Strategic Guide for DO Graduates with Low Step Scores in Otolaryngology

Understanding the Otolaryngology Match Landscape as a DO with Low Scores

Otolaryngology–Head and Neck Surgery (ENT) is consistently one of the most competitive residency specialties. For a DO graduate with a low Step score—or with below average board scores on COMLEX and/or USMLE—the otolaryngology match can feel daunting, especially in the era of the otolaryngology match becoming increasingly metrics-driven and many programs historically favoring MD applicants.

Yet each year, DO graduates match into ENT, including some who started with a low Step 1 score or struggled on an early exam. The key differences between those who match and those who don’t usually come down to:

• How early and realistically they plan
• How well they understand the current otolaryngology match landscape
• How effectively they build a targeted strategy to offset weaker scores

This article focuses specifically on low Step score strategies for a DO graduate in otolaryngology (ENT). Whether you have a single low USMLE Step 1, a weaker COMLEX Level 1, or a pattern of below average board scores, you can still build a competitive application with the right approach.

We’ll cover:

• How program directors really view low scores in ENT
• Strategic decisions about USMLE vs COMLEX for DO applicants
• Concrete tactics to strengthen your ENT application
• How to build a realistic rank list and backup plan
• Special considerations for reapplicants and those late to the game

Throughout, we’ll use the terms “low Step score” and “below average board scores” broadly—what matters most is how you respond and what you do next.

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How ENT Programs View Low Board Scores in DO Applicants

What is a “low” score in this context?

Because Step 1 is now pass/fail, program directors increasingly look at:

• USMLE Step 2 CK
• COMLEX Level 2-CE
• Trends across multiple exams (Level 1, Level 2, Step 1, Step 2)

In a highly competitive specialty like ENT, “low” is relative. While exact cutoffs vary, for many otolaryngology programs:

• Scores near or below the national mean for all test takers may be considered borderline
• Scores significantly below the mean are “low” for ENT specifically
• A single exam failure (especially if explained and followed by strong performance) is not necessarily fatal, but it does require compensation with strengths elsewhere

For a DO graduate, low scores are interpreted in the broader context of:

• Whether you took the USMLE in addition to COMLEX
• How you performed on both DO and MD-oriented exams
• Your ENT-specific experience and letters of recommendation

How much do scores matter compared with other factors?

In ENT, board scores historically served as a filter rather than the main reason you match. Many programs use cutoffs simply to manage a high volume of applications. For a DO graduate, this can be a double hurdle:

1. DO status at a program with a historical MD bias
2. Below average board scores

However, once you pass the initial filter and secure an interview, the following often matter more than the exact numerical score:

• Strong subspecialty-specific letters from ENT faculty
• Performance on ENT rotations/auditions
• Research and productivity in otolaryngology
• Program fit and professionalism shown during interviews

The strategy, then, is twofold:

1. Get past the score-based filters.
2. Outshine other applicants on everything else.

Red flags vs. manageable weaknesses

Programs tend to differentiate between:

• Red flag issues:

  • Multiple exam failures without an upward trend
  • Unexplained large score drops
  • Unprofessional behavior or major academic misconduct

• Manageable weaknesses:

  • A single low Step 1 or COMLEX Level 1 with stronger Step 2/Level 2
  • Slightly below average Step 2/Level 2 but robust ENT involvement
  • One failed exam followed by consistent improvement and an explanation

If your situation is in the “manageable weakness” category, you can often offset it with deliberate, targeted work. Even some red flag cases can be rehabilitated with time, transparency, and a structured plan—though they require especially careful strategy.

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Strategic Testing Decisions for DO Graduates: COMLEX, USMLE, and Step 2 CK

For DO graduates targeting the otolaryngology match, exam strategy is crucial—especially if you already have a low Step 1 score or below average board scores.

Should a DO applicant to ENT take USMLE?

In 2025 and beyond, most competitive ENT programs still prefer or require USMLE scores, even for DO applicants, because:

• Program directors are more familiar with interpreting USMLE
• Some programs’ filters are built around USMLE step scores
• It standardizes comparison among applicants from different schools

If you’re a DO graduate aiming for ENT and haven’t taken any USMLE exams yet:

• If still early (pre-rotation, MS2/MS3):

  • Strongly consider taking at least Step 2 CK, even if Step 1 is now pass/fail.
  • Use your COMLEX prep to double as USMLE prep; address biostatistics and pharmacology gaps.

• If you already have a low Step 1 score:

  • The single most important testing move you can make is to excel on Step 2 CK.
  • A strong Step 2 (and Level 2) can demonstrate growth and clinical strength, and partially offset your earlier performance.

If you have not taken USMLE at all and are already graduating or late in training, it may be too high-risk to attempt a new exam very late. In that case, build your strategy predominantly around COMLEX performance, clinical excellence, research, and networking.

Turning Step 2 CK into your “redemption” exam

For applicants matching with low scores, Step 2 CK is your built-in second chance:

• Aim for clear improvement relative to Step 1/Level 1
• Treat Step 2 as your primary standardized measure of clinical readiness
• For DOs, align this with a strong COMLEX Level 2-CE result

Practical steps:

1. Honest baseline check:

   • Use NBME/COMSAE practice exams to gauge your starting point.

2. Targeted remediation:

   • Identify weak organ systems or question styles from Step 1/Level 1.
   • Focus extra time on biostatistics/epidemiology, pharmacology, and high-yield internal medicine topics.

3. Dedicated study period:

   • Minimize clinical burden if possible during your primary Step 2 study phase.
   • Use high-yield Qbanks and review your incorrects systematically.

4. Evidence of improvement:

   • If your Step 2/Level 2 score represents a substantial jump, highlight this in your personal statement and possibly in the additional information section of ERAS.

Even if your Step 2 score ends up only moderately improved, showing a positive trend is critical and often more important than the exact number.

What if your Step 2/Level 2 is also low?

If both your early and later exams are below the ENT average:

• Shift your mindset to:
  “I must make the rest of my application unambiguously outstanding and provide a clear narrative and evidence that these scores do not reflect my clinical performance or dedication to ENT.”

That means:

• Exceptional clinical evaluations (especially in ENT and surgery)
• Audition rotations where you can shine in person
• Strong letters of recommendation that explicitly address your clinical strengths and work ethic
• Research productivity and involvement in otolaryngology projects

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Building a High-Impact ENT Application When Your Scores Are Weak

This section is the heart of low Step score strategies for a DO graduate in otolaryngology (ENT). The goal is to assemble an application where everything outside your test scores says:
“This person is an ENT resident already in all but name.”

1. ENT Rotations and Auditions: Where DOs Can Shine

For DO graduates, especially those with below average board scores, audition rotations (away rotations or visiting student rotations) are often the most valuable part of the application.

They allow you to:

• Demonstrate hands-on clinical skills
• Show your work ethic, reliability, and teachability
• Build relationships with attendings and residents who can advocate for you

Strategies:

• Schedule 2–3 well-chosen ENT auditions at programs that:

  • Have a track record of interviewing/matching DOs
  • Are not exclusively ultra-elite academic powerhouses
  • Have faculty or PDs known to be DO-friendly

• Be the hardest-working student on service:

  • Arrive early, stay late (within reason), be prepared
  • Read about every case you see; anticipate what residents/attendings will ask
  • Take ownership of small but important tasks: dressing changes, patient education, writing detailed notes, pre/post-op checks

• Ask for feedback early and often:

  • Signal that you want to grow and that you’re coachable
  • Address any concerns before they show up in evaluations

Remember, for an applicant with a low Step 1 score or below average boards, a glowing letter from an audition can carry enormous weight.

2. Letters of Recommendation: Quality Over Quantity

Aim for 3–4 letters, with at least 2 strong letters from otolaryngologists.

Ideal ENT letters:

• Written by faculty who worked with you closely (especially during auditions)
• Comment on your clinical reasoning, professionalism, teamwork, and technical aptitude
• If possible, explicitly mention that your exam scores do not reflect your clinical potential

Helpful steps:

• Choose letter writers who know your work best, not just the most famous name.
• Meet with them to:
  • Share your CV, personal statement draft, and score history
  • Discuss your growth after your low Step score
  • Ask if they feel comfortable writing a “strong, supportive” letter

If a faculty member seems hesitant, that’s valuable feedback—choose someone else.

3. Research and Academic Productivity in Otolaryngology

In a specialty as academic as ENT, research can be a powerful tool for matching with low scores:

• Shows seriousness about the specialty
• Gives you something compelling to discuss during interviews
• Creates mentorship relationships with ENT faculty

Strategies for a DO graduate:

• Start early if possible: During OMS-II or early OMS-III, seek otolaryngology projects (chart reviews, case reports, poster presentations).
• If starting late or as a graduate:
  • Look for short-term, high-yield projects:
    • Case reports with interesting ENT pathology
    • Retrospective chart reviews with defined outcomes
    • Quality improvement projects in ENT clinics or ORs
  • Consider a research year only if you have strong mentorship and clear project plans—don’t take a gap year just to “hope something turns up.”

Research doesn’t need to be in top-tier journals to help; consistent ENT-related output and evidence of scholarly curiosity matter more than pure prestige.

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Application Strategy: Program Selection, Narrative, and Backup Plans

1. Realistic Program Selection for a DO with Low Scores

Program choice is where many ENT applicants with weaker scores sabotage themselves. Applying mainly to ultra-competitive, top-10 academic centers is unlikely to yield interviews if you are a DO graduate with below average board scores.

Target a mix of programs:

• DO-friendly ENT programs:

  • Those that have historically interviewed or matched DOs
  • Programs with DO leadership or faculty
  • Community or hybrid community-academic programs

• Moderately competitive academic programs:

  • Mid-tier university programs where your ENT experiences and letters can stand out

• Geographically diverse options:

  • Don’t limit yourself to only one high-demand city or coastal region. Many applicants overlook excellent midwestern or southern programs that may be more open to DOs and those matching with low scores.

Use tools such as:

• Program websites (check current and past residents’ degrees)
• NRMP and specialty-specific match data
• Mentors’ and recent graduates’ experiences

In your case, more applications can help, but they need to be smartly chosen, not just numerous.

2. Crafting a Personal Statement That Works for (Not Against) You

A thoughtful personal statement can help:

• Frame your low Step score in context without making it the entire story
• Highlight your growth, resilience, and dedication to ENT
• Connect your experiences to specific aspects of otolaryngology you love

Effective approaches:

• Briefly acknowledge your low Step 1 score or early struggles if relevant:
  • Provide a concise explanation (e.g., life event, early adjustment, misaligned study approach)
  • Focus on what changed afterward: new strategies, support, habits, and improved performance
• Emphasize ENT-specific experiences:
  • Rotations that inspired you
  • ENT research or QI projects
  • Clinical stories that show your empathy and team function

Avoid:

• Over-explaining or sounding defensive
• Blaming others (school, exam, circumstances) without taking responsibility
• Making your entire statement about the exam—remember, the rest of your ENT journey is more important.

3. Leveraging the Otolaryngology Match as a DO with Low Scores

Some actionable tactics:

• Reach out professionally to program coordinators or faculty when appropriate:

  • Brief, polite emails expressing genuine interest
  • Highlight specific connections (research interests, geographic ties, mentor relationships)

• Use your mentors to advocate for you:

  • Ask if they would be willing to send a brief email or make a phone call on your behalf to specific programs
  • ENT is a small field; a call from a respected otolaryngologist can significantly increase your visibility

• Demonstrate regional and program loyalty:

  • If you have ties to a city or state, mention this in your ERAS application and at interviews
  • Some programs particularly value residents likely to stay in the region

4. Designing a Thoughtful Backup Plan

Because ENT is one of the toughest matches—especially for a DO with low scores—you should have a deliberate backup strategy:

Options include:

• Dual-apply in a related field (e.g., general surgery, internal medicine preliminary year, transitional year) while being honest with yourself and your mentors about what you would truly be happy doing.

• Prelim year with plan to reapply ENT:

  • Focus on surgical skills, OR efficiency, and earning strong letters
  • Maintain ENT involvement where possible (clinics, call with ENT team, research)

• Dedicated ENT research year (if well structured):

  • Preferably at a program or institution with an ENT residency
  • With clear deliverables (papers, presentations, consistent mentorship)

A backup plan isn’t an admission of defeat—it’s a mark of maturity. Many successful ENT residents took an indirect route, using a prelim year or research year to transform a competitive disadvantage into a strength.

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Special Considerations for Reapplicants and Late-Deciding DO Graduates

For DO Graduates Reapplying to Otolaryngology

If you already went through an unsuccessful otolaryngology match, step back and analyze:

• Where was the bottleneck?
  • Few or no interviews: may be score filters, DO bias, or weak networking
  • Many interviews but no match: possibly interview skills, rank list strategy, or program fit

Then create a 1–2 year remediation plan that might include:

• More targeted ENT research and presentations
• Additional audition rotations if feasible
• Strengthened letters of recommendation, especially from programs where you previously rotated
• If possible, a clinical position (prelim or TY) where you can demonstrate excellence

It is crucial to show that you didn’t simply “try again,” but that your newer application is substantively stronger than your first attempt.

For Late-Deciding DO Students Considering ENT

If you’re a DO student in late MS3 or early MS4 who only recently decided on ENT:

• Immediately secure at least one ENT rotation at your home or a nearby affiliated program.
• Begin (or join) ENT research projects as soon as possible.
• Meet with ENT faculty and a dean/advisor to discuss whether the upcoming cycle is realistic or whether delaying graduation or planning for a research year might set you up for a more competitive attempt.

Because otolaryngology is so competitive, a rushed, underdeveloped application can do more harm than good. Sometimes, sitting out the first possible cycle to build a strong portfolio is the smarter move.

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FAQs: Low Step Score Strategies for DO Graduates in Otolaryngology (ENT)

1. Can I realistically match into ENT with a low Step 1 score as a DO?

Yes, it is still realistic, but it requires intentional, high-effort strategy. A single low Step 1 score—especially now that Step 1 is pass/fail and emphasis is shifting to Step 2—can be offset by a strong Step 2/Level 2, excellent rotations, strong letters, and ENT-focused research. Matching with low scores is possible, but you must approach every other part of your application with extra rigor.

2. Do I absolutely need USMLE scores as a DO for the otolaryngology match?

Not every program requires USMLE, but many competitive ENT programs strongly prefer it and may not know how to interpret COMLEX-only results. If you’re early enough in training, taking Step 2 CK is usually advisable. If you’re very late or already a graduate with only COMLEX, focus on maximizing your clinical performance, research, and networking, and target programs known to be DO-friendly and flexible about exam types.

3. Should I explain my low scores in my personal statement or interviews?

Yes, but briefly and constructively. A short, honest explanation coupled with clear evidence of improvement (better Step 2/Level 2 performance, strong clinical evaluations) is ideal. Avoid lengthy justifications or blaming; focus on what you learned, the changes you made, and how those changes led to better performance and preparedness for residency.

4. Is taking a research year worth it for a DO with below average board scores targeting ENT?

It can be, if well structured. A research year can significantly strengthen an application if you:

• Work directly with otolaryngology faculty
• Produce tangible output (publications, posters, presentations)
• Build strong mentorship relationships

However, a loosely organized gap year with minimal productivity is unlikely to meaningfully help. If you choose this route, ensure you have clear goals, support, and projects lined up from the outset.

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For a DO graduate with a low Step score or below average board scores, the otolaryngology match is challenging but far from impossible. Your application must prove—through your actions, performance, and relationships—that your test scores are the least interesting thing about you. If you can do that, many programs will be willing to take a close look, and some will be ready to welcome you as a colleague in ENT.