USMLE® Step 1 & 2

COMLEX Level 1’s move to pass-fail: What it means for DO students

Brendan Murphy , Senior News Writer

In much the same way the Step 1 of the United States Medical Licensing Examination (USMLE) moved to a pass-fail setup, the first level of the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX) began administering the exam as pass-fail earlier this month.

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A webinar hosted by the AMA looked at the changes to the COMLEX Level 1 exam and how they might impact osteopathic medical students. Here are some of the key nuggets offered by the three faculty presenters.

The move to take COMLEX Level 1 pass-fail was one aimed at student wellness.

“Nationally we have a big concern that we put our students through a tremendous amount of stress, and we feel like we lose them in the spring of their second year,” said Isaac J. Kirstein, DO, a dean at the Cleveland campus of Ohio University Heritage College of Osteopathic Medicine. “The national consensus of medical schools was to push back and start the conversation that a licensing exam shouldn’t be so disruptive for medical education.”

Dr. Kirstein pointed out that both the USMLE and COMLEX exams had been misused as a tool in residency selection. Their original and validated purpose is for medical licensure.

Find out the answers to medical students’ top questions about the USMLE Step 1 score switch.



A COMLEX Level 1 score was a key metric in obtaining residency interviews for DO students in some circumstances. With that score moving to pass-fail, the factors that could replace it include a COMLEX Level 2 score and evaluations of clinical performance such as the dean’s letter, also referred to as the Medical Student Performance Evaluation (MSPE). 

“There are a lot of different ways to assess you in the clinical space,” said J. Aaron Allgood, DO, chair of the clinical science education department at A.T. Still University. “That’s where I see the emphasis going more and more is your clinical performance, with the MSPE, which takes all of the performances … and then of course your Step 2 and Level 2 [exams], which switches from basic science over to clinical.”

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Osteopathic schools require students to pass the COMLEX Level 1 and Level 2 exams for graduation. The USMLE isn’t part of the required path for DO licensure or graduation, but many DO students still take the exam to help their chances during the residency-selection process.

Those who plan to take COMLEX Level 1 and USMLE Step 1 need to make sure they are confident they can pass both exams, said Jody Gerome, DO, senior associate dean for medical education at Ohio University Heritage College of Osteopathic Medicine.

“It depends on your ability and your skill set,” Dr. Gerome said. “One of the biggest mistake a student can make is to elect to take both COMLEX Level 1 and USMLE [Step 1] and fail one exam.”

A failing score on either exam, even if you go on to pass on the second attempt, will be noted to residency program directors when you apply for positions, and will likely put you at a disadvantage, Dr. Gerome noted. 

Osteopathic medical students often feel they must take both board exams to compete with medical students from MD schools who take the USMLE series. With both first exams in the COMLEX and USMLE series going pass-fail, how might that impact the second phase of those exams?

“Discuss with your residency advising staff at your college the specialty that you are interested in, the geographic area you’d like to go to, what your whole CV and resume package looks like and make a decision on Step 2 test-taking based on all that information,” said Dr. Gerome. “I practice medicine in Ohio, which has a large number of traditionally osteopathic training programs and many of our graduates are still successful matching into these types of competitive programs without taking USMLE.

Learn about AMA policy on COMLEX and USMLE equivalency in residency selection, last modified in 2021.