Apples & Oranges: Comparing USMLE and COMLEX Scores

  • /Reviewed by: Amy Rontal, MD
  • Ryan Kelsch contributed to this post.

    A great number of DO students take both the USMLE and COMLEX in hopes of broadening their residency options. Others only take the COMLEX, and wonder how they stack up to their USMLE-taking brethren. Program directors and applicants alike want a quick and easy conversion. The two tests are distinct, the scoring algorithms for each are different, and the cohorts examined are dissimilar, but if one were to try to compare apples to oranges, this is how I would do it:

    The Raw Data: How Scoring Works on the USMLE and COMLEX

    A passing score for the COMLEX Level 1 is a 400, whereas the USMLE Step 1 is 194. Since May 2015 until present, the mean for Level 1 is 520 and the standard deviation is 85. In 2016, the mean for Step 1 was 228 and the standard deviation was 21. Using these few pieces of data, I was able to come up with this graph attempting to compare the important data points for each exam (apples to apples, if you will):


    That being said, with the recent changes in the COMLEX, the NBOME has not released new data on standard deviation and mean scores for the COMLEX so this data above may be somewhat antiquated, although scoring hasn’t changed a whole lot in the past few years.

    COMLEX Percentiles

    No matter what your COMLEX score, you’ll probably be looking for information on how your results stack up against other test takers. Since the NBOME does not report percentile rankings during COMLEX score reporting, the best way to figure out your COMLEX percentile is to use the NBOME’s COMLEX Percentile Converter. The percentile score conversion tool converts standard scores into percentiles for COMLEX Level 1, Level 2-CE, and Level 3.

    You COMLEX percentile will be calculated against other first-time COMLEX test takers taking the same Level exam in the same testing cycle.

    Apples and Oranges … and Bananas: The COMLEX, USMLE, or Both

    In the current residency program and admissions milieu, it is hard to say if a 520 COMLEX score is going to be respected the same as a 228 USMLE. The single accreditation system is in its early years of implementation, and the hope is that more programs will accept and understand the COMLEX as the USMLE’s equivalent. That being said since the ACGME is the new standard, more programs seem to currently expect applicants to have taken “their test” — in other words, they will expect the USMLE. In this current environment, I still recommend the banana option: take both the USMLE and COMLEX if you can.

    A Solid COMLEX Score May Be Enough To Compete for Most Specialties

    All this being said, there is something known as the “600 club” in the osteopathic world. Any score over 600 is seen as competitive for most specialties.

    Any score over 700 is really really high, and scores over 800 are rarely heard of for Level 1. If a traditionally allopathic program is familiar with the COMLEX, then a score “in the club” should buy you a ticket to at least an interview, barring any prejudices.

    Pass/Fail Scoring for USMLE Step 1 and COMLEX Level 1

    Recently, the NBME announced that they will be transitioning to pass/fail scoring for USMLE Step 1. The NBOME also recently announced that they are investigating this possibility and will be providing an update as early as July 2020.

    It is impossible to predict how this will change applying to residency programs for DO students. Our best guess is that residency programs will start to emphasize Level 2 scores more for DO students or prefer DO students who submit passing Step 2 CK scores.

    Decrease in Number of Questions on COMLEX

    Also, in keeping with USMLE trends of decreasing the number of questions per block, the COMLEX will transition to 44 questions per block for Level 2-CE in June 2020, and May 2021 for Level 1. The total available time to complete the exam will remain the same.