procedures, the day-to-day — and that’s essential. But what really moves the needle is having honest, unfiltered conversations with attendings who’ve already climbed the full mountain. The ones who can tell you what the lifestyle’s really like after training. What they’d do differently. What surprised them. What they never saw coming.

That kind of access — to raw, candid, been-there-done-that perspective — is where real clarity happens. Its not easy to cultivate but if you can start building those connections now, and keep your mind open along the way, you’ll be in the best position to make a decision that’s not just smart — but aligned.

The time will go by much quicker than you think but you’ve got the awareness! Just keep moving with intention.

 

[curiousaboutpod]

I'm in the same bucket but I'm not a very strong test taker on a good day so I'm hedging my bets on Step 2.

It seems the consensus is that not having step 1 will filter you out on VSLO and the more competitive for some places, the more helpful having this will be for you. In an ideal world, you'll do both but the pass % is dropping every year so I'm not too hot about step 1 honestly.

However, I know that failing step 1 (and basically not being able to step 2) will red flag your application.