Medical Students, Advising, Match

To USMLE or Not to USMLE? That Is the Question

Annually, second-year osteopathic students across the country wrestle with the question, “Do I need to take USMLE in addition to COMLEX?” As the 2020 deadline for completion of the ACGME-AOA merger approaches, this has become an even more challenging decision. 

Average USMLE and COMLEX Scores

The 2016 NRMP “Charting Outcomes in the Match” data shows that the average USMLE Step 1 scores for U.S. Seniors matching into EM was 225-245, with a mean of 233, the average across all specialties. Therefore, you only need an average USMLE score to be competitive for EM.  The average COMLEX scores were 540-640, with a mean of 593. Keep in mind, board scores do not make up your entire application and these are just general numbers. There are few hard and fast cutoffs, but if you can score within these ranges, you are giving yourself much better odds at matching.

Board Scores and Clerkships

One of the first steps to having a successful match is setting up and crushing some Emergency Medicine clerkships at residency programs in which you are interested. Preliminary data collected from approximately 120 programs to populate EMRA Match for Clerkships revealed that nearly all clerkships consider Osteopathic students. One-third of clerkships want to see an applicant’s COMLEX (or USMLE score) before extending an invitation to rotate, and about half of clerkships only accept students who have taken USMLE. A small percentage did not require scores prior to offering clerkships. Of those programs accepting both scores, there was a slight preference for USMLE.

Board Scores and the Match

For determining the effect of having USMLE versus COMLEX scores on match results, a study examining of 2011 NRMP Match data showed there were 1,482 MD students applying to EM with an 86% match rate. There were 350 DO students applying with an overall 52% match rate, 61% for students reporting a USMLE score, while 39% of students reported COMLEX only. Additional survey results showed that 77% of program directors believe it is important for osteopathic applicants to take USMLE.

Use EMRA Match

Utilizing EMRA’s Match website you can toggle “Residency” and “Clerkships” in the top left corner. Under the clerkships tab you can find a program’s preference in regards to board testing. If the program is not listed, go to the websites of the top several programs you think you may be interested in and research the answer. You can also send the program coordinator an email and simply ask.

Take the USMLE

In summary, TAKE the USMLE! Osteopathic students need to be easily comparable to allopathic peers, and this is the best way to do it. In fact, the CORD Advising Students Committee for Emergency Medicine (ASCEM – formerly known as the CORD Student Advising Task Force) strongly encourages DO students to take both Step 1 and Step 2 CK. In order to prepare, utilize both USMLE- and COMLEX-focused question banks to get a feel for the different question styles. Many students will opt to focus on preparing for USMLE and take it first. Then, they will brush up on OMM for COMLEX, and take COMLEX, usually within a week or so of their USMLE testing date.

For additional details and further advising, consult the “EM Applying Guide” and “Emergency Medicine Medical Student Planner for the Osteopathic Student,” by the CORD Advising Student Committee in EM. 


Weizberg M, Kass D, Husain A, Cohen J, Hahn B. Should Osteopathic Students Applying to Allopathic Emergency Medicine Programs Take the USMLE Exam? West J Emerg Med. 2014;15(1), 101–106.

Main Residency Match Data and Reports. National Resident Matching Program. Accessed at  

Stobart-Gallagher M, Smith L, Simpson D, et al. Emergency Medicine Medical Student Planner for the Osteopathic Student. CORD Advising Students Committee for Emergency Medicine.

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