Tag: education

TCOM Student Article

By Jared Sloan, OMS-II

This article was originally published in the January/February 2026 issue of  Tarrant County Physician.

January to February can be a tough time for many people: The air is cold, holiday street lights are taken down, New Year’s resolutions are abandoned, and osteopathic medical students are deciding whether they want to take double the amount of national licensing exams. While taking the USMLE (United States Medical Licensing Examination) Steps 1 and 2 is not a new expectation of osteopathic students, recent changes, including the formation of a single accreditation system, which fully merged the previously separate osteopathic and allopathic residency accreditation pathways in 2020, as well as the transition of STEP 1 to pass/fail scoring, have left many students scratching their heads and biting their nails at the thought of even more high-stakes exams. Early in their education, students are forced to make a career-defining choice: Should I take both the DO and MD licensure exams if it improves my residency outlook?

Since 1995, osteopathic students have taken the Comprehensive Osteopathic Medical Licensing Examination (COMLEX) as their primary means of gaining licensure. With the large overlap in content between COMLEX and the USMLE (the main difference being the inclusion of osteopathic-specific content), many professional medical societies have stated that the COMLEX is a perfectly acceptable alternative to the USMLE. However, this decision truly lies with individual residencies. Typically, osteopathic students who take STEP do so because it is required for the residencies they are interested in. But for the many year-two students who have not decided on a specific specialty, myself included, this decision is far from simple. Although many of my classmates and I are drawn to specialties that are historically “DO-friendly,” we are also aware that there is still much of medicine we have yet to experience. Many students don’t discover the field of medicine they are passionate about until their clinical rotations, but we must decide to take STEP 1 before we ever step into those roles. Students feel that by choosing not to take STEP they are closing doors to future programs before they even know about them. Many feel it is wiser to “play it safe” by taking the extra licensing exam. At the heart of this dilemma is the tension between what is technically sufficient for licensure and what is perceived as necessary to remain competitive across an increasingly uncertain residency landscape.

Unfortunately, students seeking mentor guidance on this matter often hear conflicting opinions from faculty and experienced osteopathic physicians. With the advancement of the osteopathic profession, many mentors insist that students should not feel pressured to take unnecessary exams. Others concede that, while COMLEX is becoming more accepted, there remains a very real preference for the STEP exams. Students are left with ambiguous answers and are told what they already know, namely, that choosing to take the extra exam depends on what specialty they are interested in.

How does the new pass/fail status of STEP 1 impact this predicament? Now that allopathic schools emphasize STEP 2, should second-year students feel free to skip the stress of STEP 1 and take STEP 2 only if they feel it is necessary? Yes, and some do exactly that. Many, however, are terrified by the idea of taking what feels like the most important test of our lives without taking its predecessor. While the core competencies of COMLEX and USMLE are similar in many ways, it is well known that there are differences in the style of writing and focus areas between the exams. With so much riding on STEP 2, students continue to feel pressured to prepare as best they can, which includes taking STEP 1.

Regardless of which licensure a medical student takes, almost all students would agree that these exams are hard. Fatigue, stress, and financial cost all increase when students choose to take more national boards. I know that I, and many students, worry how this increased burden will impact our performance. Taking an extra exam means risking failure on our core licensing exam or risking failure on an exam that was never necessary in the first place. Ultimately, we as medical students are high achievers, and many of us are willing to put in this extra work if it means more opportunities in the future.

Despite numerous residencies stating that they will review a COMLEX Level 2 score under the single accreditation system, students remain keenly suspicious that STEP 2 functions as a silent requirement. DO students are left wishing that our standard licensing exams were fairly considered but realize there is no way to enforce a fair consideration of COMLEX. Looking ahead, many osteopathic students are hopeful for one of two future outcomes. The first possibility is that the National Board of Osteopathic Medical Examiners (NBOME) could move toward standardization with the USMLE (potentially by accepting a unified licensing exam supplemented by osteopathic-specific assessments). However, given the NBOME’s longstanding commitment to a distinct osteopathic licensure pathway, this outcome appears unlikely. What feels like the more plausible future is that COMLEX scores will become more routinely considered by residency programs as familiarity increases. While this shift may already be underway, it will take time to fully materialize. As a result, although future osteopathic students may ultimately face fewer barriers, for the foreseeable future, many cohorts will continue to navigate a residency application in which the expectation of STEP remains firmly in place. As I look toward my future, I see a wide range of possibilities, possibilities that may quietly close if I choose to ignore this silent requirement.