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Boards as an Osteopathic Student – COMLEX vs. USMLE

The Comprehensive Osteopathic Medical Licensing Examination (COMLEX) is the osteopathic equivalent to the United States Medical Licensing Examination (USMLE) for allopathic students. Osteopathic students are placed into a unique position when it comes time to take boards. All osteopathic students must complete the COMLEX levels 1, 2, and eventually 3 in order to receive licensure as a D.O. However, osteopathic students also have the opportunity to take the USMLE as well. And, when it comes time to choose whether taking both exams are favorable or not, there are a few things that students should keep in mind:

Read: What Is Osteopathic Medicine?

1) Misunderstandings – Many pre-medical students have the misconception that despite being in an osteopathic program if you pass the USMLE or complete an ACGME residency (“M.D. residency”) you will become an M.D. rather than a D.O. On the contrary, the title that you obtain is dependent solely on the medical school you graduate from and not the boards or residency you complete.

2) Costs – These exams are expensive and some students may be required to travel to testing centers to take boards. Add in the costs for travel, lodging, transportation, and food to these exam prices and the total can add up to be extensive.

3) Time – Both of these exams are long and can take a toll on students physically and mentally. Though both of these exams test for the same material, keep in mind that the COMLEX also covers osteopathic manipulative medicine (OMM). Set aside sufficient time to study OMM before you take the COMLEX.

So when should an osteopathic student consider taking both exams?

Read: Should I Apply To D.O. schools?

One thing to remember is that as an osteopathic student the USMLE is not required and thus can be taken at any time. Although many osteopathic schools require their students to pass the COMLEX Level-1 before beginning third year clinical rotations there is no such requirement for the USMLE. Unlike the COMLEX, which must be taken in order (Level 1 then 2 then 3), there is no requirement to take the USMLE Step-1 before the USMLE Step-2. Therefore, it is possible to only take the USMLE Step-2 and not Step-1. And generally, osteopathic students do not take the USMLE Step-3, which is taken after the residency match and during residency.

All AOA (American Osteopathic Association) “D.O.” residencies accept COMLEX scores. There are also a few ACGME (Accreditation Council for Graduate Medical Education) “M.D.” residencies that accept the COMLEX as well. If a student does decide on taking the COMLEX and the USMLE, it is now required that the student report both these scores to these ACGME programs even if they accept the COMLEX. Thus, it is imperative that a student is confident that her or she will pass the USMLE if he or she decides to take the exam.

Keep in mind that there are many more ACGME residency positions than AOA positions and even more specialized programs. Taking the USMLE will definitely broaden the number of programs an osteopathic student can apply to. However, depending on which programs a student is interested in, taking the USMLE may not be necessary.

So, the answer to the question above depends on the individual student’s goals and interests. Questions such as “which residency should I choose?” “What programs I am interested in?” And “Where should I to apply to?” are all questions that can help determine if both exams should be taken.


1) Be sure you can pass and do well on the USMLE if you choose to take both exams. If you do not score at least within the range of the specialty you are considering pursuing, taking the exam has the potential to reflect poorly on you as an applicant.

2) Try to decide early. Although it is possible to delay taking the USMLE I would suggest against it.

Read: Difference Between MD and DO

3) Take the USMLE before the COMLEX but keep the testing dates close. Many osteopathic students take the USMLE first then give themselves time in-between to study OMM and then take the COMLEX after.

4) Although both exams cover similar material, some students find the question styles of the exams to be different. Be familiar with the question styles for both the USMLE and the COMLEX. Using two different question banks to prepare for each individual exam would be a good idea.

What USMLE Score Do I Need on Step 1 To Be Competitive?

If you opt for the USMLE exam, use the USMLE Step 1 Score Estimator below to help you determine what score you need to match into the residency of your choice.


Vu Tran is currently a third year medical student at Nova Southeastern University COM.

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