Bouncing Back

Failed COMLEX or USMLE? What it means for matching into residency

Failing a COMLEX or USMLE exam can be a wrenching moment in a medical student’s career, but becoming a physician is still an attainable goal.

Failing a board exam in medical school is often a devastating experience.

When John Ukadike, OMS IV, found out he failed his first COMLEX exam, feelings of self-doubt and inadequacy crept in.

“I cried immediately and felt an overwhelming feeling of despair,” says Ukadike, who attends the New York Institute of Technology College of Osteopathic Medicine in Jonesboro, Arkansas.

About 4% of first-time exam takers did not pass COMLEX Level 1 during the 2017-2018 testing cycle. A 400 is the minimum passing score for the Level 1 exam, and students can only retake COMLEX if they failed the exam, not to boost a low score. Students can retake the exam a maximum of four times in a 12-month period.

Last year, roughly 4% of DO student exam takers failed USMLE Step 1 on their first attempt.

Getting into residency is still possible

Getting into residency is still possible for students who fail a USMLE or COMLEX exam.

Almost 99% of this year’s graduating DOs placed into residency programs, according to the American Association of Colleges of Osteopathic Medicine.

The DO spoke with Ukadike, a student advisor and two program directors, who shared tips on applying to and interviewing for residency after failing COMLEX or USMLE.

Applying to residency

When selecting an applicant to interview, 70% of program directors cited a failed attempt on USMLE/COMLEX as a factor they considered, according to the NRMP Program Director’s Survey.

While a student can still match, highly competitive specialties such as ophthalmology, dermatology or neurological surgery may not be realistic options, says Amanda Deel, DO, assistant dean for clinical education at NYITCOM in Jonesboro, Arkansas.

“The ultimate goal of becoming a physician is attainable, but it may be a different path than you expected,” Dr. Deel says.

Some residency programs have cut-off scores for COMLEX/USMLE exams to help narrow down the number of applications they receive.

“We have 4,000 applicants for 40 positions,” says Conrad Fischer, MD, internal medicine program director at Brookdale Hospital Medical Center in New York City. “I can interview 400, how do I choose them?”

A board exam failure can be a red flag to program directors, says Dr. Fischer, a recognized board test prep expert and an associate professor of medicine at Touro College of Osteopathic Medicine.

“One option for students who have failed is to look at programs in less competitive geographic locations,” he says.

In the ERAS system, program directors can create filters to highlight or eliminate certain qualities, says Niket Sonpal, MD, a recognized board test prep expert and an internal medicine associate program director at Brookdale Hospital Medical Center. For this reason, program directors may not even see applications from those who’ve failed board exams.

However, a high score on the second board exam (USMLE Step 2 CK and 2 CS and COMLEX Level 2-PE and 2-CE) can help negate a failure on the first one.

Drs. Sonpal and Fischer have interviewed students at their program who have failed board exams, but have rotated with them. Through clerkships, students can prove their abilities.

Residency interviews

Students should be prepared to talk about their failure on the interview trail.

“They should not be uncomfortable discussing it,” says Dr. Sonpal, an adjunct professor of clinical medicine at TouroCOM. “Take ownership, speak about how you increased your score and own what happened.”

Programs are not interested in explanations or excuses, Dr. Fischer says.

“When a student says, ‘I had a significant life stressor and that’s why I failed,’ it may seem insensitive, but the program director might hear, ‘If I’m on call, and there’s a crashing patient, I won’t be able to handle the stress,’” Dr. Fischer says.

Dr. Deel discourages students from writing about their failure in their personal statements.

“The personal statement is meant as an extra something you’re not going to find in a CV or MSPE,” Dr. Deel says. “It’s not a time to justify or bring up reasons why this happened.”

If a program offers an applicant an interview, she suggests students take the opportunity to show how they have grown and how the experience will make them a better resident and ultimately a better physician.

Self-care

It’s common for students to fall into isolation after failing a board exam.

“Students feel like they’ve let everyone down,” Dr. Deel says. “But the world is not over and their career is not at an end.”

Ukadike gave his school permission to give his name to other students who failed as well. He wanted to connect with a peer about the disappointment. Another student who had failed eventually reached out to him. They encouraged each other as they studied for their second attempt.

“It’s a taboo to talk about your board scores, but I didn’t care,” Ukadike says. “It was nice to talk to someone. There was a lot of camaraderie.”

He also signed up for counseling.

“It was really helpful to talk to someone about it outside of medicine,” Ukadike says. “Don’t be afraid to ask for help. You don’t have to go through this alone.”

On his second attempt at COMLEX Level 1, he scored 100 points higher.

Related reading:

He nearly failed medical school before rising to new heights

Your COMLEX questions answered

What to ask during residency interviews

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