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Back to Basics: What’s the Difference Between COMLEX and USMLE?

COMLEX Level 1 will be pass/fail effective May 1, 2022

Breaking news: The NBOME(TM) will change from reporting three-digit numeric scores to reporting only “Pass” or “Fail” for COMLEX-USA Level 1 examinations administered effective May 1, 2022, aligning with the start of the 2022-2023 testing cycle. This decision was made after several years of analysis and considering input from across the education, training, and licensure continuum. 

As you may know, there are two types of licensed physicians – MDs and DOs – Doctors of Medicine and Doctors of Osteopathic Medicine, respectively. Both receive rigorous training in medicine and are nearly identical with slight variances in philosophy and training such as the addition of osteopathic manipulative medicine (OMM) to the DO curriculum.

MDs are accredited by the National Board of Medical Examiners (NBME) and take the United States Medical Licensing Exam (USMLE) series of licensing exams while DOs are accredited by the National Board of Osteopathic Medical Examiners (NBOME) and take the Comprehensive Osteopathic Medical Licensing Exam (COMLEX) series of licensing exams. DO students must take the COMLEX but also have the option to take the NBME licensing exams if they choose to do so before applying to residency.

Learn More –> How to Prepare for the USMLE and COMLEX During a Pandemic

This begs the age-old question: what is the difference between these exams, and should Osteopathic students take both exams? Considering the recent merger between the American Osteopathic Association (AOA) and American Council for Graduate Medical Education (ACGME) to form one accrediting body for residencies, it is time to revisit the topic.

How Are COMLEX and USMLE Similar and Different?

The COMLEX and USMLE are mostly similar exams in that they primarily test students on the fundamentals of medicine using the same material. The main difference is that the COMLEX also tests on osteopathic manipulative medicine by integrating it into questions. Additionally, the COMLEX:

  • Is a longer test consisting of 400 questions divided into 8 blocks while the USMLE is 280 questions divided into 7 blocks.
  • Is much stricter on break times allowing you only 10 minutes of break time after completing blocks 1 and 2, a 40-minute lunch break, and a 10-minute break after completing blocks 5 and 6.
  • You must complete 2 blocks at a time whereas on the USMLE you are allowed to take a break after each block if you would like. The USMLE allows 45 minutes of break time built in with rollover time if you finish a block faster than the given time.
  • Gives you less time per question as you are allowed an hour for each 50-question block whereas on the USMLE you are allowed an hour for each 40-question block.
  • Tends to focus more on questions regarding primary care pathology rather than evenly distributing their questions between all subjects as the USMLE does.
  • Has a different question style where it tends to ask more vague questions and asks students to pick the “most correct” answer. You must know what the question writer is trying to get at.

Should I Take Both the COMLEX and USMLE?

Traditionally under a split residency accrediting system, Osteopathic students have had the option to take the USMLE exams depending on their goals and desired specialty. Students aiming for more competitive specialties generally took both exams while those aiming for primary care specialties only took the COMLEX. With the recent merger, this question becomes more nuanced and generally the answer still depends on a variety of factors including:

  • Cost – Board examinations and preparation materials are expensive. Some students may also need to travel for exams increasing the cost even more.
  • Stress – Both the COMLEX and USMLE are challenging and long exams with major implications for one’s future career. Taking one exam is stressful enough but adding another one only increases the stress.
  • Confidence in Scores – Applications that report high COMLEX scores, but lower USMLE scores might be looked upon negatively. You should be confident you can score well on the USMLE before taking it.
  • Desired Specialty – Programs that traditionally only accept the USMLE are now also accepting the COMLEX, but some will still heavily weight a USMLE score over a COMLEX score. The more competitive the specialty you want to apply to, the more reason to consider taking the USMLE.
  • Fellowships – It might be early to start thinking about it, but some fellowships still only accept USMLE scores. You do not want to have to go back and take the USMLE licensing exams as you are finishing residency.

Merging ACGME and AOA Programs

The 2020 Residency match was the first done under a single accreditation system. Almost all of the previously accredited AOA programs have now received ACGME accreditation outside of some neurosurgery programs.

Previously the door had been open for DO students to apply to both AOA and ACGME programs whereas MD students could only apply to ACGME programs. Now, all doors are open and both MD students and DO students can apply to all accredited programs. While all programs accept USMLE scores from applicants, there are still some programs which will not accept COMLEX scores at all.

Overall, there are also many more allopathic (MD) students which means there will be more students applying using USMLE scores rather than COMLEX scores. Thus, it makes sense that osteopathic students also take the USMLE so that residency programs can evenly and accurately compare applicants using one standardized exam.

At the end of the day, the decision depends on you and what you want to do in the future. The sooner you determine whether you are taking both exams or just the COMLEX the better as you can plan and study accordingly.

Tips If You’ve Decided to Take Both the COMLEX and USMLE

If you are an Osteopathic Student that has decided to take both exams here are somethings to take into consideration

Exam timing

When you take these exams matters and how far you space them apart depends on you. Generally, they should not be taken far apart as they are very similar exams and most osteopathic students take them within a week of each other.

  • If you experience test fatigue it might be beneficial to take them about a week apart.
  • If you do not have a strong foundation in osteopathic medicine, it might beneficial to schedule them approximately a week apart to study as much OMM as possible.
  • If you have a strong foundation in OMM and do not experience much test fatigue, you can take them much closer together. Some students even take them on back-to-back days.

Studying Materials

The materials to study for both exams are very similar. Generally, the main resources students use are UWorld, USMLE First Aid, Pathoma, and Sketchy, although there are a multitude of other fantastic resources such as Anki and Boards and Beyond among others. When it comes to OMM materials the golden resource is “The Green Book,” although osteopathic schools with comprehensive curricular materials also are a great resource.

Osteopathic students typically use the same question banks that their allopathic counterparts do – UWorld, USMLE Rx, Kaplan, AMBOSS, etc. but also should incorporate a question bank with OMM questions such as COMBANK or COMQUEST. These question banks can be done in conjunction with other studying or can be done within the time between exams depending on your level of comfort.

  • Try and select a few resources that cover all the material and get through all of them. Do not try and get through every single resource as you likely will not get much out of them – this is a common mistake many students make when studying.
  • Start your studying for boards based on how strong your foundational knowledge is from your curriculum as well as with how much studying you can realistically handle. Some students start at the beginning of M2 whereas others only use the 6 weeks of dedicated board studying to prepare.
  • Use active learning techniques such as flashcards or testing yourself to learn rather than passive learning techniques such as simply reading.
  • The more questions you can do, the better! Try and learn as much as you can from doing questions and make sure not to ignore OMM specific question banks.
  • OMM questions on the COMLEX are generally very easy compared to other questions and are free points if you have studied for it. Do not miss out on these free points!

Learn how our COMLEX tutoring course works. We have both Level 1 and Level 2 support.

Need Help Studying for the Boards?

The COMLEX and USMLE are challenging exams that medical students must take to graduate to medical residency programs in their path to becoming licensed physicians. While both exams are fairly similar, they still have their differences which must be accounted for while preparing. Given the recent merger, the decision to take both exams for osteopathic students is dependent on the student’s circumstances, desired specialty, and future goals.

Need help studying for these board exams and want a highly qualified tutor? MedSchoolCoach has got you covered!

NBOME and the National Board of Osteopathic Medical Examiners are registered service marks of the National Board of Osteopathic Medical Examiners, Inc. (NBOME). The NBOME seal, the examination names COMAT, COMLEX, COMLEX-USA, COMSAE, COMVEX and CATALYST, and all other designated marks and styles are trademarks or service marks of the NBOME

Sahil Mehta

Sahil Mehta M.D. is an attending physician in the Department of Radiology at Beth Israel Deaconess Medical Center and the Founder of MedSchoolCoach. Dr Mehta is one of the world’s experts on medical school admissions having founded MedSchoolCoach in 2007. MedSchoolCoach provides admissions consulting to premedical students in the form of interview preparation, essay editing and general advising. In the past 10 years, he has had a hand in over a thousand acceptances to medical school.

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