To Take the USMLE or Not To Take the USMLE ...

[druidboy05]

I'm an OMS-II now, gearing up to study for the upcoming COMLEX/USMLE. At this point, I am planning to take the USMLE. However, yesterday, an Instagram famous DO physician with almost a following of 40K posted on her story about how DO students should just stick with taking one exam, especially for those graduating after 2020 given the upcoming merger. When asked if certain programs would still require a USMLE score, even after the merger, she said no.

But I had heard differently - that because of the merger, the competition will increase for residency spots and therefore DO students should take the USMLE to stay competitive. Did I hear wrong, is this doc right? Am I unnecessarily forking over $600+ for a second test when I could just take the COMLEX and be less stressed out all together? I figured who would know better than SDN, so please, enlighten me.

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[DrGainzzz]

I too would like to know this... incoming DO first year trying gauge if I need USMLE for EM post merger

 

[AnatomyGrey12]

Take. The. USMLE. Anyone who says otherwise either has their head in the sand (the AOA) or is blatantly lying

 

[NotYou20]

Wrong time to care about $600. Penny wise and a pound foolish. I hope you don't think 40k followers on insta=credibility.

Plan on taking step 1. To make it less stressful ignore comlex and all comlex specific resources except the green book

 

[Dr. Death]

Take. The. USMLE. Anyone who says otherwise either has their head in the sand (the AOA) or is blatantly lying

You should put the osteopathic charting outcomes in your signature. It applies here too.

 

[LutGholein]

If you can pass it(USMLE) you should definitely take it to keep doors open.

 

[UnoMas]

I'm an OMS-II now, gearing up to study for the upcoming COMLEX/USMLE. At this point, I am planning to take the USMLE. However, yesterday, an Instagram famous DO physician with almost a following of 40K posted on her story about how DO students should just stick with taking one exam, especially for those graduating after 2020 given the upcoming merger. When asked if certain programs would still require a USMLE score, even after the merger, she said no.

But I had heard differently - that because of the merger, the competition will increase for residency spots and therefore DO students should take the USMLE to stay competitive. Did I hear wrong, is this doc right? Am I unnecessarily forking over $600+ for a second test when I could just take the COMLEX and be less stressed out all together? I figured who would know better than SDN, so please, enlighten me.

Is this guy Dr. Mike, he's FM. Follow his advice if you are planning to go into FM.

Take Step 1 and 2 and study your butt off for them. The $1200 will pay off. Keep all your options open

Edit: nvm it's a her

 

[smukke]

I've had PDs (non FM) tell me that a passing Step 1 score is better than no Step 1, they would have at least looked at my app.

 

[DrWhozits]

The match rate for people TAKING the USMLE, not even necessarily passing, is higher than those that took just COMLEX.

Just because an idiot has 40k people following him/her, doesn’t make them not an idiot.


Source: Charting Outcomes 2018

 

[EKGdoc]

The match rate for people TAKING the USMLE, not even necessarily passing, is higher than those that took just COMLEX.

Just because an idiot has 40k people following him/her, doesn’t make them not an idiot.


Source: Charting Outcomes 2018

 

[EKGdoc]

Maybe for FM u might not need it. For any remotely competitive specialty u will. They don’t know what they’re talking about. Am core faculty at ACGME EM residency (and a DO), and we’ve required USMLE for years. Just do it.

 

[Drrrrrr. Celty]

Here's the thing though. You never really know what you're getting into when you think you want to do X specialty. So why close doors prematurely?

Personally I considered FM as my number 2 option in case I didn't like Psych. FM ended up mostly falling off my list entirely and in my opinion was not a good match for me because I felt like I was doing less medicine and more checking boxes and making sure basic things were being followed through. And also well patient visits are boring. It didn't excite me.

S0 for me FM made me tired and not excited. So IM replaced it as my number 2. Because while I'm exhausted in IM, I genuinely find it interesting.

 

[getfat]

Who was the instagram poster @druidboy05?

Agreed with everything the above posters have stated. USMLE Step 1 increases your chances at multiple programs.
But beware! I have been explicitly told to take the USMLE unless the following:

• You are bottom 1/3 of your class. You'll know because you have had appointment with student affairs more than once. You need to focus on passing the COMLEX and are unlikely to pass USMLE anyway.
• You have multiple NBMEs below passing (<200) within 1 month of test day. A failing USMLE Step 1 is worse than no USMLE.

 

[tunicaexterna]

I think the caveat is though: don’t take it if you think there’s a possibility you could fail. If your test scores are relatively close to the pass fail line do not take it.

Edit: I have friends that were scoring within 10 pts of the pass fail line and they ended up failing. Now they regret taking it

Sent from my iPhone using SDN mobile app

 

[DrWhozits]

Family Medicine: 27 matched; 2 unmatched.
Internal Medicine: 27 matched; 4 unmatched.

These numbers are the people WHO FAILED or did very poorly Step 1 (<180 - 200).

Meanwhile: Applicants who applied to IM with ANY Step score (pass or fail) matched at a rate of 96.2%. Applicants with only COMLEX matched IM at a rate of 88.5%. FM with any Step score had a rate of 92.7% compared to 90.1% with COMLEX only.

Unless I’m missing something here, the most recent data squashes any notion that taking the USMLE hurts you in anyway. I understand that FM and IM are the inner circles of hell, but you can still match somewhere even if your things don’t goes as planned for you. I don’t think there should be advice without exceptions; however, I do believe that we as students (and more importantly, our administrations) need to forget this old rule, and adapt and embrace the new.

TLDR; USMLE good, COMLEX only bad.

 

[druidboy05]

@getfat I'll PM you, don't want to put her on blast.

And yeah, I'm still planning to take the USMLE - I was just curious if the 2020 merger meant that I was wasting my time taking it, like this physician alluded to, but it seems like no one really knows what's to come from the merger, so might as well still take it at this point.

 

[UnoMas]

@getfat I'll PM you, don't want to put her on blast.

And yeah, I'm still planning to take the USMLE - I was just curious if the 2020 merger meant that I was wasting my time taking it, like this physician alluded to, but it seems like no one really knows what's to come from the merger, so might as well still take it at this point.

That logic doesn't make sense. The DO residencies got gobbled up by ACGME; historically COMLEX only residencies now accepting applications with USMLE only, COMLEX only or both. If anything the merger makes a better case for students to take both exams. Dubious advice from instagram celebrities...

 

[tunicaexterna]

Family Medicine: 27 matched; 2 unmatched.
Internal Medicine: 27 matched; 4 unmatched.

These numbers are the people WHO FAILED or did very poorly Step 1 (<180 - 200).

Meanwhile: Applicants who applied to IM with ANY Step score (pass or fail) matched at a rate of 96.2%. Applicants with only COMLEX matched IM at a rate of 88.5%. FM with any Step score had a rate of 92.7% compared to 90.1% with COMLEX only.

Unless I’m missing something here, the most recent data squashes any notion that taking the USMLE hurts you in anyway. I understand that FM and IM are the inner circles of hell, but you can still match somewhere even if your things don’t goes as planned for you. I don’t think there should be advice without exceptions; however, I do believe that we as students (and more importantly, our administrations) need to forget this old rule, and adapt and embrace the new.

TLDR; USMLE good, COMLEX only bad.

Where in the charting outcomes does it talk about this ? I believe you, I just haven’t looked through the charting outcomes very thoroughly at this point.


Sent from my iPhone using SDN mobile app

 

[getfat]

@getfat I'll PM you, don't want to put her on blast.

And yeah, I'm still planning to take the USMLE - I was just curious if the 2020 merger meant that I was wasting my time taking it, like this physician alluded to, but it seems like no one really knows what's to come from the merger, so might as well still take it at this point.

Thanks a lot!

I've noticed that people not actively involved medical education have less of an idea that would make a competitive DO applicant. This Instagram celebrity is an attending and probably is speaking about her own personal experience. I'm sure whenever she was applying to residencies a COMLEX would suffice but now if you can take both please take both.

The people that know best in regards to matching are 4th years, recent grads and program directors (assistant, heads, those in the hierarchy of ranking you). They are actively involved in the process and know what works best right now.

Its kinda like when people now ask me about applying to DO schools. I personally feel I'm out of touch with what makes a competitive applicant or what "DO schools are looking for" (and I'm two years out). I just haven't put in the time to stay up to date.

 

[DrWhozits]

Where in the charting outcomes does it talk about this ? I believe you, I just haven’t looked through the charting outcomes very thoroughly at this point.


Sent from my iPhone using SDN mobile app

They don’t. I just did some rudimentary math for the two Step 1 Charts for IM and FM,

 

[tunicaexterna]

They don’t. I just did some rudimentary math for the two Step 1 Charts for IM and FM,

Gotcha, thanks

 

[Postictal Raiden]

The match rate for people TAKING the USMLE, not even necessarily passing, is higher than those that took just COMLEX.

Just because an idiot has 40k people following him/her, doesn’t make them not an idiot.


Source: Charting Outcomes 2018

Could you please point me towards where you found this information on Charting Outcomes? I’m not able to see where they listed information about comlex-only vs comlex+USMLE

 

[Scrubs101]

Could you please point me towards where you found this information on Charting Outcomes? I’m not able to see where they listed information about comlex-only vs comlex+USMLE

I think theyre talking about for example 200-210 USMLE vs score not listed (which we assume is no usmle, but we cannot confirm this i think?)

Gas
19 matched vs 2 unmatched for 200-210 range
Vs
25 matched vs 10 unmatched score not listed

That being said scoring 190-200 was 0 for 2, but this group isnt large enough to draw conclusions that a 190-200usmle is worse or not IMO.

EM and DR both dont get better match % w USMLE vs without until 210+ however

FM 190-200 has better match rate than not reported

IM 200-210 range is when % gets better than not reported

For neuro 190-210 went 3 for 3 but sample size is too small to compare, and 200-210 matched worse than both 190-200 and unreported, so we’ll hopefully see better numbers when more applicants transition to acgme match.

But for now its pretty safe to say aim for 210 if you plan on taking it but 200+ is better for most specialties than no USMLE at all

Edit: just noticed OP said taking USMLE w/o passing, im gonna say that is either not true or not provable at this current time

 

[AnatomyGrey12]

(which we assume is no usmle, but we cannot confirm this i think?)

I think it's pretty clear though honestly. The category for "score not listed" related to COMLEX is essentially zero in every specialty, while every USMLE graph has a healthy dose of "score not listed" I personally think the only conclusion there is that it is the people that didn't have a USMLE.

 

[Scrubs101]

I think it's pretty clear though honestly. The category for "score not listed" related to COMLEX is essentially zero in every specialty, while every USMLE graph has a healthy dose of "score not listed" I personally think the only conclusion there is that it is the people that didn't have a COMLEX.

Is this possible? I looked at US allopathic seniors and theres a unknown score report section for usmle as well (most are close to 0, but not always 0) my only guess would be that DOs w/o comlex 1 vs MDs w/o USMLE 1 just put it off until end of 4th year after match maybe? If not my only other guess would be theres a way to opt out of reporting scores for data collection, someone else may be able to comment on that

 

[atomheart]

I would use worst case scenarios.

If Instagram is right but you take step 1+2 you're out $1200 because of random people on the internet. Sorry. At least your time isn't wasted since the board materials align well enough for comlex.

If SDN is right but you don't take USMLE, you have just let a random but famous person on the internet singlehandedly alter your career potential and training. If that's worth $1200 to you then good luck.

Then of course there's the middle ground where the USMLE neither helps nor hinders your applications. Maybe you don't do well, and get screened out of programs--you will always be able to fall back on others given no other red flags, and you can adjust your career plans from there. This is very similar to the student who was going EM in M2, but failed to take USMLE and is now going IM because it was "what he wanted to do in the first place". The reverse of this is also true: a great score will get your foot in the door, but maybe you never wanted to go to those programs. These are most likely what influence your decision making but I would not consider these very serious in my thought process compared to the logic above. I'm sure there are a group of admins at your DO school that will say otherwise, but a poor USMLE score is not a bigger boogeyman than failing to take the USMLE. Study hard for a great score and keep these other scenarios out of your mind.

 

[AnatomyGrey12]

Is this possible? I looked at US allopathic seniors and theres a unknown score report section for usmle as well (most are close to 0, but not always 0) my only guess would be that DOs w/o comlex 1 vs MDs w/o USMLE 1 just put it off until end of 4th year after match maybe? If not my only other guess would be theres a way to opt out of reporting scores for data collection, someone else may be able to comment on that

Typo. I meant they most likely didn't have USMLE. I fixed it in the post.

 

[DrWhozits]

I think theyre talking about for example 200-210 USMLE vs score not listed (which we assume is no usmle, but we cannot confirm this i think?)

Gas
19 matched vs 2 unmatched for 200-210 range
Vs
25 matched vs 10 unmatched score not listed

That being said scoring 190-200 was 0 for 2, but this group isnt large enough to draw conclusions that a 190-200usmle is worse or not IMO.

EM and DR both dont get better match % w USMLE vs without until 210+ however

FM 190-200 has better match rate than not reported

IM 200-210 range is when % gets better than not reported

For neuro 190-210 went 3 for 3 but sample size is too small to compare, and 200-210 matched worse than both 190-200 and unreported, so we’ll hopefully see better numbers when more applicants transition to acgme match.

But for now its pretty safe to say aim for 210 if you plan on taking it but 200+ is better for most specialties than no USMLE at all

Edit: just noticed OP said taking USMLE w/o passing, im gonna say that is either not true or not provable at this current time

For IM, 27/31 (87.1%) matched with a USMLE score <200. While it is true that this value is lower than the overall match rate of COMLEX only/Score Not Reported (88.5%), this 88.5% value is for all scores for COMLEX only.

So my original statement works upon the assumption that those who would score <200 on the USMLE, would most likely also score low on the COMLEX. Thus, by referencing the COMLEX score chart, one can see that there is a decreased match rate with lower scores.

Without knowing which of these individuals took both exams and which did not, makes it impossible to make a completely true statement. However, one can say that even a failed attempt on the USMLE has a better match rate than COMLEX only with a score <450.

With some logical assumptions, one could state that it is generally in your best interest to take the exam, IMO.

 

[shadowlightfox]

The only fields where taking the COMLEX alone wouldn't hurt you are family medicine and orthopedic surgery, and even then, for the latter, you should still take USMLE for backup purposes.

Hell, honestly, take the USMLE even if you want to do family medicine. It's objectively a better exam and thus has a better gauge on how you were as a medical student compared to the COMLEX.

 

[kopftonmd]

The only fields where taking the COMLEX alone wouldn't hurt you are family medicine and orthopedic surgery, and even then, for the latter, you should still take USMLE for backup purposes.

Why do you say ortho?

 

[shadowlightfox]

Why do you say ortho?

Correct me if I'm wrong for those who are more knowledgable in the matter, but before the merger, making it into ACGME orthopedic residency was nigh impossible for DO students. The number of DO residents who matched into those are fewer than how many you can count in one hand.

If you were a DO and wanted ortho, you had no choice but to settle for AOA residencies.

This is before the merger, though. Now that there is no more AOA vs ACGME residencies. How will that affect the current former AOA ortho residencies in the long term? That I do not know.

 

[deleted645092]

My school had the Internal Residency medicine director for one of the hospitals associated with one of the state's MD programs come in for a talk, and she said that she "highly recommends" that anyone from my school take Step 1 if they plan to apply there for residency after 2020. And their program is notoriously friendly for taking grads from my school.

People who say that you only need COMLEX like to use the argument that "you legally can't be discriminated against" for only having COMLEX when applying for residencies after 2020 because it is considered a valid licensing exam for all residencies. But what are you gonna do if you apply without Step 1 and don't get invited for an interview, sue them claiming you were screened out because of discrimination, rather than there being dozens if not hundreds of higher-scoring applicants?

In the end I took it because I would rather have it and not need it, than need it and not have it. Granted, I'm waiting on my score praying every day that I didn't fail and look like an idiot for advocating for DO students taking it, but oh well.

 

[Bea5T]

I too would like to know this... incoming DO first year trying gauge if I need USMLE for EM post merger

100% need to take both steps

 

[hallowmann]

My school had the Internal Residency medicine director for one of the hospitals associated with one of the state's MD programs come in for a talk, and she said that she "highly recommends" that anyone from my school take Step 1 if they plan to apply there for residency after 2020. And their program is notoriously friendly for taking grads from my school.

People who say that you only need COMLEX like to use the argument that "you legally can't be discriminated against" for only having COMLEX when applying for residencies after 2020 because it is considered a valid licensing exam for all residencies. But what are you gonna do if you apply without Step 1 and don't get invited for an interview, sue them claiming you were screened out because of discrimination, rather than there being dozens if not hundreds of higher-scoring applicants?

In the end I took it because I would rather have it and not need it, than need it and not have it. Granted, I'm waiting on my score praying every day that I didn't fail and look like an idiot for advocating for DO students taking it, but oh well.

To be clear, this is not a legal issue. You need to complete the COMLEX series to be licensed as a DO in almost all states, and completing Level 1, 2 CE and 2 PE are COCA requirements for graduation from DO school. Residencies can discriminate against you for any reason that isn't considered protected (e.g. race, religion, sex, etc.). They absolutely can discriminate against you for basically everything not protected, including being a DO and only taking the COMLEX.

The point that people always try to make is the argument that ">70%" of residencies aren't "USMLE only" residencies, meaning you don't have to have a USMLE score to even be considered for an interview. Now just because its not spelled out as a requirement doesn't mean its not a make or break variable when it comes to getting invited for interviews or ranking.

 

[deleted645092]

To be clear, this is not a legal issue. You need to complete the COMLEX series to be licensed as a DO in almost all states, and completing Level 1, 2 CE and 2 PE are COCA requirements for graduation from DO school. Residencies can discriminate against you for any reason that isn't considered protected (e.g. race, religion, sex, etc.). They absolutely can discriminate against you for basically everything not protected, including being a DO and only taking the COMLEX.

The point that people always try to make is the argument that ">70%" of residencies aren't "USMLE only" residencies, meaning you don't have to have a USMLE score to even be considered for an interview. Now just because its not spelled out as a requirement doesn't mean its not a make or break variable when it comes to getting invited for interviews or ranking.

Yea that’s the point I was trying to make, just not as eloquently lol. It’s an actual argument people have made to me when we discussed whether or not we were going to take it, thinking that they can actually claim discrimination.

 

[hallowmann]

Yea that’s the point I was trying to make, just not as eloquently lol. It’s an actual argument people have made to me when we discussed whether or not we were going to take it, thinking that they can actually claim discrimination.

I tried to convince people in 2nd year to take the USMLE, but sometimes it just wasn't worth it. They made their decision already not to take it.

I do know one or two people that could have done without the USMLE, but I know far more people that regretted not taking it in 3rd/4th year and some that even took Step 2 CK to try and make up for it (which is actually beneficial, just not as much as Step 1).

The truth is that if you're scoring >215 on NBMEs, its worth it to take Step 1. If you're <210, then I'd consider it too much of a gamble. In between, its kind of a gray area. Generally speaking NBMEs are (were?) +/-5 points off from the real deal. In my day UWSAs also grossly inflated scores, like 10-20 pts above the real deal, but it sounds like maybe its closer to 5-10 above the real thing now.

 

[getfat]

but I know far more people that regretted not taking it in 3rd/4th year and some that even took Step 2 CK to try and make up for it (which is actually beneficial, just not as much as Step 1).

I don't wanna derail the thread but how many DO students usually take Step 2 CK?

It seems alot less common but wouldn't it help? When I talk to older students they all say "take Step 2K" but none of them actually took it in the first place.

 

[hallowmann]

I don't wanna derail the thread but how many DO students usually take Step 2 CK?

It seems alot less common but wouldn't it help? When I talk to older students they all say "take Step 2K" but none of them actually took it in the first place.

~33% of DOs, >2000 DO students take it every year. I can't tell how many of those did not take Step 1 though, and I imagine most did. I know at least a few people that took only Step 2CK, so it happens, but like you said, its not all that common.

In general, you should take both Step 1 and Step 2 CK if you will do OK/aren't at risk for failing.

 

[Staphylococcus Aureus]

I agree with the above, but I think SDN underestimates just how many students aren’t hitting >215 on NBMEs. (For example, in my schools c/o ‘18, of those that took it only the 1st quintile students broke an average >215).

I get the vibe that some people think if only those small minority of <215 students did drilled UFAP they could easily get 230. The fact is the DO curriculum is not tailored to the USMLE, some topics glaringly so, and it’s an uphill battle to learn things you bared saw during MS1-2 (especially if you’re a non traditional student without a deep biology backing).

 

[shadowlightfox]

The fact is the DO curriculum is not tailored to the USMLE, some topics glaringly so

You see, I have a problem with this statement. Questions styles and emphasis on some topics, sure, but I have a hard time understanding how a school that can prepare you for COMLEX isn't preparing you for USMLE. If you take out OMM, the topics are nearly identical for both exams, even if one exam emphasizes physio and bio more while the other emphasizes anatomy and microbiology more. It's why UWorld is the most valuable learning tool for not just USMLE, but for COMLEX as well.

I was under the impression that if you're not adequately preparing students for USMLE, you might as well not be preparing them for COMLEX either. The topics on my COMLEX were no different from the topics on my USMLE, even if the difficulty was not the same.

 

[Drrrrrr. Celty]

I agree with the above, but I think SDN underestimates just how many students aren’t hitting >215 on NBMEs. (For example, in my schools c/o ‘18, of those that took it only the 1st quintile students broke an average >215).

I get the vibe that some people think if only those small minority of <215 students did drilled UFAP they could easily get 230. The fact is the DO curriculum is not tailored to the USMLE, some topics glaringly so, and it’s an uphill battle to learn things you bared saw during MS1-2 (especially if you’re a non traditional student without a deep biology backing).

I think most people on here are already highly proactive students who invest enormous amounts of time in developing study plans that compensate for any issues with curriculum. But not every school is the same and not every school population is the same.

But honestly, the fact is a lot of DO students don't even do Uworld or UFAPS. This is especially true in newer schools or those without lots of upper classmen aiming for ACGME>

 

[AnatomyGrey12]

But honestly, the fact is a lot of DO students don't even do Uworld or UFAPS. This is especially true in newer schools or those without lots of upper classmen aiming for ACGME>

Yep, I would estimate half my class has no idea what UFAPS even stands for.

 

[sunshinefl]

Yep, I would estimate half my class has no idea what UFAPS even stands for.

Probably about the same here. When I mention it, I either get “omg! How did you find out? What is it again?” Or “yupp, on it.” And it’s 50/50.

 

[kopftonmd]

Yep, I would estimate half my class has no idea what UFAPS even stands for.

Just to help out us poor incoming students, what does UFAPS stand for, again?

 

[Scrubs101]

Just to help out us poor incoming students, what does UFAPS stand for, again?

Uworld
First Aid
Pathoma
Sketchy

 

[kopftonmd]

Uworld
First Aid
Pathoma
Sketchy

Gracias.

 

[Goro]

I'm an OMS-II now, gearing up to study for the upcoming COMLEX/USMLE. At this point, I am planning to take the USMLE. However, yesterday, an Instagram famous DO physician with almost a following of 40K posted on her story about how DO students should just stick with taking one exam, especially for those graduating after 2020 given the upcoming merger. When asked if certain programs would still require a USMLE score, even after the merger, she said no.

But I had heard differently - that because of the merger, the competition will increase for residency spots and therefore DO students should take the USMLE to stay competitive. Did I hear wrong, is this doc right? Am I unnecessarily forking over $600+ for a second test when I could just take the COMLEX and be less stressed out all together? I figured who would know better than SDN, so please, enlighten me.

If you're gunning for specialties, especially the more competitive ones, then go for USMLE.

If your preclinical GPA is 80-85% or higher, take USMLE, even if you want FM. It will open more doors.

I am somewhat doubtful that all residencies will be OK with only COMLEX after 2020. Hell, a good number of them won't be OK with DOs, much less COMLEX.

 

[StudentDr100]

Sadly those who support the DO manipulation skills are more interested in protecting their own jobs, lack of real clinical skills and agencies than advancing the health professions. If you can pass and want a primary care specialty I would say you should take it. For more competitive specialties I'll leave the advice to someone else.