COMLEX vs USMLE: The Big Differences (Not a "Should I take it?" thread)

[Planes2Doc]

I'm supposed to take COMLEX Level I this summer, and was debating as to whether or not to take USMLE. Based on what I've been looking at, I will probably not end up taking the USMLE. There are plenty of threads about whether you should take it or not, and this isn't what it's about.

Instead, I was wondering about the differences between the two exams. Alright, so I've heard the USMLE is a better-written test. But I heard that it is more difficult content-wise. For instance, I just managed to finish the Biochem section in First Aid, and it was like banging my head against a brick wall. The Biochem class I took at my school was actually fairly simple, so a lot of things in FA are topics I have never seen before! I've heard from fellow classmates that there is less of an emphasis on Biochem on the COMLEX versus the USMLE. I was wondering as to what extent, and also about other topics as all. What's easier? What's harder? What is heavily emphasized? What isn't? I'd love to hear from those who took the tests. I've searched and searched, and couldn't find any threads pertaining to this. Thanks for the help!

---

Members don't see this ad.

 

[Thought Crime Spree]

The COMLEX for me was 1/3 straightforward 1st order questions, 1/3 moderate 2nd order questions and 1/3 out of left field obscure questions that probably everyone guesses on. Many questions were confounded by poor sentence structure and grammatical errors which confused what was actually being asked. There was OMM and the biochem questions were much simpler.

USMLE is almost 100% moderate 2nd and 3rd order questions with a few easy and obscure questions. The questions require more critical thinking, there were more sophisticated biochem questions and more bioethics questions.

 

[meliora27]

Biochem is notoriously weak at many DO schools and as such, many DO students feel unprepared to tackle the biochem tested on Step 1 of the USMLE. Furthermore, this weak biochem foundation coupled with the prevailing thought that biochem is emphasized on the USMLE scares many DO students into not taking the USMLE.

Here's what I can tell you. The M in USMLE stands for MEDICAL. This is not some master's level biochem exam. There are only so many questions allotted to biochem, so the test writers are going to want to get the most bang for their buck. Focus on the big hitters with clinical relevance. Enzymes deficiencies, inborn errors of metabolism, CAH, know the rate limiting enzymes, what would back up if you have a deficiency, how do certain meds/toxins interfere with basic cellular processes.

I thought First Aid/DIT/Goljan did a great job in preparing me for thr biochem. Granted, it was probably what I feared the most, so I really studied a lot for it, but in reality, thr biochem on my Step 1 really wasn't that bad.

If there is a really complicated question, remember, that the test writers only have so many questions to test your knowledge, so breathe, step back a second, and try to ask yourself what big topic is this convoluted question stem really trying ask?

 

[Goro]

Nationwide DO students do less well on USMLE than on COMLEX. However, IF you are doing well in your classes, AND you do well on whatever diagnostics you have for COMLEX, you'll probably do OK on USMLE.

It's hard to advise my students for USMLE, because we don't get USMLE results, only data voluntarily reported to us from the students who took it.

But a rough rule of thumb I use is that if you're doing poorly in your coursework (say, < 80% in all courses), stick with COMLEX only.

My students generally have the attitude that COMLEX is a mere hurdle to get over with before taking USMLE. Those who have taken COMLEX are rather contemptuous of it. Good luck, though, Planes!

 

[FrkyBgStok]

Another difference is that the USMLE seems to be a more balanced test. My COMLEX seemed to have like 15 questions on wrist dysfunctions, but not a single question on embryology. It was like this in other sections. It almost feels like the USMLE tests one question on every topic in the first two years, where COMLEX focuses heavily on 5 or 6 subjects and completely ignores huge numbers of topics.

 

[cliquesh]

I thought the usmle step 1 was more straightforward and well written than the Comlex level 1. I thought Comlex level 2 was much better. I did have a lot more statistic questions on the usmle. I had more micro and biochem questions on the Comlex. The biochem questions were straightword (storage disease type questions, which I've only seen once as a resident so far). I also had a lot of ethics, legal, and OMM questions on the Comlex. I remember leaving the testing center and thinking to myself that the Comlex 1 didn't really test my medical knowledge; it just seemed like a random test. I still score >600, so whatever.

I'd recommend reading first aid a few times and then doing as many questions as you can.

 

[smile33]

I had a question about doing as many questions as you can. Should someone planning to only take the COMLEX 1, still do a lot of Uworld questions or should they plan to spend more time doing COMBANK/COMQUEST. I hear you should still do Uworld to learn better, but I am concerned that they way UWorld asks you questions will take away from question style preparation for the Comlex. Some say Comlex is "straightforward," sometimes I feel like overthinking a question and having too much other information will take away from the best simpler answer the question is getting at...

 

[racerwad]

I had a question about doing as many questions as you can. Should someone planning to only take the COMLEX 1, still do a lot of Uworld questions or should they plan to spend more time doing COMBANK/COMQUEST. I hear you should still do Uworld to learn better, but I am concerned that they way UWorld asks you questions will take away from question style preparation for the Comlex. Some say Comlex is "straightforward," sometimes I feel like overthinking a question and having too much other information will take away from the best simpler answer the question is getting at...

I don't think anyone would classify the COMLEX as "straightforward"; it the most consistently ambiguous exam I've ever taken. That said, if you want to know the material comprehensively, I'd use uworld. Both combank and comquest's explanations were less thorough than uworld. I used the COMLEX oriented qbanks to familiarize myself with the question-style and omm.

 

[BigSib]

Reposting my response on another thread:

1. The USMLE may have A-J options; the COMLEX will only have A-E. The USMLE likes to eliminate all guesswork involved by providing opposites of all distractors and correct answers.
2. Question stems may include osteopathic structural examination findings, most commonly viscerosomatic/Chapman's relationships, which may seemingly be the only indication for an answer choice.
3. The USMLE has more basic laboratory techniques (gel electrophoresis, genetic interpretation) and hard basic sciences like biochemistry pathways than the COMLEX.
4. The COMLEX tends to use pathognomonic, 'classic', findings presented in such a way that you have difficulty recognizing that it's right in front of you. This is a bad example, but they will not say "positive Babinski sign" but rather "extension of the great toe upon plantar stimulation."
5. The COMLEX wants to know 'what is the most likely' while the USMLE often asks for associations in attempt to make them third order.
6. The COMLEX generally has shorter question stems and has about 50% multiple-part (one stem with two questions) question types with some matching. There is more randomness to the COMLEX with sometimes questions being a single sentence and other times taking up half the page. The USMLE mostly has single questions with longer stems; sometimes it may be better to read the question and gloss over the answer choices before delving into the question stem.
7. As for images there is more histology on the USMLE (see #3).
8. The USMLE will provide more theoretical situations (e.g., a researcher wants to know XYZ) than the COMLEX, which seemingly has none. The COMLEX is more about patient presentations.

 

[j4pac]

Take USMLE if:
- You are applying to MD residencies other than PM&R (you don't need USMLE for the mass majority of PM&R programs)
and
- You are going ok in school. If you are struggling to pass in medical school...you are at risk of failing the COMLEX and need to focus on only COMLEX.

 

[0ncogene]

Take USMLE only if you can hit atleast average for the specialty you are interested in. There is no point in scoring below average for that specialty.

A good COMLEX score without USMLE score > good COMLEX score with bad USMLE score

 

[Planes2Doc]

Reposting my response on another thread:

1. The USMLE may have A-J options; the COMLEX will only have A-E. The USMLE likes to eliminate all guesswork involved by providing opposites of all distractors and correct answers.
2. Question stems may include osteopathic structural examination findings, most commonly viscerosomatic/Chapman's relationships, which may seemingly be the only indication for an answer choice.
3. The USMLE has more basic laboratory techniques (gel electrophoresis, genetic interpretation) and hard basic sciences like biochemistry pathways than the COMLEX.
4. The COMLEX tends to use pathognomonic, 'classic', findings presented in such a way that you have difficulty recognizing that it's right in front of you. This is a bad example, but they will not say "positive Babinski sign" but rather "extension of the great toe upon plantar stimulation."
5. The COMLEX wants to know 'what is the most likely' while the USMLE often asks for associations in attempt to make them third order.
6. The COMLEX generally has shorter question stems and has about 50% multiple-part (one stem with two questions) question types with some matching. There is more randomness to the COMLEX with sometimes questions being a single sentence and other times taking up half the page. The USMLE mostly has single questions with longer stems; sometimes it may be better to read the question and gloss over the answer choices before delving into the question stem.
7. As for images there is more histology on the USMLE (see #3).
8. The USMLE will provide more theoretical situations (e.g., a researcher wants to know XYZ) than the COMLEX, which seemingly has none. The COMLEX is more about patient presentations.

Thanks! Can you possibly give an example of #1 if possible?

 

[Petypet]

As a 2nd, going on 3rd year, you will shut a lot of doors by not taking the USMLE. You don't know what specialities you will enjoy and why shut yourself out of all potential options. That said, DO schools do not teach toward the USMLE and thus it will take some preparation and most DO students do average or below because they aren't prepared. Prep for the USMLE, take some practice tests and if you are doing average or better go for it.

 

[cliquesh]

I had a question about doing as many questions as you can. Should someone planning to only take the COMLEX 1, still do a lot of Uworld questions or should they plan to spend more time doing COMBANK/COMQUEST. I hear you should still do Uworld to learn better, but I am concerned that they way UWorld asks you questions will take away from question style preparation for the Comlex. Some say Comlex is "straightforward," sometimes I feel like overthinking a question and having too much other information will take away from the best simpler answer the question is getting at...

I would do uworld first to learn the material. The explanations in uworld are great, and you'll learn a lot just from reading the answers. After you're done with uworld you should do combank and comquest because, like you said, the question formats are different. I'd probably try to do combank/comquest twice if that's the only test you're going to take. It sounds like a lot, but once you get use to doing questions, you should end up being able to do several hundred each day. I did 250 questions so far today and I'm not really even studying for anything.