USMLE vs COMLEX

[JimmyB123]

I'll be attending a DO school in the fall and I understand that in principle, the school will prepare me for COMLEX. But my question is what are the differences between the exam in that preparing for COMLEX doesn't prepare you for USMLE? Clinically you are learning the same thing. If someone can explain this that would be great! I have to be honest - I don't know much about either exam.


On a side note, do you guys think by 2017 (when I'll take the boards), taking only the COMLEX will satisfy most programs if I'm applying both osteo and allo? Not gunning for anything incredibly competitive.

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[DrEnderW]

The tests cover the same content. The main difference is the format and style of how the questions are asked. If you know the M1-M2 content, you will be prepared for both. Obviously, the inclusion of OMM in COMLEX is different as well.

I think you'd be crazy to not enter medical school with the plan to take the USMLE (aside from some rare exceptions). It's the gold standard and a good USMLE score will always be in your favor. There will be nuances if you don't think you'll get a good USMLE score but that is nothing to worry about now. Personally, I don't see the accreditation merger changing anything.

There's a detailed thread discussing this in this subforum and you'll be able to read about some legitimate reasons why people chose to opt out there.

 

[Goro]

They are two different tests but if you do well on COMLEX, you'll do well on USMLE.

USMLE likes more biochem and molecular genetics content, and is better written. They have a much bigger bank of items as well.
USMLE items tend to be longer, sometime massive paragraphs, through which you have to sift all the data out. But sometimes if you merely look at the last sentence, you can get the answer readily.


Taking COMLEX will satisfy a lot of ACGME RD's. This will become easier with the AOA/ACGME merger as well.

I'll be attending a DO school in the fall and I understand that in principle, the school will prepare me for COMLEX. But my question is what are the differences between the exam in that preparing for COMLEX doesn't prepare you for USMLE? Clinically you are learning the same thing. If someone can explain this that would be great! I have to be honest - I don't know much about either exam.


On a side note, do you guys think by 2017 (when I'll take the boards), taking only the COMLEX will satisfy most programs if I'm applying both osteo and allo? Not gunning for anything incredibly competitive.

 

[Thought Crime Spree]

They are two different tests but if you do well on COMLEX, you'll do well on USMLE.

USMLE likes more biochem and molecular genetics content, and is better written. They have a much bigger bank of items as well.
USMLE items tend to be longer, sometime massive paragraphs, through which you have to sift all the data out. But sometimes if you merely look at the last sentence, you can get the answer readily.


Taking COMLEX will satisfy a lot of ACGME RD's. This will become easier with the AOA/ACGME merger as well.

No.

 

[DocVapor]

No.

Interesting!

 

[Goro]

Why do you say this?

No.

 

[Thought Crime Spree]

Why do you say this?

Because pretty much the only correct piece of information in your post is that the USMLE is a better written test then the COMLEX.

 

[Goro]

I'm only reporting what my students tell me, and what I see from retired USMLE items.

Because pretty much the only correct piece of information in your post is that the USMLE is a better written test then the COMLEX.

 

[MLT2MT2DO]

I'm only reporting what my students tell me, and what I see from retired USMLE items.

I would say if you do well on the USMLE you'll do well on the COMLEX, not necessarily the other way around.

Also the last paragraph is really over reaching.

 

[Goro]

At my school at least, there's a direct correlation between how well my kids do on COMLEX with USMLE. Now, ALL DO students fare worse on USMLE than do MD students, and this is also true for my students. We constantly warn our weakest students to NOT take USMLE...with little success with the unwise ones, to their peril.

On the last para, I'm only reporting what every one of my highly AOA connected colleagues have to say, so I have to take my Deans and my DO dep't
chairs word on this more than yours on this one. I suppose time will tell.

I would say if you do well on the USMLE you'll do well on the COMLEX, not necessarily the other way around.

Also the last paragraph is really over reaching.

 

[reapplicanthelpme2014]

Because pretty much the only correct piece of information in your post is that the USMLE is a better written test then the COMLEX.

Can you elaborate on the main differences then?? How can we be more prepared for the USMLE?

 

[Tri4thlete]

Goro, what do you consider "weaker/weakest" students? I am constantly debating if I want to take the USMLE. The main reason is obvious, to be compared on the same playing field as our MD counterparts. But getting a low score on the USMLE can probably do more harm than good.

 

[MLT2MT2DO]

At my school at least, there's a direct correlation between how well my kids do on COMLEX with USMLE. Now, ALL DO students fare worse on USMLE than do MD students, and this is also true for my students. We constantly warn our weakest students to NOT take USMLE...with little success with the unwise ones, to their peril.

On the last para, I'm only reporting what every one of my highly AOA connected colleagues have to say, so I have to take my Deans and my DO dep't
chairs word on this more than yours on this one. I suppose time will tell.

Not to be cynical but of course AOA colleagues are going to tell you the USMLE rarely matters and soon won't. Ask 4th years that have interviewed ACGME or past students in ACGME spots currently, it very much does matter.

Also there is a direct correlation mostly due to the fact those that take the USMLE study for that test as the "real" (lack of a better term) test, and supplement it with about 24-48hrs of OMM cramming

 

[RadsonRads]

Not to be cynical but of course AOA colleagues are going to tell you the USMLE rarely matters and soon won't. Ask 4th years that have interviewed ACGME or past students in ACGME spots currently, it very much does matter.

Also there is a direct correlation mostly due to the fact those that take the USMLE study for that test as the "real" (lack of a better term) test, and supplement it with about 24-48hrs of OMM cramming

That's because it's all you need.

I only applied to ACGME and they all care zero about the COMLEX, and I'm ok with this.

 

[05silvergt]

Goro, what do you consider "weaker/weakest" students? I am constantly debating if I want to take the USMLE. The main reason is obvious, to be compared on the same playing field as our MD counterparts. But getting a low score on the USMLE can probably do more harm than good.

I'm interested in this as well.

Are you talking about consistent B students or students who are doing slightly better than passing?

 

[MLT2MT2DO]

That's because it's all you need.

I only applied to ACGME and they all care zero about the COMLEX, and I'm ok with this.

Swell, I took the USMLE and nearly all have been thankful for it. Did you go community programs then?

 

[Goro]

I never said that and neither did my colleagues. I said "after the merger", and they refer to that as well. My students also take USMLE very seriously, in fact, more seriously than COMLEX!

Not to be cynical but of course AOA colleagues are going to tell you the USMLE rarely matters and soon won't. Ask 4th years that have interviewed ACGME or past students in ACGME spots currently, it very much does matter.

 

[RadsonRads]

Swell, I took the USMLE and nearly all have been thankful for it. Did you go community programs then?

I interviewed at some community programs, yes

 

[Tri4thlete]

To OP:

1) To be the safest, take both USMLE and COMLEX, nuff said, just grit your teeth and do it.

2) If you don't want to do the work, call every program you are interested in and ask them what they prefer. Don't just look on their website. Talk to someone over the phone or in person. Some may say they accept COMLEX no problem, and some may say that you can do just COMLEX but really really really really prefer USMLE, if you catch my drift.

3) See 1)

 

[MLT2MT2DO]

I never said that and neither did my colleagues. I said "after the merger", and they refer to that as well. My students also take USMLE very seriously, in fact, more seriously than COMLEX!

Not to be cynical but of course AOA colleagues are going to tell you the USMLE rarely matters and soon won't. Ask 4th years that have interviewed ACGME or past students in ACGME spots currently, it very much does matter.

You're right, sorry I put words in your mouth I read "will satisfy most" too fast. It's what reading SDN between patients gets you. Sorry about that.

 

[meliora27]

I was recently at an interview at what is regarded in SDN-speak as an upper, mid-tier ACGME university program. I was the only DO at the interview. Each class (IM) had roughly 40 residents, so out of a housestaff of 120 there were ZERO DO's. One of my interviewers went so far as to thank me twice for taking the USMLE (and doing well on it) as that was what allowed me to interview. Other DO applicants apparently applied with only COMLEX scores and I assume they did not even get an interview.

 

[costales]

The tests cover the same content. The main difference is the format and style of how the questions are asked. If you know the M1-M2 content, you will be prepared for both. Obviously, the inclusion of OMM in COMLEX is different as well.

Which makes some questions downright fun to read, like "A 16-year-old boy develops diarrhea and stomach pain after eating rewarmed leftover vegetable fried rice. Physical examination reveals acute tissue changes at T5-L2 paraspinally. Which is the most likely pathogen?"

 

[meliora27]

Which makes some questions downright fun to read, like "A 16-year-old boy develops diarrhea and stomach pain after eating rewarmed leftover vegetable fried rice. Physical examination reveals acute tissue changes at T5-L2 paraspinally. Which is the most likely pathogen?"

You can't B. cereus with that example

 

[DocVapor]

You can't B. cereus with that example

This wins the internet.

 

[as90]

do not take the usmle if you have not finished uworld and are not consistently scoring well on the nbme exams.

 

[JimmyB123]

Which makes some questions downright fun to read, like "A 16-year-old boy develops diarrhea and stomach pain after eating rewarmed leftover vegetable fried rice. Physical examination reveals acute tissue changes at T5-L2 paraspinally. Which is the most likely pathogen?"

Food poisoning

Jk I don't know what the case is most classic for. I feel dumb

 

[DrEnderW]

Food poisoning

Jk I don't know what the case is most classic for. I feel dumb

Haha it is food poisoning but there's no reason you should know. It's from the toxins of B. cereus bacteria that classically grow in Chinese buffet food. The funny part is the OMM spine diagnosis, which adds absolutely nothing for you diagnostically and no one would really check, but they include it in there for the lolz. Basically a kid comes in there with diarrhea and you palpate his back to double check that the diarrhea could possibly be a true story.

 

[Petypet]

On a side note, do you guys think by 2017 (when I'll take the boards), taking only the COMLEX will satisfy most programs if I'm applying both osteo and allo? Not gunning for anything incredibly competitive.

Never know that until you go through it. Everyone changes their mind. Plan on doing the best you can on both exams to keep all options open.

 

[j4pac]

I looked at the match rate of those who did and didn't take the USMLE for PM&R...the difference is negligible.

I would recommend taking the USMLE Step 1 because at that point most people are pretty ignorant for what their future holds. But if you want to do PM&R...then there is absolutely no need to do USMLE Step 2.

 

[NurWollen]

You can't B. cereus with that example

That was glorious.

 

[discostu42]

doing well on comlex does not at all equate with strong performance on the usmle in my experience, or that of many of my classmates. Friends of mine who studied exclusively comlex related material & resources (OMM/micro/pharm w/COMBANK/COMQUEST) with minimal pathophysiology/biochem (the crux of USMLE step 1 imo) did much better on comlex than me, but significantly worse on USMLE.

 

[Wolverines83]

I'll be attending a DO school in the fall and I understand that in principle, the school will prepare me for COMLEX. But my question is what are the differences between the exam in that preparing for COMLEX doesn't prepare you for USMLE? Clinically you are learning the same thing. If someone can explain this that would be great! I have to be honest - I don't know much about either exam.

On a side note, do you guys think by 2017 (when I'll take the boards), taking only the COMLEX will satisfy most programs if I'm applying both osteo and allo? Not gunning for anything incredibly competitive.

Since there are plenty of programs who prefer (require?) USMLE and there's no way you know what you want to do (trust me, you don't), you should take the USMLE to keep your doors open. The money is a drop in the damn bucket compared to all the other expenses and studying for the exams overlaps greatly (except for biochem and OMM).

Truth is, studying for COMLEX will more or less prepare you for 80% of the USMLE. Phys, pharm, path, biostat, are the same regardless of what book you study from.

HOWEVER, THERE ARE TWO IMPORTANT THINGS TO NOTE:

1) The COMLEX has basically no biochem. The USMLE has plenty. You WILL bomb the USMLE if you don't seriously supplement your biochem knowledge. Fortunately, this is easy as long as you start early enough. People like Rapid Review biochem and the Lange biochem flash cards. Personally, I think USMLE World is plenty to supplement your biochem (in addition to First Aid, obviously). YMMV

2) The questions on the USMLE are VERY different. Who cares what's "better." Point is, they're different so you need to study differently for them. For this it's simple. Get USMLE World and go through it in its entirety with emphasis on items you aren't doing well on. (Personally, this was all the biochem supplementation I needed. I did biochem questions for days on end.) Fortunately, this also prepares you well for the COMLEX, so you don't need another question bank except to practice some OMM questions.

Summary:
1) Take USMLE, would suck to not be able to apply to a program simply because you didn't take their test
2) Study HARD for your first two years, keep first aid by your side and supplement all coursework with that starting the beginning of 2nd year. Don't worry about A's. When in doubt, prioritize board scores over exam scores (sorry faculty!)
3) Memorize first aid
4) Get USMLE world maybe 90 days (120?) before your exam date and go through it 100%, repeating items you don't understand
5) Take NBME exam one month out and another 2 weeks out. Only take USMLE if you're doing well. If not, bail.
6) Take USMLE a couple days before COMLEX. Study OMM during those couple days in between.

 

[meliora27]

.
6) Take USMLE a couple days before COMLEX. Study OMM during those couple days in between.

I'm going to go against the grain here. I can only speak from personal experience but when I took Step 1 I took it 12 days after COMLEX.

I knew that I was only applying to ACGME programs so the USMLE was my sole focus. I knew that I could pass COMLEX so just wanted to get it out of the way. I then used those 12 days to really go over genetics, biochem, and physiology at a deeper level. I also went through the first 3 chapters of pathoma again during this time where it goes over a lot of the fundamental principles. I truly think that this made the difference and was a large part of why I scored well.

 

[Wolverines83]

Yeah I think that's reasonable too. That's probably the most debatable part of all the "conventional wisdom" again, everything comes with the YMMV disclaimer!

 

[racerwad]

I'm going to go against the grain here. I can only speak from personal experience but when I took Step 1 I took it 12 days after COMLEX.

I knew that I was only applying to ACGME programs so the USMLE was my sole focus. I knew that I could pass COMLEX so just wanted to get it out of the way. I then used those 12 days to really go over genetics, biochem, and physiology at a deeper level. I also went through the first 3 chapters of pathoma again during this time where it goes over a lot of the fundamental principles. I truly think that this made the difference and was a large part of why I scored well.

I 100% agree. I used the COMLEX as another assessment exam and used the interval between the two to beef up weak spots or reinforce material I knew. I did this for both steps. I interviewed only ACGME and the only program that commented on my COMLEX scores (they were lower) basically said, "yeah, we know they aren't much of an exam". The PD also acknowledged that he couldn't really tell a good score from a bad one and was glad I took USMLE to put myself on the same page as his allopathic applicants.

Any osteopathic medical student who doesn't take USMLE runs the risk of essentially wasting their tuition dollars.

 

[JimmyB123]

I haven't replied on this thread but have been just observing the traffic. Learning a good bit.

Lets say I apply to an AOA residency, but in addition to my COMLEX score I also have a USMLE score. Can the USMLE score have any weight on my application to this program?

 

[Wolverines83]

Supposedly no but I was asked for my USMLE scores at an AOA program. So....who knows? My guess is that was an anomaly and 99% of programs won't care.

 

[JGimpel]

As someone that has gone through all of these hoops with a lot of assistance from upperclassmen and attendings, I'll put my actual experiences down. Your mileage and heartache may vary:

It's an MD world now and the COMLEX is going down, probably in the next 5 years (praying for it!). For that and many other reasons, you need to take USMLE Step 1. By the way, the AOA accredits most residencies like COCA accredits most medical schools, pay your fee and give them syllabi that will never actually be followed and you get accredited when your check clears.
*The commonly accepted dynamic duo of doing well on the USMLE Step 1 and passing the COMLEX 1 are what I've seen work in both the competitive and non-competitive programs as the way to go. Doing well on the COMLEX too is always great, but gets you mixed results. You're in luck since most people perform better on the USMLE than the COMLEX since it's a much higher quality test that really does show that you know the medicine.
*It's now public knowledge for MD and DO staff that the COMLEX (at any level) is a horrible test and shouldn't be the main reason to pick one student over another for this whereas the USMLE is reliable for that.
*MOST DO residencies that MOST DO students would actually be interested in going to haven't increased in size for a long time, so you'll be applying for 1 out of 6 spots that 1000+ other DO students are applying for. While not as desireable as the top MD programs that the SDN family says they want (Derm with MOHS at Hopkins), they are often more competitive than them for that reason. You will be applying to MD residencies just like most other DO students do, so put yourself in the best position to be competitive.

Next is what happens for the rest of your time in med school/GME:
1. You should schedule your COMLEX 2CE and PE as soon as possible (when you're ready, off course) to get ranked in many DO programs, but after you're accepted and start your 1st day of residency, these don't matter anymore.
2. You appply for your educational medical and controlled substance license with your fingerprinting done. Your program will have your transcripts from when you applied so they'll vouch for you on your state license apps. Nobody cares about your scores or which test you took anymore. Any med students that ask you about when you become a Resident are sent to the med library to review the journal of gerontologic colorectal surgery for that day. Never ever ask, trust me!
3. You'll take your COMLEX 3 sometime in your first year and nobody cares what this score is on this or any other COMLEX you've taken, as long as you've passed them.
4. You eventually apply for your permanent Medical, Controlled Substance and DEA license. The clerks just see that you have a passing score for all 3 levels, then check that box. That's all.
5. Fellowships may request your inservice and/or COMLEX scores, but as long as you do well in rotations with them, stay in touch and your portfolio is what they're looking for, they probably won't even ask about them.

This seems to be the general way things went for myself and many residents commiserating about this with me.

Gimp

 

[meliora27]

The COMLEX is an embarrassment. I really hope is falls by the wayside sooner than later. You would think that the public after all would be more comfortable knowing that every physician practicing in America as taken and passed the same set of basic exams.

 

[ewax]

They are two different tests but if you do well on COMLEX, you'll do well on USMLE.

USMLE likes more biochem and molecular genetics content, and is better written. They have a much bigger bank of items as well.
USMLE items tend to be longer, sometime massive paragraphs, through which you have to sift all the data out. But sometimes if you merely look at the last sentence, you can get the answer readily.


Taking COMLEX will satisfy a lot of ACGME RD's. This will become easier with the AOA/ACGME merger as well.

I respect you for being a school admin, but you have no idea what you're talking about here.

 

[Goro]

I've seen versions of both exams, the actual items, and am just telling you what my own students and grads tell me.

I respect you for being a school admin, but you have no idea what you're talking about here.

 

[Buckeye1992]

In Bradenton, our Dean will strongly recommend not taking the USMLE if you have a history of barely passing major courses (PBL) and doing poorly on our diagnostic exams. So pretty much the bottom 10 ish percent. Then again we historically test very well so maybe it would be higher at other schools? Not really sure?
Anyway, anyone have advice for when to take the two exams? I have heard study for USMLE then take the comlex a week later after studying for OMM. Thoughts?

 

[racerwad]

In Bradenton, our Dean will strongly recommend not taking the USMLE if you have a history of barely passing major courses (PBL) and doing poorly on our diagnostic exams. So pretty much the bottom 10 ish percent. Then again we historically test very well so maybe it would be higher at other schools? Not really sure?
Anyway, anyone have advice for when to take the two exams? I have heard study for USMLE then take the comlex a week later after studying for OMM. Thoughts?

That was discussed just a few posts above. I took COMLEX first and used it as another assessment prior to USMLE. Someone else did the same and we both found that to be a fairly successful strategy.

 

[koan]

I did the other way around (usmle first, 3 days of Savarese -- a week is excessive -- then comlex) and felt this was best. Same for step 2.

 

[Dr. Zombie]

I did the other way around (usmle first, 3 days of Savarese -- a week is excessive -- then comlex) and felt this was best. Same for step 2.

No COMBANK to get used to COMLEX style of questions?

 

[koan]

No COMBANK to get used to COMLEX style of questions?

Sorry, yes, I did all the OMM questions in COMBANK during those three days as well as the questions in Savarese. I don't think the style requires much adjustment -- although it is different -- except for questions that are directly about OMM.

 

[JGimpel]

From my experience through all 3 levels of this trash, the COMLEX has increased the length of many questions but kept the answer choice count as low as before, so I see no reason why the UW questions couldn't be used for the COMLEX. For OMM, buy Comquest for a month or 3 and do the OMM questions over and over again and make sure you can describe in detail everything that's going on.

 

[meliora27]

From my experience through all 3 levels of this trash, the COMLEX has increased the length of many questions but kept the answer choice count as low as before, so I see no reason why the UW questions couldn't be used for the COMLEX. For OMM, buy Comquest for a month or 3 and do the OMM questions over and over again and make sure you can describe in detail everything that's going on.

For Level 3, did you find you had to spend a lot of time recalling the OMM stuff. I'm going into an ACGME residency and haven't seen/done any OMM since my second year of med school with the exception of COMLEX Level 2 and the PE exam. I really don't think I'll remember anything at all sans the ability to memorize some viscerosomatics

 

[JGimpel]

Yeah, do you want to do something written as crappy as the COMLEX for "realism?" Why not do UW, the best resource for either test and supplement OMM as I stated above.

 

[el mero mero]

i did the percentile on both exams, and I did well. yes they're different, but besides OMM, it's still medicine. I do agree that the USMLE is written more clearly.