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What Does Step 1/Level 1 Going Pass/Fail Mean for DOs?

What will the world be like when USMLE Step 1 and COMLEX Level 1 are pass/fail? Obviously, something has to take its place. I have been involved in the resident selection process at my program for the last four years, and I can tell you from experience that a decent Step 1/Level 1 exam score gets your foot in the door and increases your chances of landing that audition or an interview.

Low scores automatically get you excluded and impressive marks become significantly important as the final rank list is constructed.

Board scores aren’t the only factor that admissions committees consider, but they are one of the most important and form a benchmark with which to evaluate students.

You Still Need to Study When Step 1 and Level 1 are Pass/Fail!

The fact that Step 1/Level 1 will be pass/fail does not mean that you should slack on preparing for the test. In my experience, students who did well on Step 1/Level 1 also tend to do well on Step 2/Level 2.

The knowledge gained in the first two years in medical school is critically important and forms the foundation for your medical career. Deficiencies in the fundamental aspects of medicine will not only become evident on your clinical rotations but will also likely translate to lower-than-expected Step 2/Level 2 marks.

The ability to answer difficult questions on Step 2/Level 2 relies on your understanding of the basic pathophysiology and mechanisms learned while studying for Step 1/Level 1.

Although Step 1/Level 1 will not be as meaningful for the match process going forward, you should still prepare for it as if it is the most important test of your life.  

Why Your Step 1/Level 1 Score is Important for Residency

The boards are important to resident selection committees for several reasons. First, they are an objective way to compare candidates. All of the residents and attendees on admissions boards have taken either the COMLEX or USMLE and can readily recognize a competitive score.

Secondly, a strong board score is a good indicator of how a medical student will perform once they become a resident. This is felt to be especially true in demanding specialties where the resident is expected to work intensive hours, stay up to date on current literature, and prepare for cases and the clinic.

How will you be an effective resident if you weren’t able to keep up and study in a less stressful environment such as medical school? 

How Should DO Students Plan for a Pass/Fail Step 1/Level 1 Exam?

For osteopathic students, the COMLEX or USMLE exams are a matter of which residency program you wish to match into. If you are aiming for traditional DO programs, taking only the Level 1 or 2 may be appropriate.

However, if you wish to match into a residency that hasn’t taken many DOs in the past, you will want to consider taking the USMLE Step exams. The USMLE is important in this situation, as you will be competing with MD candidates and it is difficult to compare Level and Step scores.

They are very different tests: a USMLE score will allow your evaluators to compare you, apples to apples, to traditional medical students. If you are applying to a traditional MD program, understand that the attendees may not recognize a strong COMLEX Level 1 or 2, as they primarily deal with allopathic students.


Although I am a resident in a traditionally DO orthopedic residency, I can guarantee that my program shares many similarities with other competitive residencies in terms of evaluating incoming medical students. Board scores are consistently a tidemark that either get you an interview or get you denied. With Level 1/Step 1 becoming pass/fail (of course you still must pass), Level 2/Step 2 scores will be the new standard.

To have control of your future and to be able to dictate where you end up for residency you must develop a well-rounded application which entails meaningful life experiences, research, excellent letters of recommendation from practitioners in your desired field, great audition rotations, and most importantly you must also CRUSH your board examinations. Good luck!