Demystifying COMLEX Level 2: Preparation Essentials

As a senior tutor at Elite Medical Prep and a DO physician, I have helped a lot of DO students with their preparation for the COMLEX Level 2 exam. During our first tutoring session, I often receive a lot of questions regarding the COMLEX Level 2 exam. Now that the COMLEX Level 1 is pass/fail, doing well on the COMLEX Level 2 exam is becoming more important. In this blog post, I plan to answer some of the most commonly asked questions in hopes of demystifying the COMLEX Level 2 exam for those who need some guidance on where to start. 

Understanding the COMLEX Level 2 Exam

What Content High-Yield on the COMLEX Level 2 Exam?

The #1 question I get asked when tutoring for COMLEX level 2 is “what should I focus on for the exam”? If you feel overwhelmed with the amount of material being tested on the exam, you are not alone! First, it is important to understand the breakdown of the exam. There are 8 major Clinical Science Disciplines: Emergency Medicine, Family Medicine, Internal Medicine, Obstetrics/Gynecology, Osteopathic Principles and Practice, Pediatrics, Psychiatry, and Surgery. On the NBOME website, you can find a blueprint that outlines 7 “competency domains” and 10 “clinical presentations” that is designed to test your clinical problem-solving skills. 

Let’s take a closer look. 

OPP

Under “competency domains”, you will see that “Osteopathic Principles, Practice, and Manipulative Treatment” (AKA OPP or OMM) makes up approximately 10% of the exam. Since OPP is highly embedded in the osteopathic medical school curriculum and students typically have longitudinal exposure to OPP concepts, I highly recommend students utilize this to their advantage.

Your number one priority should be to master OPP. If you can ace this section of the exam, you will be at a great starting point. Of note, high-yield concepts to focus on are: viscerosomatics, chapman points, counterstrain points, indirect vs direct techniques, HVLA contraindications, sacral somatic dysfunction, treatments for upper extremity and lower extremity somatic dysfunctions, rib dysfunctions, and lymphatics. Make sure you lock in these easy points!

Ethics and Medical Law

Under “competency domains”, you will see that #4 – #7 make up a large portion of the Level 2 exam. It all falls under the “ethics and medical law” category. Ethics tends to be a topic that students struggle with because there is such a variety of ways it can be asked. Therefore, it is imperative that you expose yourself to all the different clinical scenarios possible with special attention to the phrasing of each question. AMBOSS has great practice questions for ethics. In terms of medical law, the COMLEX Level 2 exam is known for testing students on specific landmark court cases (i.e. Tarasoff v Regents of the University of California) and latin terms (i.e. res ipsa loquitur). There are many resources like Anki decks and Quizlet flashcards that can help you memorize these high-yield facts. 

Musculoskeletal System

In keeping with OPP being one of the high-yield categories on the exam, the MSK system should also be a point of focus. First, start with understanding the anatomy. Then, pay attention to the location of the disease and how it presents. Be familiar with the physical exam findings and recognize which “Special Tests” (i.e. Adson test) can be used to evaluate a disease. Learn to determine which OPP techniques can be used to more conservatively treat musculoskeletal dysfunctions prior to surgical procedures.

USPSTF Guidelines and CDC Vaccine Guidelines

Very high-yield! There will be many questions testing you on these guidelines and should be easy points if you memorize them. The best way to approach this is to utilize a flashcard system like Anki with a spaced-repetition review. 

In terms of targeting the other clinical systems, this warrants a more personalized approach. How much time you spend on other systems depends on your knowledge base. Regardless, the first step is to recognize what you struggle with and create a personalized study plan to target your weaker areas. 

How is the Level 2 exam different from the Level 1 exam?

The biggest difference between the Level 2 exam and the Level 1 exam is that Level 2 focuses more on application of clinical knowledge rather than foundational biomedical science knowledge. This is reflected in the “best next step in management”-type questions. These questions test your understanding of the treatment/management algorithms. However, it is important to note that foundational science knowledge still plays a role in the Level 2 exam. 

Resources

Which question bank should I use for COMLEX Level 2?

You have probably heard that UWorld is the gold-standard question bank for medical board exams. The question bank is extensive, covers high-yield material, and their explanations are unmatched. It even has a flashcard feature which you can use to take notes for convenience during the question review process. I highly recommend utilizing this question bank throughout your clinical year to learn the material well. UWorld also has fantastic images, charts, and treatment algorithm outlines that make the review process more digestible. 

However, in my experience working with students who need to retake the COMLEX Level 2 exam, I find that UWorld may not be the best. The problem is that the question style and wording on the Level 2 exam are very different from the UWorld question bank. Although I would recommend using UWorld throughout the year for clinical rotations and general studying, switch to COMBANK (TrueLearn) or COMQUEST when you get to your dedicated period. If you have a short 4 weeks to prepare for the exam, these question banks would be a better option as they best mirror the vagueness that you will encounter on your actual Level 2 exam. 

What practice assessments/exams should I use for the COMLEX Level 2?

COMSAEs

These practice exams best mirror the topics and content of the Level 2 exam. Aim to complete all of the COMSAEs available for purchase. Previously, COMSAE exams only came with a score report without an answer key. In February 2024, NBOME released updated COMSAE forms with answer keys that can be identified by the letter “b” after the form number. While these come with answer keys, they do not provide detailed answer explanations. It is important to note that your osteopathic medical school may purchase additional COMSAE exams for you although those forms will not come with answer keys.

WelCOMs

This is an assessment series that can be purchased on the CATALYST platform through NBOME. Currently, there are 6 forms available for purchase with 75 questions per form. These questions can be answered at any time with no time limit per question. The great thing about these forms is that they offer rationales and resources for each question. It is a great way to get exposure to the type of questions you may encounter on your real exam. You may also choose to do multiple forms back-to-back to simulate a full “4-hour practice assessment”. 

COMBANK Self-Assessments

This is included in your COMBANK subscription and will provide you with a score percentage along with a predicted 3-digit score range.  TrueLearn continually works to narrow this range with each regular version update.

Others

UWorld self-assessments, NBME exams, AMBOSS Step 2 CK self-assessment, Free 120. If you are only taking the COMLEX Level 2 and not the Step 2 CK exam, these should be completed only if you have enough time.

Should I use Anki for the COMLEX Level 2 exam?

Yes, but you should make your own Anki cards! Anki is a flashcard program that helps with spaced-repetition review. The goal with using Anki is to have frequent exposure to concepts that give you trouble. Without some form of review, what you learned a month ago may not stick. Although there are many Anki decks floating around the internet, none compares to the one that you make. First of all, the premade Anki decks have way too many cards and simply cannot be feasible for many students to keep up. Secondly, making the cards yourself is a form of active learning in itself. It also ensures that you are only taking notes on content that you struggle with. 

For effective flashcard creation, I recommend starting with practice questions and then creating cards based on the ones that challenge you the most. If I found that I knew a concept well and completely understood the question, then I would not make a card on it. However, if I encountered a topic that I needed more practice on, I would make a maximum of 2-3 Anki cards per question. The cards should be succinct and not too wordy. In my COMLEX Level 2 study schedule, I would make sure that I set time aside each day to review my Anki cards. 

Very commonly, students ask me what they can do if they have tried Anki in the past and it absolutely does not work for them. In that case, I would recommend another form of note-taking. If you are a “pen and paper” type of note-taker, then you may consider physical flashcards or having a spiral notebook. The same concept of taking succinct notes applies. 

What additional resources should I use?

I have to emphasize that your #1 priority should be practice questions along with proper review and understanding of the questions. Other resources should be used in conjunction with question banks for further understanding. Below is a list of some more suggested COMLEX level 2 resources. However, I would recommend choosing a few additional resources that work for you and sticking to them. Avoid being overwhelmed with too many resources. Quality over quantity!

White Coat Companion and Step-Up to Medicine Textbooks

The White Coat Companion textbook is created by the creators of the Boards and Beyond video series. The content is succinct, well-organized, and has space for annotation. The Step-Up to Medicine textbook is also well-organized and very comprehensive. These textbooks are great resources for reference when you need to learn a particular topic in more detail.

Savarese OMT review book (“green book”)

This book is my favorite for high-yield OPP concepts. It has everything you need to master the OPP section of the exam. Pay particular attention to the “trigger points” and “memory tools” boxes throughout the book.

First Aid for Psychiatry book

Another one of my favorites. Psychiatry is all about knowing the DSM-5 criteria, medication of choice, and medication side effects. This book is well-organized and contains all the high-yield information you need to know in regards to psychiatry. 

Sketchy

Throwback to Level 1 preparation. Microbiology and pharmacology are high-yield concepts that you will encounter for Level 2 as well. If you find yourself struggling with these concepts, consider incorporating these videos into your study plan. In particular, bugs related to bioterrorism and zoonotics are known to be heavily tested on COMLEX exams. The specific characteristics of bacteria, viruses, and parasites are also fair game for the Level 2 exam.

Other Video Resources

Divine Intervention videos/podcasts, Dr. High Yield on Youtube, Dirty Medicine videos, USMLE Step 2 Secrets podcast, OnlineMedEd, USMLE Guys High-Yield for COMLEX Level 2 videos. Whenever I was driving to my clinical rotations, working out, or doing chores around the house, I would listen to these videos to maximize my learning. Utilize your time well! 

Should I take a prep course for the COMLEX Level 2 exam?

Consider your performance on previous exams including Level 1, clinical COMAT/Shelf exams, and practice COMSAE exams. If you performed below average or right around average, you may benefit from more help. Prep courses often have a strict schedule with tutors that lecture you on content based on systems. Usually, these are provided in group settings. They can be helpful for those who need a strict schedule to keep them accountable. 

However, there are advantages to personalized tutoring sessions that “traditional prep courses” cannot offer. Some of my students have expressed to me that prep courses were unable to provide them with personalized attention. In my COMLEX Level 2 tutoring sessions, I focus on helping students identify their weaknesses and provide concrete solutions on how to tackle them. We create individualized study plans based on each student’s unique timeline. Through in-depth discussions, we determine what resources work best for their learning styles. We address any barriers to learning including test-taking anxiety and diagnosed learning disorders. There is an emphasis on test-taking strategies and learning how to effectively review practice questions. As a tutor, my ultimate goal is to provide students with the tools they need to succeed on their upcoming board exams and beyond. 

Timeline and Study Schedule

When should I start studying for the COMLEX Level 2 exam?

As soon as possible! It is never too early to start developing a study plan for the COMLEX Level 2 exam. With clinical rotations and required COMAT/Shelf exams, it is easy to put off Level 2 studying until the last minute. The reality is that if you took your Pediatrics COMAT/Shelf exam in the beginning of the school year, you probably will not remember the pertinent details by the end of the year. You want to be continuously reviewing throughout the year so that your dedicated study period seems less daunting. 

How can I study for the COMLEX Level 2 exam in 4 weeks?

If you find yourself in a situation where you have 4 weeks to prepare for the Level 2 exam, do not panic! The key is to quickly develop a study plan and stay consistent. Make sure that you are utilizing resources that work for you. Avoid making dramatic changes to your study plan throughout your dedicated study period. Start with taking a practice assessment exam to establish a “baseline”. Identify your knowledge gaps. First focus on doing daily practice questions, then utilize additional resources when reviewing the questions. Elite Medical Prep has sample study plans that can serve as a great starting point. More information can be found in this blog post. 

If you find that your initial practice assessment score is very low or you do not see significant improvement, consider delaying your exam until you are better prepared. Seek out help!

If I am taking both the Step 2 CK and the COMLEX Level 2 exam, when should I schedule them?

Typically, students take the Step 2 CK first and then the COMLEX Level 2 exam one week after. This gives adequate time to further strengthen your OPP knowledge prior to sitting for the COMLEX Level 2 exam. However, each student’s situation is unique. Check out this blog post for more insight.

Final Thoughts

I hope that this blog post was able to answer some of your questions regarding the COMLEX Level 2 exam. I recognize that many students preparing for the exam may have other questions that were not addressed here. Please feel free to check out other blog posts on the Elite Medical Prep website. 

If you would like more information on how to succeed on your exam and explore how our 1-on-1 tutoring services can help you, schedule a free consultation to learn more!