Strategic Tips for DO Graduates with Low Step Scores in Chicago

Understanding the Impact of a Low Step Score as a DO Graduate in Chicago

As a DO graduate in Chicago, facing a low Step 1 score—or generally below average board scores—can feel discouraging, especially in a competitive environment with many strong MD and DO applicants. But “low” does not mean “no chance.” With a strategic, data-driven plan, you can absolutely build a successful path into residency in Illinois and beyond.

This article focuses on low Step score strategies specifically for DO graduates in Chicago, with a strong emphasis on:

• How residency programs in Chicago and Illinois actually view low USMLE and COMLEX scores
• Targeting programs likely to consider DO applicants and lower scores
• Concrete steps to strengthen the rest of your application
• Communicating about your scores without sounding defensive
• Making the most of the osteopathic residency match environment after single accreditation

You’ll also find actionable advice, examples tailored to the Chicago residency programs and Illinois residency landscape, and a FAQ at the end.

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1. Reframing “Low Scores”: What They Mean in the Chicago/Illinois Context

1.1 What counts as a “low Step score” now?

With Step 1 now pass/fail, “low score” usually refers to:

• A failed Step 1 attempt
• A low Step 2 CK (often < 220–225, depending on specialty)
• Below average COMLEX Level 1/2 scores for your target specialty
• A failed COMLEX attempt

Residency programs in Illinois that receive hundreds or thousands of applications often use score filters—but those filters are not universal, and some are much more DO-friendly and holistic than others.

For DO graduates, “low” might mean:

• COMLEX Level 1: < 450
• COMLEX Level 2: < 450–475
• Step 2 CK: < 220–225

These are not hard cutoffs, but they are useful reference points. Many primary care and community-based programs in Chicago and across Illinois are more flexible with scores, especially if you show strength in other areas.

1.2 How Chicago and Illinois programs think about scores

Illinois has a mix of large academic centers and community-based teaching hospitals. In Chicago and the region, you’ll find:

• Highly competitive academic programs
  • Often at major institutions (university-affiliated, tertiary centers)
  • More likely to have rigid score filters and heavy research focus
• Mid-sized community programs
  • Often university-affiliated but more service-oriented
  • Frequently more DO-friendly, may use more holistic review
• Smaller community and regional programs across Illinois
  • Often significantly more open to DOs and applicants with below average board scores
  • Strong emphasis on clinical performance and professionalism

For a DO graduate matching with low scores, you should strategically focus on the mid-sized and community Illinois residency programs that have a track record of accepting DOs and considering the whole applicant.

1.3 Osteopathic background: Strength and stereotype

Your DO training is a real asset, but you must be aware of lingering misconceptions:

• Some academic programs still (quietly) prioritize MD applicants and higher scores.
• Others actively value osteopathic graduates, especially in primary care, family medicine, internal medicine, PM&R, and psychiatry.

Your task is to:

1. Identify which Chicago residency programs are historically DO-friendly, and
2. Show clearly that your clinical skills, professionalism, and fit outweigh score concerns.

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2. Targeting the Right Programs: Where DOs with Lower Scores Actually Match

2.1 Start with DO-friendly specialties

Your specialty choice is the single biggest controllable factor in matching with low scores. As a DO graduate in Chicago, you’re in a region where many programs value osteopathic physicians in:

• Family Medicine
• Internal Medicine (community-focused)
• Pediatrics (some community and regional programs)
• Psychiatry (many DO-friendly programs in Midwest states)
• PM&R (traditionally more open to DOs, but can be competitive at top centers)
• Emergency Medicine (more challenging with low scores, but some DO-friendly sites remain)

If your scores are significantly below average, and especially if you have a fail on your record, aiming for highly competitive fields (e.g., dermatology, plastic surgery, orthopedics, neurosurgery, diagnostic radiology) is usually unrealistic unless you have extraordinary compensating strengths and are open to a multi-year alternative pathway.

2.2 Prioritize community-based and regional Illinois residency programs

Look beyond just “Chicago” as a city name:

• Target suburban and regional programs in the greater Chicago area
• Explore downstate Illinois and neighboring Midwest states (Indiana, Wisconsin, Iowa, Michigan)
• Focus on programs with:
  • A history of matching DO graduates
  • Lower average board scores listed in their program data or NRMP/ERAS filters
  • Emphasis on service, primary care, and underserved populations

Example approach for an Illinois-focused DO graduate with a low Step 2 score:

1. Chicago metro:
   • Community-based Internal Medicine and Family Medicine programs
   • Psychiatry programs at hospitals that actively recruit DOs
2. Suburban programs (e.g., in surrounding counties):
   • FM/IM with strong outpatient focus
   • Some transitional year programs if part of a long-term plan
3. Statewide Illinois:
   • Community Family Medicine in smaller cities
   • Rural-track programs that value commitment to underserved care

2.3 Use DO- and score-friendly filters deliberately

When researching programs:

• Check FREIDA and program websites for:
  • Proportion of DO vs MD residents
  • Minimum USMLE/COMLEX requirements
  • Stated commitment to holistic review
• Ask recent alumni or current residents (via email or LinkedIn):
  • “Does your program interview DOs with low Step 2/COMLEX scores?”
  • “How does your PD view a failed attempt if there’s subsequent improvement?”

If you attend(ed) a DO school in or near Chicago, leverage your school’s GME office and alumni network to identify Illinois residency programs that historically look beyond scores.

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3. Strengthening Your Application Beyond the Numbers

If your boards are a liability, everything else has to be an asset. For a DO graduate aiming for osteopathic residency match success with low scores, focus on four pillars:

1. Clinical performance and letters of recommendation
2. Sub-internships and audition rotations (especially in Illinois/Chicago)
3. Personal statement and narrative framing
4. Professionalism, reliability, and evidence of growth

3.1 Clinical grades and narrative evaluations

When programs are concerned about scores, they look for evidence that:

• You take good care of patients
• You’re safe, reliable, and coachable
• You perform well under supervision

Maximize your core and elective rotations:

• Seek out strong clinical sites in Chicago, especially where residents and attendings are known to write detailed, supportive evaluations.
• Consistently ask:
  • “Is there anything I can do to improve?”
  • “Where do you see areas of growth for me?”

If your school allows, intentionally choose rotations at Illinois residency sites where you might later apply—this can set up strong letters and insider advocates.

3.2 High-impact letters of recommendation (LORs)

For DO graduates with below average board scores, LORs can be decisive. Strong letters should come from:

• Physicians in your intended specialty
• Ideally at Chicago or Illinois residency programs or well-known institutions
• Attendings who directly supervised you and can speak in detail about your clinical work

Ask for letters from people who can say things like:

• “This student functions at or above the level of an incoming intern.”
• “I would be comfortable having them care for my own family.”
• “Their board scores do not reflect their clinical judgment and work ethic.”

Be explicit when requesting:
“I’m applying in Internal Medicine and I’m particularly concerned that my Step 2/COMLEX scores may hold me back. If you feel comfortable, would you be willing to specifically address my clinical strengths and potential as a resident in your letter?”

3.3 Sub-internships and audition rotations in Chicago and Illinois

For DO graduates, especially with low Step scores, audition rotations can be your single best way to overcome filters.

Tactics:

• Target Illinois residency programs that accept visiting students and have a reputation for being DO-friendly.
• Aim to rotate early enough (late 3rd year/early 4th year) to secure letters before ERAS submission.
• On rotation, aim to be:
  • Present and prepared (arrive early, know your patients thoroughly)
  • Low-maintenance, high-output (volunteer for tasks, help the team)
  • Professional and humble, particularly about areas you’re improving

If you impress a program on rotation, they may override score filters to give you an interview and advocate for you in Rank Committee discussions.

3.4 The personal statement: Turning a liability into a growth story

If you have a failed Step or very low score, your personal statement is the place to:

• Briefly acknowledge it (no excuses)
• Explain contributing factors only if they are clear and factual (e.g., illness)
• Emphasize what you changed afterward
• Demonstrate how your subsequent performance reflects improvement

Example framing (condensed):

“Early in my training, I struggled with standardized exams and failed my first attempt at Step 1. While this was a significant setback, it forced me to critically evaluate my study methods, time management, and stress coping strategies. With guidance from faculty and peers, I developed a structured study plan, prioritized active learning, and sought help early. As a result, I passed Step 1 on my second attempt and performed substantially better on COMLEX Level 2 and my clinical rotations, where I felt my strengths in patient communication and team-based care could be fully expressed.”

Keep it:

• Honest but not overly confessional
• Focused on growth, insight, and current competence
• Connected to your desired specialty and future goals

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4. Tactical Application Strategy for Matching with Low Scores

4.1 Applying broadly and realistically

With below average scores, your application list must be larger and more strategically diversified than that of a typical applicant.

For a DO graduate in Chicago applying to a less competitive specialty with low Step/COMLEX scores:

• Total programs: Commonly 50–80+ for primary care, potentially more depending on your profile and geographic flexibility.
• Program mix:
  • 20–30%: Chicago and Illinois programs (DO-friendly, community-heavy)
  • 50–60%: Other Midwest and national community programs known to consider DOs
  • 10–20%: “Reach” programs if you have significant strengths (research, strong letters, unique background)

If you are highly geographically restricted (e.g., must stay in Chicago), be aware this raises your risk significantly. You may need:

• More audition rotations locally
• Even stronger networking
• Consideration of preliminary or transitional year options as a bridge if categorical spots are limited

4.2 Addressing score concerns in ERAS

Use all the ERAS tools available:

• MSPE (Dean’s Letter): If possible, ask your school to highlight your clinical performance and professional growth.
• Additional comments section (if available): Briefly describe any major context (health, personal crisis) that contributed to a failed exam, followed by clear evidence of recovery.
• COMLEX-only vs both exams:
  • Many Chicago and Illinois programs are now comfortable with COMLEX alone.
  • However, some competitive or historically MD-heavy programs heavily prefer USMLE Step 2 CK.
  • If you have the capacity and timeline, consider taking Step 2 CK and preparing intensively to show upward trajectory.

4.3 Letters from DO vs MD attendings

As a DO aiming for osteopathic residency match success, letters from DO faculty—especially in your specialty—carry unique weight, but MD letters from respected Chicago/Illinois attendings also help, particularly if:

• They are at programs with strong reputations
• They explicitly recommend you as a resident at their own or similar institutions

Aim for:

• 1–2 letters from your intended specialty
• 1 from a core discipline (e.g., IM, FM, Pediatrics) or a respected faculty member who knows you well
• At least 1 letter that directly addresses your clinical competence despite low scores

4.4 Strategic use of OMT and osteopathic identity

In the single accreditation era, some programs especially appreciate the osteopathic skill set:

• Family Medicine programs serving chronic pain, musculoskeletal conditions, and underserved populations
• PM&R programs focusing on function and rehabilitation
• Some Internal Medicine programs that emphasize holistic care

Highlight:

• OMT skills and relevant clinical experiences
• Cases where osteopathic principles improved patient outcomes
• Your willingness to teach OMT to co-residents and integrate it into team-based care

This can differentiate you in a positive way, especially when competing with MD applicants with similar or slightly better scores.

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5. Interviews, Ranking, and Backup Planning

5.1 Securing interviews with low scores

To increase your odds of interviews in Chicago and Illinois:

• Apply early: Submit ERAS on the opening day, with all materials complete (including Step 2/COMLEX 2 if possible).
• Send targeted emails to programs where you have genuine ties:
  • “I grew up in Chicago / attended medical school in Illinois / my long-term goal is to serve this community.”
  • Mention any prior rotation or research experience at that institution.
• Ask faculty mentors to contact programs on your behalf, especially if they have relationships with Illinois program directors or chiefs.

5.2 Interview performance: What matters most with low scores

Once you’re in the room (or on Zoom), your goal is to make it impossible for them to see only the number. Focus on:

• Professionalism and maturity: Own your history, don’t blame others.
• Insight and growth: Be prepared to talk specifically about what changed after your low score.
• Fit with program mission: Know why the program exists and how you align (e.g., “serving underserved patients on Chicago’s South Side”).
• Concrete examples: Share patient stories that show your clinical reasoning, empathy, and teamwork.

If asked directly about your low score:

1. Acknowledge the concern.
2. Briefly explain any key context.
3. Emphasize changes you made.
4. Point to evidence of improvement: stronger clinical evaluations, better subsequent exams, successful sub-internships.

Example response:

“You’re right to ask about that. My Step 2 score is lower than I had hoped. Looking back, I underestimated how much I needed to adjust my study approach from pre-clinical to clinical years. After getting that result, I met with faculty and created a structured, question-based study schedule and sought help early rather than waiting. Since then, my COMLEX Level 2 improved, and more importantly, my clinical evaluations show that my bedside performance and clinical reasoning are much stronger than my test score suggests.”

5.3 Ranking strategy with low scores

When building your rank list:

• Rank programs in your true order of preference—if they interviewed you, they’re at least potentially interested regardless of scores.
• Don’t “game” the algorithm by ranking “safeties” higher just because you think you’re more likely to match there; rank according to where you truly want to train.
• Consider including:
  • Community Illinois residency programs that felt welcoming and DO-positive
  • Out-of-state programs that seemed especially supportive of non-traditional or lower-score applicants
  • Any preliminary or transitional programs if you’re pursuing a bridging strategy (e.g., reapplying later in a different specialty)

5.4 Backup options if you don’t match

If you don’t match, that does not end your career. For DO graduates in Chicago, realistic next-step options include:

• SOAP (Supplemental Offer and Acceptance Program):
  • Many unfilled positions are in Family Medicine, Internal Medicine prelim, Transitional Year, and sometimes Pediatrics or Psychiatry.
• Additional clinical experience:
  • A supervised year as a research fellow, clinical assistant, or prelim resident can strengthen your application.
• Re-taking exams (if appropriate):
  • If you passed but barely, focusing on a strong Step 3/COMLEX 3 later can show upward trajectory—though this is more helpful once you are already in or just before residency.
• Revisiting specialty choice:
  • Some DO graduates pivot from more competitive fields into primary care and have excellent long-term careers in Illinois.

Your strategy after a non-match year should be individualized with the help of:

• Your school’s advising office
• A trusted faculty mentor familiar with GME in Chicago
• Possibly an external advisor with residency match experience

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6. Long-Term Mindset: Career Success Beyond the Score Report

Residency programs know this: board scores predict test-taking, not necessarily clinical excellence. Many outstanding physicians had:

• Failed or low Step/COMLEX attempts
• Non-linear paths through training
• Initial matches at smaller or less well-known programs

As a DO graduate in Chicago with a low Step score, your goals should be:

• Get into a solid, supportive residency where you will develop strong clinical skills
• Build a reputation for hard work, reliability, and compassionate care
• Leverage Chicago’s rich network of hospitals and clinics to craft the career you want—whether in hospital medicine, outpatient primary care, subspecialty training, or academic roles

Your score is a data point, not a verdict. With targeted program selection, strong clinical performance, and a clear growth narrative, you can absolutely succeed in the osteopathic residency match—even from a position of below average board scores.

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FAQs: Low Step Score Strategies for DO Graduates in Chicago

1. Can I still match into a Chicago residency program with a low Step 2 or COMLEX score?

Yes, but you must be strategic. You are more likely to match into:

• Community-based IM or FM programs
• Psychiatry or PM&R programs that are DO-friendly
• Programs that explicitly state holistic review and have a history of accepting DOs

Your chances improve significantly if you:

• Complete audition rotations at those programs
• Get strong letters from local attendings
• Clearly explain your growth and strengths in your personal statement and interviews.

2. Should I take Step 2 CK if I already passed COMLEX but my scores are low?

It depends:

• If your COMLEX scores are very low and you believe you can perform meaningfully better on Step 2 CK with focused preparation, taking Step 2 may show upward trajectory and open more doors, especially at MD-heavy Chicago programs.
• If standardized testing is a major challenge and your COMLEX is at least adequate for primary care, it might be better to focus on clinical performance, rotations, and applications rather than risking another low score.

Discuss this with a mentor or advisor who knows your specific score profile and target specialty.

3. How many programs should I apply to if I have below average board scores?

For a DO graduate with low scores aiming at primary care or psychiatry:

• Often 50–80+ programs is reasonable, depending on your competitiveness and flexibility.
• At least half should be community and DO-friendly programs; a smaller portion can be Chicago or Illinois “reach” programs if you have strong ties or impressive letters.

If you are very geographically restricted (e.g., Chicago only), understand that your risk of not matching increases, so you must maximize networking and audition rotations.

4. How do I talk about a failed Step or COMLEX exam in interviews without hurting my chances?

Use a structured, concise approach:

1. Acknowledge the failure without excuses.
2. Provide brief context if there was a clear, specific factor (illness, family crisis), but don’t over-focus on it.
3. Emphasize what you changed: new study strategies, time management, support systems.
4. Highlight evidence of improvement: later exam scores, strong clinical evaluations, positive feedback from sub-internships.

Programs are not looking for perfection; they’re looking for insight, accountability, and growth. Showing that you learned from the experience can actually strengthen their confidence in your resilience as a future resident.

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By combining realistic program targeting, strong clinical performance, and a clear, honest narrative, DO graduates in Chicago with low Step scores can still successfully navigate the residency match and build rewarding careers in Illinois and beyond.