I'm a DO student who is applying right now. I was STRONGLY encouraged to take USMLE if applying to ACGME by several program directors. Some programs won't look at your application at all without USMLE scores, and some admit they don't care what your score is on it, they just want to make sure you can pass it, then they focus on your COMLEX scores. It is kind of absurd really, but it is what it is. My biggest piece of advice is that if you do the AOA route you MUST do auditions. The majority of the programs do not say this on their website, but in reality REQUIRE an audition rotation to even be considered, were that is definitely not true on the ACGME side. It is not a rare event for AOA applicants who scored well above the national average on COMLEX I and II to only get 2-3 interviews after applying to all the AOA programs because they didn't do auditions...again, it is absurd, but it is all the game we have to play. Let me know if you have any other questions.