The Program Director Associations Guide for Residency Applicants is a collaborative effort between the Organization of Program Directors Association (OPDA), the Association of American Medical Colleges, and the American Medical Association. Its purpose is to provide specialty-specific guidance, application information, and resources.
For 2026-2027, the Guide specifies that USMLE scores are not required for DO applicants to General Surgery programs. In addition, the Association of Program Directors in Surgery (APDS) said, “Supported by the evidence, APDS strongly supports treating COMLEX-USA as equivalent to USMLE for DOs in General Surgery.”
Recent guidance and advocacy efforts in Orthopedic Surgery, Thoracic Surgery, and Urology have similarly emphasized consideration of COMLEX-USA without requiring DO applicants to complete an additional licensing examination. This trend reflects increasing recognition of COMLEX-USA as the licensure examination for osteopathic medical students and more expanded confidence in its use across the specialties by residency program directors (PDs) as part of holistic review of residency applicants.
“The guidance issued by OPDA highlights the unique contributions that DOs bring to the field of surgery,” said John R. Gimpel, DO, MEd, president and CEO of the NBOME. “As more DOs continue to enter surgical fields, we are hopeful that this guidance, combined with the research, provides further evidence to program directors for equivalent use of COMLEX-USA results and fair and inclusive holistic review practices by PDs of DO residency applicants.”
The OPDA Guide update highlights a broader trend across surgical training and marks the latest in a series of public confirmations of the acceptance of COMLEX-USA from residency program director associations and other specialty groups.
As part of its strategy to provide evidence for the use of COMLEX-USA for DO applicants, the NBOME published research in the Journal of Surgical Education in August 2025, which found positive correlations between performance on COMLEX-USA and the American Board of Surgery (ABS) In-Training Examination and the ABS Qualifying Examination for board certification.
This study remains the largest investigation of the relationship between performance on a licensing examination and outcomes in surgical training and certification and adds to the important evidence supporting the use of COMLEX-USA as part of holistic review of residency applicants.
According to the National Residency Matching Program, surgery consistently ranks among leading specialties in which DO graduates match. Over the past decade, osteopathic representation across surgical specialties has grown substantially, reflecting both increasing interest among DO graduates and expanded opportunities within surgical training programs. Surgery is among the top five non-primary care specialties in which DOs practice, according to the American Osteopathic Association.
“General Surgery benefits from diverse experiences and perspectives including those brought by osteopathic physicians,” said Kari M. Rosenkranz, MD, Chair of Association of Program Directors in Surgery and Jennifer Serfin, MD, of the Association of Program Directors in Surgery Application Cycle Committee.
“Our updated guidance reflects the Association of Program Directors in Surgery’s support for evaluating osteopathic applicants using COMLEX-USA in lieu of USMLE scores as evidence confirms their equivalency in predicting later success. This recommendation enforces the APDS commitment to a fair, holistic review process allowing programs to identify the candidates well positioned for success as defined by the unique goals and values of each program.”