Is COMLEX Harder Than USMLE?

This is a common question that my osteopathic medical students ask me. The answer is not so straightforward because they are different exams. As a DO student, an important decision that you have to make is whether or not you should take the USMLE exams in addition to the required COMLEX exams. In this blog post, let’s explore the similarities and differences between the two exams! 

Is COMLEX Level 1 harder than the USMLE Step 1?

Yes and no. 

COMLEX Level 1 is often considered easier to pass than USMLE Step 1, as DO students can leverage their OPP knowledge to their advantage. However, COMLEX questions tend to be more vague in style, leaving many students uncertain about what the test writers are looking for. Additionally, COMLEX is known for its wildcard questions, making it challenging to anticipate what will be asked. Questions can range from very easy to very difficult to interpret, and answer choices often narrow down to a 50/50 guess.

USMLE Step 1 question stems are well-written and tend to be longer. Those who struggle with reading speed and time management during the exam find this exam to be harder. USMLE has more predictable questions and maturation of UWorld will prepare you well. However, questions can feel very moderately difficult throughout the entire exam because they require attention to detail and significant logical reasoning. Answer choices for USMLE tend to be more complicated and may be more difficult to narrow down to 50/50. 

How does COMLEX structure compare to Step 1?

COMLEX Level 1 is 9 hours long including breaks. You’ll have three scheduled breaks, and a total of 60 minutes of allotted break time to split among them as you choose. This means you can allocate your break time flexibly, such as taking 15 minutes for the first break, 20 minutes for the second, and 25 minutes for the third. There are 352 questions divided into two 4-hour sessions. You will need to self-pace each 4-hour block to ensure that you have enough time to complete all questions. This comes out to approximately 82 seconds per question. See the outline below. 

USMLE Step 1 is 8 hours long including breaks in between each block. There are 280 questions in seven, 1-hour blocks, with 40 questions per block. Once your 1 hour mark is up, your block will end abruptly. This comes out to 90 seconds per question. 

Check out the COMLEX Tutorial and USMLE Tutorial to familiarize yourself with the exam interface.

How does COMLEX Level 1 scoring compare to USMLE Step 1?

Both exams have become pass/fail. There is no concrete evidence of what percentage of questions you need to answer correctly in order to pass. However, as a general guideline, I would recommend aiming to score at least 65-70% consistently on your practice question sets when preparing for both exams.

How does COMLEX Level 1 content compare to USMLE Step 1?

While the majority of content will be similar, it is important to know that the blueprint / content outline of each exam is slightly different. Check out the COMLEX blueprint/content outline here. The USMLE blueprint can be found here and the content outline here. 

COMLEX focuses more on:

• OMM
  • Expect to see videos on physical exam maneuvers or OMM special tests
• Musculoskeletal
  • All MSK pathology, diagnosis, and treatment is important. Of course, expect a lot of crossover with OMM material.
• Microbiology
  • COMLEX is known to test microbiology concepts in obscure ways and will provide very few clues in the clinical vignette. You must know the characteristics of each bug. Bioterrorism is also very high-yield. Sketchy microbiology will be your best friend. 
• Ethics/medical law/public health 
  • These questions tend to be very vague and can be hard to predict. You are also expected to know the landmark court cases and certain latin terms. Utilize high-yield flashcards like Turn Up 2 Law & Ethics Anki deck and other Quizlets. Expose yourself to as many ethics practice questions as possible. I would highly recommend AMBOSS ethics questions in addition to COMBANK questions. 

USMLE focuses more on:

• Pathology
  • Pathoma is a great resource for understanding pathology.
• Biochemistry
  • Pixorize is a great resource for learning biochemistry pathways.
• Immunology
• Embryology
• Genetics

How should I prepare for both COMLEX and USMLE exams?

UWorld is the best question bank to learn material for both exams, however, COMBANK questions will be more similar in style to the COMLEX.

Use COMSAEs to assess your readiness for the COMLEX. Use NBMEs to assess your readiness for the USMLE. NBME exams should also be utilized in your preparation for the COMLEX if you have enough time to fit it into your study schedule. 

Refer to the previous question for more recommendations on resources for targeted systems. 

If I only use the UWorld question bank, will I be prepared for the COMLEX exam in addition to the USMLE exam?

Most likely yes, but not always. If you can do well on the UWorld questions, you’ll likely be well-prepared for the similar concepts tested on the COMLEX exam. However, in my experience, some students struggle with the vague question style of COMLEX which UWorld questions cannot replicate. This boils down to how good of a test taker you are. Most often, students will require experience with a substantial amount of practice questions in COMBANK to become comfortable with the COMLEX question style. 

Check out this excellent blog post to learn more about predicting conversion of COMLEX Level 1 to USMLE Step 1. 

What are the differences between COMSAEs and NBMEs?

COMSAE

• The new forms available for your purchase that are labeled with the letter “b” provide answer keys. However, there are no detailed answer explanations. 
• The forms that your school provides will not give you an answer key. 
• Wide range in scoring. Expect to add or subtract 50 points to your score.

NBME

• Great answer explanations so you can review each question in detail.
• The score is more accurate and predictive than COMSAEs. May often underestimate your actual score.

Should I take COMLEX before USMLE?

Approximately 50% of osteopathic students take COMLEX before USMLE and 50% of students take COMLEX after USMLE. However, it depends on your unique situation and timeline. For example, some students prefer to take the COMLEX approximately 1 week after the USMLE, using that time to solidify their OMM knowledge. 

Final Thoughts

As you can see, the COMLEX and USMLE exams can be very different. Hopefully, this blog post provided some insight into their similarities and differences. If you are interested in learning more about how you can be successful in these exams, our expert COMLEX tutors at Elite Medical Prep are here to help. We can discuss your unique situation and craft an individualized study plan that works for you! Schedule a free consultation to learn more!