The Match Process

What do I do if I am not matched with a residency program after the NMS match?

  • The AOA match, in which only AOA-approved programs participate, is known as the National Matching Service (NMS). The last NMS is scheduled to be in 2019. With the transition to a single graduate medical education (GME) accreditation system, the primary matching service after 2019 will be the NRMP.
  • If you are not matched to a residency program after the match process, you will receive notification along with a list of residencies participating in the “Scramble,” the post-match process that helps connect programs that have vacant positions to students still needing a post-graduate position. See the AOA post-match list. You may choose to delay post-graduate education for a year. 
  • Another option is to apply to an ACGME-accredited post-graduate program through the NRMP match. Time will be very short, so if you elect to pursue this latter option, immediate action will be necessary.  The NRMP match starts in mid March.  During this week, the Scramble officially begins on Tuesday at noon Eastern time, when the NRMP posts the List of Unfilled Programs to its website. The Scramble continues until noon on Thursday, when U.S. medical schools hold their Match Day ceremonies. Although the unfilled positions remain posted until May 1 in the NRMP Registration, Ranking, and Results (R3) System, few are available after the first 48 hours. Review a timeline for the “managed Scramble”.

Single GME Accreditation

What is the new single GME accreditation system?

  • A single GME accreditation system, which was approved by the AOA, ACGME, and AACOM in 2014, is to be fully implemented by July 2020. This new system will allow graduates of osteopathic and allopathic medical schools to complete residency and fellowship education in ACGME-accredited programs with a focus on common competencies and consistent evaluation. This system will recognize the unique principles and practices of osteopathic medicine and ensure that osteopathic students and graduates have unrestricted access to training opportunities in the specialties and locations of their choosing. It will also provide new training opportunities for MDs in osteopathic principles and practice. See more information on the single GME accreditation system.

Program Selection

What do I need to do to get accepted into a very competitive post-graduate program?

  • The process of qualifying for a post-graduate program starts on day one of medical school. Most post-graduate education programs set their own selection criteria, which they feel best serves their program. Osteopathic medical students are highly competitive in all venues—allopathic as well as osteopathic. The main question you need to get answered is, “Which program is right for me?”  Check out the information about selection criteria and use it to help you prepare yourself for that next educational opportunity.

Is an “Audition Rotation” required for consideration in a post-graduate program?

  • Generally, an “audition rotation” is not required. Such a rotation may, however, provide you with additional information with which to evaluate the program and its appropriateness for you. Moreover, it gives program personnel the opportunity to evaluate you and your work. If you choose to do this, plan to have it completed by December 1 of your last year in medical school.

Which residencies are preferred if I am interested in continuing to a fellowship program?

  • Your best chance of being accepted into a program will depend on your credentials, though preference may be given to candidates who completed their primary residency in the same institution. It is always a good idea to inquire directly of the program, asking where current fellows did their residencies.

Board Exams

Must I take USMLE board exams to apply to an ACGME-accredited post-graduate program?

  • Each post-graduate program—allopathic and osteopathic—sets its own selection criteria. Many ACGME-accredited programs accept COMLEX-USA scores on par with USMLE scores, while others will require all applicants to take USMLE. Check with each program under your consideration to ascertain which licensure board exams are required for applicants.

Which ACGME programs accept COMLEX without requiring the USMLE?

  • Each ACGME program determines which set of board scores it will accept. You are well-advised to ask specific programs under your consideration about their requirements. Remember that as an osteopathic physician, passing COMLEX-USA is required for state licensure; USMLE results cannot be substituted.

What are the new changes to COMLEX-USA? 

  • As of 2018, the content and format of COMLEX-USA will reflect changes designed to emphasize evidence-based and competency-based evaluation. The changes acknowledge the evolving practice of osteopathic medicine in the modern world. The National Board of Osteopathic Medical Examiners (NBOME) plans to continue to make changes to COMLEX-USA as necessary to ensure that the exam series remains current and meets the needs of DOs and their patients. In addition, as of the 2018-2019 test cycle, Level 3 resident/exam candidate eligibility will require attestation from an AOA- or ACGME-accredited GME program director that the candidate is in “good academic and professional standing.” As of the 2019-2020 test cycle, Level 1 and Level 2 candidates will require attestation from an AOA COCA-accredited COM dean that they are in “good academic and professional standing.”
  • Read FAQs on COMLEX-USA as it relates to transition to the single GME accreditation system.

Any advice on whether or not to take the USMLE Step 1?

  • Choosing to take USMLE Step 1 may broaden your opportunities later. Many students make this choice before they have determined which specialty to pursue. Persons following a military path can present either USMLE or COMLEX scores for consideration in post-graduate programs, so it is not necessary to take USMLE. Basically, the potential benefits of also having USMLE scores are program-specific and specialty-specific, so make sure you understand these possible benefits before it is too late.

What is the minimum board score that will ensure my acceptance into a given program?

  • Each program determines its own threshold on scores, which are only one factor in the set of credentials that are considered in the decision process of the program’s final rank order list. In general, there is no minimum score, though some highly competitive programs may use scores as initial screening criteria. Check with all programs under your consideration about their processes.

Application Process

Can I apply to more than one specialty field?

  • You may apply to as many programs and specialties as you wish. However, keep in mind that multiple applications set up a situation in which you will be comparing apples to oranges in your final decision about your rank order list. This also means that additional time and money are required to complete the interviews, not to mention the extra time taken away from your clinical rotations. Your school likely has some limits on the amount of time that you can be away for interviews. Be sure to check on that and pace yourself accordingly.

Can I apply to more than one residency program in a given specialty?

  • You can apply to any number of different residencies at any number of different sites. Program directors, however, will question your interest in their programs when they know you are considering others—though the directors will be aware of that information only if you tell them. You want to be honest and not waste either the program’s interview time or your own time, so you should have your choices narrowed down before you begin the interview process.

Is there a correlation between a student’s class rank and the program in which he/she is accepted for post-graduate education?

  • Programs to which a student applies will consider all of the student’s credentials—including medical school grades, board scores, class rank, recommendations, application information, and leadership activities. This does not mean that you will not be accepted if you are in the lower quartile of your graduating class. Nevertheless, remember that this is a competition for the best places and best applicants. Thus, you will want to have every competitive advantage possible. Advisors and mentors are good sources of additional information about particular specialties and programs.

My school uses a Pass/Fail grading system.  How will that be viewed by programs in which I am interested?

  • Many schools now use the Pass/Fail system rather than actual grades. Programs factor this into their consideration of applicants’ credentials.

Student Electives

What time of year should I visit a prospective program for an elective?

  • You should plan to visit a program in which you are interested by December 1 of your fourth year. ACGME-accredited programs and some AOA-approved programs are still interviewing candidates in early January, but that may be too late for proper consideration.

Additional Questions?

AACOM staff do not rate or rank programs or answer questions about specific sites or educational programs. Such questions are best answered by contacting staff at the site or program of interest. We do invite questions that you do not find answers to in this resource. Please send those questions to the AACOM communications department at,  and we will consider adding that information to our list of frequently asked questions.