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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 192. 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):

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Apples and Oranges…and Bananas: The COMLEX, The 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. As the single accreditation system is implemented, the hope is that more programs will accept and understand the COMLEX as the USMLE's equivalent. The other option (which I foresee happening) is, as programs merge and the ACGME becomes the new standard, more programs will 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.  


NBOME COMLEX-USA Score Interpretation

USMLE Score Interpretation Guidelines

COMLEX 3 Digit Score Conversion 

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Ryan Kelsch

Ryan Kelsch

Ryan is a third year medical student currently attending Midwestern University Chicago College of Osteopathic Medicine. He attended the University of Illinois at Urbana-Champaign where He studied molecular and cellular biology and tutored extensively organic and inorganic chemistry as a private tutor. Ryan scored a 263 on USMLE Step 1 and a 790 on COMLEX Level 1 and is currently ranked 3rd in his class of over 200. He wishes to pass his success down to his students. It would be his honor to serve his students in whatever needs they have.
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