How to Prepare for the USMLE and COMLEX Exams Simultaneously

One of the most common questions for osteopathic medical students planning to take the USMLE (United States Medical Licensing Examination) is how to best allocate their time between studying for the USMLE and COMLEX (Comprehensive Osteopathic Medical Licensing Examination).

Although there is a considerable amount of content overlap between the two examinations (fortunately!), the COMLEX competency “Osteopathic Principles, Practice, and Manipulative Treatment” has substantially different content and, according to the COMLEX Level 1 blueprint, comprises a minimum of 11% of the exam’s content. That’s a high enough percentage that you can’t just study for the USMLE.

In this article, I will give you my best advice for studying the overlapping content of the USMLE and COMLEX and preparing for the remaining content that is distinct.

Choosing Your Study Methods

Most medical students own a copy of the review book, First Aid for the USMLE. While thumbing through its pages one day, I noticed a section near the beginning titled “Learning Strategies,” which details the most productive methods for studying board content. The authors divided the sections into high-, medium-, and low-efficacy study methods based on research about learning and test-taking.

It was no surprise that the most effective study methods included question banks (such as UWorld) and practice tests. The “practice like you play” adage holds true, right? The other high-efficacy learning strategy was distributed practice, with spaced repetition flashcards being an excellent example. In a nutshell, these three — First Aid, UWorld, flashcards — represent the best tools to simultaneously prepare for both USMLE Step 1 and COMLEX Level 1.

First Aid was not the only place I received the advice to prioritize practice questions. My school’s medical education department gave a board preparation presentation to my class with a similar message. The presenter told us that many metrics had been studied that might predict performance on the USMLE and the COMLEX: MCAT score, undergraduate GPA, class rank, etc. One of the strongest, if not the strongest, predictors for performance on the medical boards was the number of practice questions completed.

While the thought of practicing for two high-stakes standardized exams at the same time may feel daunting, don’t forget the content overlap! The reality is that once you’ve honed your resources and gotten into the groove of a good study strategy, it’s actually not as intimidating a feat as you might think.

Avoiding Resource Overload

One of the most challenging decisions to make during medical school is how to allocate your time among the endless resources at your disposal. Fortunately, using the information above, it’s easy to see that practice tests and question banks (QBanks) are the most effective and fruitful use of your time in studying for both the USMLE and COMLEX. So, the next question is: which QBanks are the highest yield for both exams?

ForUSMLE Step 1, it is well known among medical students that UWorld is the gold standard. If word of mouth isn’t enough, however, First Aid comes in handy yet again. In a section near the back of the book, the authors give ratings to various resources grouped by topic. Not surprisingly, the QBanks with the highest ratings include UWorld and the NBME practice tests. Given the considerable content overlap between the USMLE and COMLEX, it is fair to say that these QBanks are also highly effective for the COMLEX Level 1.

Then what about that remaining content — the “Osteopathic Principles, Practice, and Manipulative Treatment” — covered on COMLEX Level 1 but not USMLE Step 1?  Traditionally, students have used COMBANK and COMQUEST, which both do a good job of mimicking the question style of the COMLEX. However, UWorld recently launched a COMLEX Level 1 product, bringing their signature challenging questions and detailed explanations to the COMLEX-prep table. If I had to go back and do COMLEX Level 1 all over again, I know I’d try out UWorld’s product; I can only imagine that they’ll soon be setting the gold standard for COMLEX as well.

Timing of the Tests

A final question students often bring up is how to schedule the USMLE and COMLEX in relation to one another. While there is no definitive way to do this, I recommend taking the USMLE first, followed by the COMLEX 3-4 days after. This will give you a few days to study and refresh your memory on COMLEX-specific questions while keeping you from forgetting the majority of overlapping material you just saw on the USMLE.

Final Pieces of Advice

I always tell the students I tutor that success on board exams is based roughly on 70% content knowledge, 15% test-taking strategies, and 15% endurance. While studying content is obviously most important, your test-day approach to the questions you don’t know makes a difference, too. You will inevitably come across questions that either (1) you never got around to studying or (2) are experimental or designed to distract you. These questions try to take your time away from more straightforward questions in the block. My advice is to flag these questions and come back to them later. This helps prevent you from getting so flustered that you trip over the questions you’d otherwise feel more confident about.

There’s also the endurance factor. Both examinations are grueling in length, so it’s best to build your stamina ahead of time. The best way to do this is to progressively develop your focus and concentration by doing increasingly longer sets of consecutive questions (mixed and timed). Above all else, try to maintain a positive attitude and use these techniques to decrease your test anxiety going into the examinations; this will help you keep your composure and approach the questions in the most logical way possible on test day.

Best of luck studying for your USMLE Step 1 and COMLEX Level 1!

[Originally guest published on the UWorld Blog]