The dreaded time has come to dish out $500 and prepare for our first of many licensing exams, the COMLEX. Passing the COMLEX exam is a mandatory requirement in order to begin third year clerkships, and therefore every student in the class must take it. Yet the USMLE, given by the National Board of Medical Examiners (NBME), is optional. So who should take the USMLE and who should avoid it?
Disclaimer: The following information is solely of my own opinion based on information gathered from program directors of residency programs, NYCOM alumni, and current applicants. Any decision to take or not take the USMLE should be discussed with your advisor or mentor.
1) I believe that most NYCOM students should not take the USMLE. First of all, the added risk of taking another exam, which will be seen by the residency review committee, is something that should not be taken lightly. A poor score will hurt you. A mediocre score will not help you. Only a great score may give you an advantage.
2) If you are applying to allopathic programs, you do not need to take the USMLE. There are certain exceptions; if you want to go to a competitive major university allopathic program for most specialties, including internal medicine, you should take the USMLE. Why? You will essentially be competing with the best students in the world. For example, internal medicine at NYU is a very prestigious program. The best students from every medical school in the country will apply. If you can be negatively distinguished (by not having a good USMLE score) from the rest of the pack then you may be at a disadvantage. Note that some New York City programs simply do not take DO students into residency for certain fields, yet for others they do, one being PM&R. Bottom line: You don’t want to look any worse on paper than anyone else applying.
3) Remember that we are competing against the entire pool of people taking the test, the majority of which are allopathic students. Many schools may focus their curriculum in certain areas that our school does not. For the most part, our exams are not very representative of the kinds of questions seen on the USMLE, or the COMLEX for that matter. Therefore we should be cautious in thinking that doing well on our lecture exams directly translates to doing well on the USMLE.
4) Finally, remember that board scores are only a part of the package when applying to residency programs. In a survey published in Academic Medicine (2009; 84(3):362-367) residency program directors ranked factors they considered important in matching into their programs. The top five academic criteria were grades in required clerkships, Step 1 score, grades in senior electives in specialty (essentially your showcase rotation), number of honors grades and Step 2 scores, in that order. Take my advice with a grain of salt. I have not applied to a residency program before, nor do I have inside information.
Best of luck studying!