Do Osteopathic DO Students Need to Take USMLE Step Exams?
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Historically, DO students were recommended to take both the COMLEX and USMLE Step exams (specifically Step 1 and Step 2 CK) in order to be competitive for residency applications. However, now that both COMLEX Level 1 and Step 1 have become pass/fail, DO students wonder if they should still take the Step 1 exam. Additionally, they’re questioning whether scoring well on USMLE Step 2 CK will become even more crucial.
While the answer is often nuanced and not “one size fits all”, let’s look at some objective data to better understand this. The National Residency Matching Program (NRMP) conducted a survey with residency programs for the 2024 main residency match which can be found here. I will be using this data for the discussion in this blog post. Keep in mind that the total response rate is 18%. This means it’s not a complete representation of all programs in the country.
Do DO Students Need to Take the USMLE Step 1 Exam?
Although DO students don’t need to take the USMLE Step 1 exam to graduate and receive their medical license, it serves a different purpose. It plays a crucial role in applying for competitive specialties.
Percentage of programs requiring a pass on USMLE Step 1 vs. COMLEX Level 1 to select DO applicants for interview:
| Specialty | Pass on USMLE Step 1 | Pass on COMLEX Level 1 | Require Pass on Both |
| Anesthesiology | 86% | 85% | 76% |
| Child Neurology | 69% | 85% | 58% |
| Dermatology | 100% | 20% | 20% |
| Emergency Medicine | 55% | 90% | 54% |
| Family Medicine | 60% | 97% | 58% |
| Internal Medicine | 69% | 90% | 64% |
| Internal Medicine/Pediatrics | 80% | 87% | 67% |
| Neurological Surgery | 80% | 70% | 50% |
| Neurology | 55% | 90% | 45% |
| OB-GYN | 90% | 81% | 72% |
| Orthopedic Surgery | 77% | 77% | 76% |
| Pathology | 75% | 92% | 71% |
| Pediatrics | 38% | 96% | 39% |
| Physical Medicine and Rehabilitation | 63% | 95% | 63% |
| Psychiatry | 69% | 90% | 67% |
| Radiation Oncology | 86% | 71% | 71% |
| Radiology-diagnostic | 96% | 82% | 78% |
| Surgery-general | 89% | 89% | 78% |
| Vascular Surgery | 89% | 78% | 78% |
We can see that most specialties will require a pass on the USMLE Step 1 exam to be considered for an interview, with the exception of pediatrics, neurology, emergency medicine, and family medicine. If you are considering these specialties, you may be able to match without taking the USMLE Step 1 exam if you apply strategically. This means that you need to apply broadly and specifically to DO-friendly programs.
In general, I would still recommend to sit for the USMLE Step 1 exam. Therefore, plan ahead and create a study schedule that will allow you to be successful on both exams. Our 10-week COMLEX Level 1 study plan was made with this purpose in mind.
Be sure to regularly take practice assessments (NBME for Step 1 or COMSAE for COMLEX 1) to assess your readiness. However, if you’re struggling to pass your COMSAE practice assessment exams just 4 weeks out from your test date, then you need to adjust your priorities. I would recommend focusing on passing the COMLEX first. After you pass your COMLEX Level 1, you can then consider spending more time studying for the Step 1 exam.
Should DO Students Take the USMLE Step 2 CK Exam?
Yes, DO students should take the USMLE Step 2 CK exam. Most programs will prefer a Step 2 CK score although the score ranges vary. A notable exception is the specialty of pediatrics, where 40% of survey respondents indicated that they do not consider the Step 2 CK for DO medical students. More competitive specialties such as anesthesiology, neurological surgery, orthopedic surgery, diagnostic radiology, general surgery, and vascular surgery require a “target score” when selecting applicants for interview.
Which Specialties Absolutely Require a High Step 2 CK Score?
Using the NRMP “Charting Outcomes in the Match 2024” data, we can see that Dermatology, Orthopedic Surgery, Diagnostic and Interventional Radiology, Plastic Surgery, and Anesthesia tend to be some of the most competitive specialties. One of our senior residents has written an excellent blog post further explaining the official match data and I would recommend checking it out.
Should DO Students Take the USMLE Step 3 Exam?
The USMLE Step 3 exam is usually taken after you have matched into residency. Therefore, it is typically not considered important for residency applications. Most DO students opt out of taking the Step 3 exam. Instead, they typically choose to only sit for the COMLEX Level 3 exam, which is required for medical licensing.
What Other Aspects of the Residency Application Are Important to Program Directors?
Program directors consider several key factors when choosing applications for interviews. Besides great board exam scores, the top 7 factors are:
- Medical Student Performance Evaluation (MSPE/Dean’s Letter) – 85%
- Letters of recommendation in the specialty – 84%
- Grades in required clerkships – 70%
- Class ranking/quartiles – 66%
- Grades in clerkship in desired specialty – 60%
- Audition elective/rotation within your department – 60%
- Personal prior knowledge of the applicant – 58%
As you can see, your evaluations and performance during clinical rotations are important! Your exam score tells a program that you can learn the material well. However, your interaction with others and your clinical rotations tells a program whether you will do well on the job. They are looking for people who are teachable, passionate about the specialty, and eager to learn. Plan for audition rotations to show your interest. Show that you are someone they would love to work with!
Want to boost your chances of matching into your dream residency program? Our expert tutors at Elite Medical Prep can help. Please do not hesitate to reach out to schedule a free consultation to get started.
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