Why a few number of D.O. students take USMLE Step 2 CS and Step 3?

[rasis]

Hi everybody, this is my first post on this website but I was reading and following your informative posts for some years now
There was one question in my mind that I couldn't find any convincing answer for it online; so I thought it is worth to ask it here so may be it would be helpful for other people too.
I recently noticed that there are a significant number of D.O. students taking USMLE Step 1 and Step 2-CK for obvious reasons with a good passing rates in addition to their COMLEX requirement. But I also noticed that a few number of them take USMLE Step 2-CS (66 in 2013) and even fewer take USMLE Step 3 (25 in 2013).
My understanding is that in order to apply for an ACGME residency program, one should take USMLE at least up to the Step 2-CS. Can a practicing osteopathic physician or someone in the ACGME program or anyone with a knowledge in this area tell me why most of the D.O. students stop taking USMLE after Step 2-CK ? And whether or not step 2-CS is even required for applying to an ACGME program? I know step 3 is to be taken during the residency but step 2-CS is in the fourth year.
I appreciate your responses

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[67552931811]

Hi everybody, this is my first post on this website but I was reading and following your informative posts for some years now
There was one question in my mind that I couldn't find any convincing answer for it online; so I thought it is worth to ask it here so may be it would be helpful for other people too.
I recently noticed that there are a significant number of D.O. students taking USMLE Step 1 and Step 2-CK for obvious reasons with a good passing rates in addition to their COMLEX requirement. But I also noticed that a few number of them take USMLE Step 2-CS (66 in 2013) and even fewer take USMLE Step 3 (25 in 2013).
My understanding is that in order to apply for an ACGME residency program, one should take USMLE at least up to the Step 2-CS. Can a practicing osteopathic physician or someone in the ACGME program or anyone with a knowledge in this area tell me why most of the D.O. students stop taking USMLE after Step 2-CK ? And whether or not step 2-CS is even required for applying to an ACGME program? I know step 3 is to be taken during the residency but step 2-CS is in the fourth year.
I appreciate your responses

Why take CS or step 3? You don't need either to be a licensed physician as a DO and residencies only care about step 1 and or CK. Seems like a massive waste of cash to me.

 

[hallowmann]

The CS and Step 3 cost like $2000 a piece. Residency programs generally don't care about either, and to a DO, they are useless. Why would anyone spend that money for a useless exam? DOs MUST already take the COMLEX PE and Level 3 to get licensed in all states. Programs only care that you can get licensed. As a result they really only care that you take those and pass them.

To answer your question about ACGME programs, this really is program specific, but very few "require" the CS. Many want to know that you passed the PE, but very few care that you even take the CS. It's also more expensive and difficult to schedule because it only takes place at certain locations around the country (i.e. most people will need to take off from rotations and fly somewhere to take it), unlike Step 1 and 2-CK which can be taken at almost any prometric center.

 

[group_theory]

COMLEX 1, 2, and PE passage is required in order to graduate from DO school. You take a one day exam (COMLEX 3) during residency and you're done and are eligible for medical license in all 50 states (and territories)

USMLE 1 is optional (but helps tremendously for ACGME programs). USMLE 2-CK also helps. USMLE 2-CS is expensive, only located in 5 centers (that all MD students and IMGs have to go to), and adds nothing of value in the eyes of residency. USMLE 3 is a 2-day exam. And if you complete the USMLE series (but not COMLEX), you are eligible for most but not all 50 states (some states requires COMLEX and will not accept USMLE, including California, Florida, Pennsylvania, etc.)


And no one cares about usmle (or comlex) after intern year. If you want to say you took the same exam as the MD, then do an acgme residency and take the ABMS boards (such as ABIM, ABS, ABA, ABP, ABEM, ABFM, etc). The only time your comlex or usmle scores will come into play ever again is if you are applying for fellowship, or state license. Even the paperwork to get credential to work in a hospital (which is a LOT of paperwork) didn't ask for my comlex/usmle scores.

 

[rasis]

COMLEX 1, 2, and PE passage is required in order to graduate from DO school. You take a one day exam (COMLEX 3) during residency and you're done and are eligible for medical license in all 50 states (and territories)

USMLE 1 is optional (but helps tremendously for ACGME programs). USMLE 2-CK also helps. USMLE 2-CS is expensive, only located in 5 centers (that all MD students and IMGs have to go to), and adds nothing of value in the eyes of residency. USMLE 3 is a 2-day exam. And if you complete the USMLE series (but not COMLEX), you are eligible for most but not all 50 states (some states requires COMLEX and will not accept USMLE, including California, Florida, Pennsylvania, etc.)


And no one cares about usmle (or comlex) after intern year. If you want to say you took the same exam as the MD, then do an acgme residency and take the ABMS boards (such as ABIM, ABS, ABA, ABP, ABEM, ABFM, etc). The only time your comlex or usmle scores will come into play ever again is if you are applying for fellowship, or state license. Even the paperwork to get credential to work in a hospital (which is a LOT of paperwork) didn't ask for my comlex/usmle scores.

Thank you for the complete response. But can you clarify that if for instance I take COMLEX 1, 2, PE (but not 3) plus all of the USMLE series, am I be still able to practice in some states?
Also as far as the ABMS boards go, do I require to take all USMLE series to be eligible for those boards or one can take COMLEX and apply for ABMS boards ? How about the fellowships? If I want to get into an MD fellowships do I need to be in MD residency and take USMLE Step 3 or it is possible to get into them using COMLEX 3 with or without MD residency.
My last question is about the merging program. As you may know ACGME and AOA programs are merging starting 2015 over a gradual course of five years. So if these residency programs merge, what is going to happen to COMLEX and USMLE? is there going to be one comprehensive exam for both degrees? or the different exams continued to be administered?

Sorry I asked too many questions but it is really confusing how the next generation of medical students especially D.Os going to apply for residency starting 2015.

I appreciate your response.

 

[FrkyBgStok]

I don't know the answer to that because no one looks into it. Sounds pretty asinine. You HAVE to take the comlex levels 1, 2, and PE. The usmle step 1 and 2 are $600ish and the CE is $1200 + travel. There isn't a single program in the nation that cares if a DO takes the USMLE CS so why waste the incredible amount of money? And the COMLEX level 3 and the USMLE step 3 do the same thing, so why waste the money? If you have money to burn, find something better to burn it on. I believe group theory is right in saying NO ONE cares about the USMLE vs COMLEX in residency and beyond. fellowship don't care either. and by the time you are starting residency, they will have the other answers ironed out. as of right now, you need to do an md residency to go to an md fellowship. thats all. it isn't confusing how they will apply. it is not much different the years before it. if anything, it will be easier and more streamlined. no one knows what will happen to the tests. that is part of the transition.

 

[babdoc]

Also as far as the ABMS boards go, do I require to take all USMLE series to be eligible for those boards or one can take COMLEX and apply for ABMS boards ?

I straight up called the ABIM when I was a fourth year because I got some (bad) advice from a PD that I needed to take USMLE Step 2-CS and Step 3. Their response was that you DO NOT need to complete the USMLE series in order to be eligible to take the ABIM certification exam. Their only requirements are 1) that you have completed an ACGME-accredited IM residency and 2) have a state license. COMLEX 1-3 is all that a DO needs to get a state license as far as exams go, and USMLE 1 and 2-CK are almost universally all you need to get into an ACGME residency. Needless to say, I didn't rank that program.

 

[hallowmann]

Thank you for the complete response. But can you clarify that if for instance I take COMLEX 1, 2, PE (but not 3) plus all of the USMLE series, am I be still able to practice in some states?
Also as far as the ABMS boards go, do I require to take all USMLE series to be eligible for those boards or one can take COMLEX and apply for ABMS boards ? How about the fellowships? If I want to get into an MD fellowships do I need to be in MD residency and take USMLE Step 3 or it is possible to get into them using COMLEX 3 with or without MD residency.
My last question is about the merging program. As you may know ACGME and AOA programs are merging starting 2015 over a gradual course of five years. So if these residency programs merge, what is going to happen to COMLEX and USMLE? is there going to be one comprehensive exam for both degrees? or the different exams continued to be administered?

Sorry I asked too many questions but it is really confusing how the next generation of medical students especially D.Os going to apply for residency starting 2015.

I appreciate your response.

As a DO, expect to take the entire COMLEX series. COMLEX 1, 2 & PE must be taken to get your degree. In addition, as group_theory stated, some states require that you take Level 3, so unless you want to unnecessarily limit your ability to practice in all 50 states, you should take that as well.

You are not required to take the entire USMLE series to take the ABMS boards. As babdoc said, you only need to have completed an ACGME accredited residency and be licensed (i.e. universally you need to have taken all of the COMLEX exams). As people have said, you will generally need to take USMLE Step 1 and 2-CK (very few, if any, expect 2-CS) to get into any program (some will take you with only the COMLEX, but others require or prefer the USMLE).

Some fellowships will take into account USMLE 3 scores, but they still look at Step 1 and 2-CK. In many cases, you don't need to take Step 3, but this is really program specific. I believe you have to complete USMLE Step 2-CK and 2-CS in order to take Step 3, but as you saw, only 22 people out of over 2000 DOs that do ACGME residencies take Step 3 and that's only a 3rd of those even eligible to take it.

As of 2016 (i.e. the upcoming year) you will be required to have completed an ACGME program in order to get an ACGME fellowship. If things go according to plan, all residencies will be ACGME accredited by 2020 and there will no longer be any only "AOA accredited" residencies. If you will be finishing your residency before 2020, and you are in an AOA residency, as long as that residency receives "ACGME pre-accreditation" status (a status given to any program that simply applies for accreditation during the transition), you will be eligible to do an ACGME fellowship. That said, your chances at ACGME fellowship are much better if you complete an ACGME residency.

The USMLE and COMLEX are designed for state licensure, and as such any changes in the accreditation of GME will basically not affect them. It is up to the state medical boards to decide whether or not to require those exams for licensure. As a result, the exams aren't going anywhere. As I said above, if you are a DO or plan to go to a DO school expect to take the entire COMLEX series for licensure.

 

[JGimpel]

As someone that has gone through all of these hoops with a lot of assistance from upperclassmen and attendings, I'll put my actual experiences down. Your mileage and heartache may vary:

It's an MD world now and the COMLEX is going down, probably in the next 5 years (praying for it!). For that and many other reasons, you need to take USMLE Step 1. By the way, the AOA accredits most residencies like COCA accredits most medical schools, pay your fee and give them syllabi that will never actually be followed and you get accredited when your check clears.
*The commonly accepted dynamic duo of doing well on the USMLE Step 1 and passing the COMLEX 1 are what I've seen work in both the competitive and non-competitive programs as the way to go. Doing well on the COMLEX too is always great, but gets you mixed results. You're in luck since most people perform better on the USMLE than the COMLEX since it's a much higher quality test that really does show that you know the medicine.
*It's now public knowledge for MD and DO staff that the COMLEX (at any level) is a horrible test and shouldn't be the main reason to pick one student over another for this whereas the USMLE is reliable for that.
*MOST DO residencies that MOST DO students would actually be interested in going to haven't increased in size for a long time, so you'll be applying for 1 out of 6 spots that 1000+ other DO students are applying for. While not as desireable as the top MD programs that the SDN family says they want (Derm with MOHS at Hopkins), they are often more competitive than them for that reason. You will be applying to MD residencies just like most other DO students do, so put yourself in the best position to be competitive.

Next is what happens for the rest of your time in med school/GME:
1. You should schedule your COMLEX 2CE and PE as soon as possible (when you're ready, off course) to get ranked in many DO programs, but after you're accepted and start your 1st day of residency, these don't matter anymore.
2. You appply for your educational medical and controlled substance license with your fingerprinting done. Your program will have your transcripts from when you applied so they'll vouch for you on your state license apps. Nobody cares about your scores or which test you took anymore. Any med students that ask you about when you become a Resident are sent to the med library to review the journal of gerontologic colorectal surgery for that day. Never ever ask, trust me!
3. You'll take your COMLEX 3 sometime in your first year and nobody cares what this score is on this or any other COMLEX you've taken, as long as you've passed them.
4. You eventually apply for your permanent Medical, Controlled Substance and DEA license. The clerks just see that you have a passing score for all 3 levels, then check that box. That's all.
5. Fellowships may request your inservice and/or COMLEX scores, but as long as you do well in rotations with them, stay in touch and your portfolio is what they're looking for, they probably won't even ask about them.

This seems to be the general way things went for myself and many residents commiserating about this with me.

Gimp

 

[rasis]

@JGimpel, @hallowmann, @babdoc, @FrkyBgStok thank you very much . You guys are amazing. I got all I needed thanks to you. I really had doubt about the future of D.O., however, I am now more relieved

 

[JGimpel]

@JGimpel, @hallowmann, @babdoc, @FrkyBgStok thank you very much . You guys are amazing. I got all I needed thanks to you. I really had doubt about the future of D.O., however, I am now more relieved

Thank you and you're welcome! We've all been there, glad to help.