I just took the USMLE today June 11 and the COMLEX on the 8th,9th.
Some thoughts:
COMLEX:
Very grueling, endurance test; often you just want to quit and turn it in. Lots and lots of pictures. Need the pictures to answer the questions usually. The micro was exceptionally difficult. A lot of fungus questions and rare stuff. Pictures of fungi too. MRIs, tons of chest x-rays, pictures of micro; giardia, ova, worms, gram stains, etc etc. Even an MRI of some torn up knee ligaments. Not sure how you can study for this, other than do a radiology rotation.
The exam overall, had a very clinical slant to it. Very few straight recall questions. There were no "buzzwords", no "malar rash". They describe it. They don't say "clue cells" they just say cells with bacteria attached to them. However, they did use "school of fish" for Chancroid. It depends on how much the buzzword may tip you off.
Becuase of the huge clinical slant to the exam, you often sit their wondering "how on earth am I suppposed to know that?" or "What class was taht from?" For example, how long does it take air to be reabsorbed after abdominal surgery? Or other very clinical questions.
Also they assume you know the pathology. There weren't straight up pathology questions. They would describe a disease like myasthenia gravis, you figure it out, but they ask you about future complications, possible treatments, etc. Rarely do they ask straight pathology, like "which receptor is being attacked by the antibodies in this patient?" It's more of an applied/implied pathology.
The pharm on the comlex was difficult too. They asked about alternative drugs and alternative therapies. So many questions were about a woman having HTN and Diabetes and taking hormone replacement, what other drug can you add for "something" taht won't "something". You need to know the mechanisms of how these drugs work and how they may affect each other. Simply knowing that clonazapine cause "agranulocytosis" is not enough... know what it is and how it affects other stuff. (The USMLE wants you to know the mechanism of how it causes the agranulocytosis)
The COMLEX loved the common diseases; HTN, CHF, Emphysema, Stroke, CAD, Diabetes, Toxicities, prostate, UTIs, hormone replacement, drug abuse, alcoholism, and seizures. Know theses diseases well and their processes. Not many rare diseases tested. Lots and lots of ECG with rythms, know the patterns, they loved these. Even Wenckbach and Mobitz II.
The Micro was very tough compared to the USMLE. You need to focus on the fungi as well as bacteria/virus. No need to know the shape or structure of viruses, you don't need to know if it is encapsulated, single stranded, DNA or RNA etc etc. (The USMLE expects you to know it) Just know the disease it may cause. Again, the focus is clinical not basic science/minutiae. In reality... who cares if it is a single stranded positive RNA virus? It sucks that it causes herpes, that's all.
The Anatomy/Neuro was substantial, this is expected. Being DOs, you better know your anatomy real well. They asked about the phrenic nerve referring pain to the shoulder from the gall bladder (the USMLE did too), the tibial nerve, peroneal, fibular, common and deep, and pudendal, rectal, testicular torsion.... stuff DOs know a lot about. Enjoy these!
Not on the COMLEX, include subjects like; Epidemiology, biostatistics, ethics, legal issues, no calculations at all. Other low-yield topics include; biochem, immuno, behavioral, OMM. Surprisingly, the OMM was not very difficult, and not very much. For OMM, know the contraindications for OMM for various disease states (usually common sense). The behavioral was easy to figure out, just know the basics. The biochem focused on the obvious enzyme and nutrient deficiencies, no need to know details about transcription, translation, post-transitional modification, etc. The immuno part focused on some interleukins, and teh roles each type of cell plays. Just know the basics.
A lot of people complain that the comlex is "not well written". This simply is not true... it's too well written. It's just very hard. In terms of grammar and English, I am an editor (have been for 17 years), when I read I always pick up on English and grammar mistakes.... comlex did not have any, it was well written. Although one question on the USMLE had bad grammar. People who complain about this, probably did not study enough or know enough. The test is an IQ test of sorts. You have to apply, evaluate, and choose correct answers among many correct answers. (Unlike the USMLE, where only usually one answer is correct)
Comlex Q-Bank is a waste of money... nothing like the real test. The closest was the NBOME 200 released items. Howver, the regular USMLE Q Bank had very good questions, especially pharm and micro... very helpful.
Conclusion: the COMLEX is a very difficult test, that really tests your intelligence and endurance. It focuses on common diseases that you will see a lot of. Because, it is so clinical, there is no real way to "cram" or "review" for the test. Know the drugs and bugs, the rest is your reasoning and IQ.
USMLE:
If you are a DO taking the USMLE, focus on minutiae. Little details about mechanisms and theories.
The USMLE asks lots of questions in the form of experiments on rats, arteries, etc. Like if you were measuring the tension of this artery before adding epinephrine and drugs X look at these graphs and figure it out.
The USMLE covers all the topics in First Aid. You will get a topic from every section. Usually the ethics and legal stuff is easy to figure out. You will also have to do a few calculations. These are easy points. The behavioral is usually pretty obvious as well.
The hard stuff on the USMLE is the BIOCHEM. It's very detail and mechanism oriented--not clinical. Know what signals cause what, why things happen... don't just memorize buzzwords and associations. I guess bichem at DO schools is just taught differently, we focus on disease and clinical relevance, they focus on mechanism and details or how things work. Don't get me wrong, we did that too, but they go into more detail (I took biochem at an MD and a DO school).
Pathology on the USMLE is just more straight recall of a disease process , then a second step on how it works, like myasthenia gravis above. Or how to treat it etc. The path and biochem on the USMLE likes to ask about the Zebras... the rare diseases that you won't see, whereas the COMLEX asks about more common diseases.
The pictures on the USMLE are usually useless, only in a few cases do you need them. Also they are rare, the histo/path pics are not very many, but they love graphs and charts.
The anatomy and neuro was not heavily tested, coming from a DO background you will rock these questions. They did have 2 or 3 questions on iliopsoas (psoas) and quadratus lumorum. Pray that you get a lot of anatomy.
The Micro on the USMLe was a joke, if you have a strong micro department, it's real easy. Simple stuff. Most cases start with a fever, and cough. Age group tips you off. Some end up with joint pain, or lung pain, cardiomyopathy, etc. Don't worry.
There really was no way to "cram" for it. A lot fo stuff was not in review books, and you just learned it in class. Both tests asked about Leptin and Neuropeptide Y for some reason. Even though this is not taught in most schools. A lot of the USMLE questions were straight from QBank, except for all the "experiments"... Qbank doesn't have any "experiment" based questions.
The USMLE was an easier test, the questions usually did not require too much "thought"... just straight up recall, and some application. Not really an "IQ" test. Not as thought provoking or clinical as the COMLEX.
Of course, the USMLE comes in different versions, so yours may not be the same.
If anyone has any questions, feel free to ask, now that I am done... phew!!
