If you could choose between the USMLE or COMLEX to graduate

[meltedbrain]

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I don't what changes are coming to the DO field with the annoucned ACGME and AOA merger. Obviously a long shot but if DO schools allowed you take either the USMLE or COMLEX to graduate which one would it be?

 

[DocEspana]

1) The ACGME people I know straight up said they don't really care about displacing the COMLEX or lessening its worth, and that the AOA is super obsessed with not giving any ground on the centrality of the COMLEX to DO education. So no, there will be no changes to speak of in the COMLEX and its relevance.

2) I'd pick the COMLEX. Easier test. I'd rather take the easier test with some wonky questions, than the harder one with occasional impossible questions. (now to be fair, both are super difficult, but its clear the COMLEX is more straight forward with their questions, minus wonky ones)

 

[p30doc]

USMLE any day. The COMLEX is a terrible test.

 

[MrBeauregard]

USMLE.

I'd rather compare myself to ~27,000 medical students than to ~5,000 students.

It's also a superior test that evaluates your basic science knowledge using novel situations, unlike the COMLEX, which simply pushes the limit on weirdness. I also agree with DocEspana that the COMLEX (at least my form) was/is easier, minus the wonky questions. But I would personally rather take a hard test.

 

[DocVapor]

Best option: Improve the COMLEX to be comparable to USMLE, with a good calculator between the two. I am spending time learning OMM, I want to be able to show that I learned it and am proficient in it.

I would also accept taking the USMLE if there was an added OMM component to it that would be added on and scored separately if it was maybe an extra hour or two the same day. I would not accept having to go back a second time to take the module... might as well just take the whole COMLEX if that's the case.

 

[deleted245139]

USMLE and day - you can actually control how well you do with how hard you prepare.
...the comlex is a pure crapshoot

 

[bleeker10]

I would rather take a test where you have metrics that accurately gauge your progress and help predict your test scores, such as UW and NBME practice exams, rather than a test where you can take a COMSAE and score +/- 100-200 points different on the COMLEX. I don't see the value in taking a test just because it's easier. Easier doesn't necessarily mean its appropriately measuring your knowledge as a future physician, which the COMLEX fails at.

On level 1, I had about 10 questions asking for the definition of somatic dysfunction. Where's the value in being asked this so many times? On level 2, I had maybe 2 questions covering HTN, DM, CAD, etc while a large chunk (15-20%) were based on a surgical subspecialty. Again, where's the value in making a test based on primary care and not testing us on the common day to day primary care issues?

I would rather take a harder test knowing it is not a crapshoot, knowing if you put in time and effort you can do well. COMLEX is just not this type of test. But I don't foresee it ever being done away with completely.

 

[roast]

USMLE, this test is written so much better. It fairly tests your knowledge of all the basic sciences learned in the first two years. My comlex exam totally skipped out on entire systems and tested me super heavy on repro and endocrine. Half the OMM crap on the test was just ridiculous and I had never even seen it before (chapmen point for torn ACL?) i mean i found myself wanting to comment on every other question on the comlex.

 

[DocEspana]

I still say that if you had the choice to do one to graduate. You pick the easier one. "Better written" be damned. Both are hard. Both address plenty of relevant stuff. Both have their super stupid subject matter they love (omm in useless situations vs "associated zebras" that are required to get the right answer, but have no basis in reality)

I would rather make the graduation requirement but you see 1 if all things were equal.

 

[cliquesh]

I still say that if you had the choice to do one to graduate. You pick the easier one. "Better written" be damned. Both are hard. Both address plenty of relevant stuff. Both have their super stupid subject matter they love (omm in useless situations vs "associated zebras" that are required to get the right answer, but have no basis in reality)

I would rather make the graduation requirement but you see 1 if all things were equal.

I thought all of the usmle zebras were found in first aid or other board review material. I had no idea what some of the comlex zebras were. What did you end up applying for, Docespana? Urology and something else?

 

[deleted245139]

I still say that if you had the choice to do one to graduate. You pick the easier one. "Better written" be damned. Both are hard. Both address plenty of relevant stuff. Both have their super stupid subject matter they love (omm in useless situations vs "associated zebras" that are required to get the right answer, but have no basis in reality)

I would rather make the graduation requirement but you see 1 if all things were equal.

but would you call the COMLEX "easier"? I would argue that because some questions are so vague and require you to infer what the author intends (vs the USMLE information overload), it makes the COMLEX MUCH more difficult. It's an 'any-given-sunday' type of exam. Granted, both USMLE and COMLEX can, and do, cover every topic of medicine possible (thus forcing you to prepare as such), but the COMLEX leaves SO much up to inference. There isn't any skill or knowledge to that.... it's a combination of luck and reading inbetween the lines. I did as well as I did on COMLEX because of this attitude when answering: "It's not what I know the answer to be, it's what I know the author wants me to select".

Are all COMLEX exams vague and poorly writen? No... but there in lies another major complaint - inconsistancy from exam to exam.

All this being said, I'm just glad all I have left is Step III haha

 

[DocEspana]

I thought all of the usmle zebras were found in first aid or other board review material. I had no idea what some of the comlex zebras were. What did you end up applying for, Docespana? Urology and something else?

Well first, every document you read (First aid, kaplan review, private review lecturers, subject specific review books) will say different things are the "Zebra-correlations". And this is the rare thing to look out for that will tie it all together. Very few of these are ever agreed on resource-to-resource.

But the reason is, and I have a world class USMLE review doctor to thank for this, the USMLE uses "Correlations" that don't exist outside of the USMLE. AKA, they expect you to answer questions using rare symptomology or rare correlated diseases that have either been proven to be incorrect years ago, or were never shown to be correlated at all but are frequently passed on word-of-mouth from older doctor to younger student. When one resource decides to fact check its stuff, it will then contradict first aid. And when it misses some stuff, a third resource which also decided to tighten its information might correct that mistake and contradict the first source and first aid. The reliance on using these "zebra correlations" has lead to many USMLE questions in recent years being thrown out, much more than ever before if my source is to be believed, because people are (correctly) calling out the USMLE on making up pathology, presentations, and "risk factors" that wouldn't exist in reality at any rate higher than the rate in the general population at large.

This is a frequent complaint of my MD school friends, but we never hear it because we are too busy complaining about the COMLEX to take a hard look at the USMLE.

but would you call the COMLEX "easier"? I would argue that because some questions are so vague and require you to infer what the author intends (vs the USMLE information overload), it makes the COMLEX MUCH more difficult. It's an 'any-given-sunday' type of exam. Granted, both USMLE and COMLEX can, and do, cover every topic of medicine possible (thus forcing you to prepare as such), but the COMLEX leaves SO much up to inference. There isn't any skill or knowledge to that.... it's a combination of luck and reading inbetween the lines. I did as well as I did on COMLEX because of this attitude when answering: "It's not what I know the answer to be, it's what I know the author wants me to select".

Are all COMLEX exams vague and poorly writen? No... but there in lies another major complaint - inconsistancy from exam to exam.

All this being said, I'm just glad all I have left is Step III haha

I would 100% call the comlex easier and I would not argue that the questions are so vague. I would argue that some of the questions give you totally useless information which drove me crazy (everything in the usmle is relevant. everything). The useless information is generally not going to give you any pause though if you know what clinical differentiation you are looking for. The problem I (and every student) had was the frustration when i hit a question and didn't know what the relevant differentiating factor was... so i had a few facts that all seemed unrelated to me.... because one was the hugely relevant one but I wast thinking of the right pathology to begin with, so it looked rather unimpressive to me. It really leaves very little up to inference, but you feel infinitely more lost on a comlex question when you dont "know" what the right pathology is. USMLE gives you a false sense of confidence by having so much info that you know is all relevant that you feel like you can logic your way down to the final answer. COMLEX will leave you stranded, and is designed that way, if you don't know the right answer.

The above is how the COMLEX people explained the test and its love of "useless info" to me. Now I heard it from someone who is on the COMLEX payroll, so take it with all the salt you wish, but it was a perfect fit for my experience with the level 1 and 2.

I have heard a ton about inconsistency exam to exam. I fully believe it too. I hear it too often for it to be false. But they (again the comlex people) say that the test has a very good reproducible. If taken over and over (after having done a requiste large amount of practice questions) studied students score roughly the same thing every time they take it if made to take it in serial over a relatively short time frame. So at least by internal research, its a reproducible test. I think if its reproducible its also accurate, but we can argue over that.

Plus COMLEX III doesn;t have the super annoying open ended patient interaction portion that drives so many interns insane.

 

[dozitgetchahi]

The COMLEX is a joke and no, it's not easier than the USMLE. Unless you consider 'easier' to involve wide swaths of vague, irrelevant questions involving obscure trivia, OMM that nobody has ever heard of, grammatical and punctuation errors, etc. I'll take the USMLE any day, baby. I came out of both USMLE steps knowing I did well. I came out of both COMLEX steps wondering if I even passed, despite ultimately doing well on them. It's a 'crapshoot' test that doesn't inspire confidence at all.

Furthermore, if the USMLE writers are throwing out a lot of qs than the COMLEX authors must be throwing out at least twice as many. That's the only way I could see them making the test reproducible.

 

[meltedbrain]

So it will still be a good idea for applicants to traditional ACGME residencies to take the USMLEs? I don't really see all MD residencies readily taking the COMLEX over the USMLE post merger.

It feels as if this merger is just a ripple in the pond in terms of uniting the physician landscape.

 

[JGimpel]

The COMLEX is very strange; like beyond adding an additional piece to a 3 person chess game on Big Bang Theory strange. The problem is that there is no good way to study for 30-40% of this test. If you do well, you wonder how. If you do poorly, you wish you knew why. If you went bo'nananas on USMLE World, that would probably translate into doing reasonably well on the USMLE. If you didn't study the intimate details of chicken wishbone reflexology, you may still do poorly on the COMLEX.

Challenge me with the USMLE any day rather than confuse me with the COMLEX. This bogus test will be gone soon, or the AMA will take back its residency slots for good and the AOA execs will have to apologize live on Oprah for being idiots and maybe we'll still have a shot at ACGME pre-lim spots for pathology at the end of the day. Path is just not for me. Maybe I'm being selfish with this post.

 

[DrPapa]

USMLE is, by far, way easier than COMLEX. It's not even close. Sure the USMLE has flaws, but it is so much easier because you can actually figure out what the question is asking. I had no clue for a good chunk of COMLEX questions. Also, COMLEX step 2 & 3 tests things like practice management, law and latin, things that aren't in any review book, anywhere. I actually got questions asking about what factors to consider when negotiating with insurance companies. I thought I was taking the wrong exam many times throughout my test.

Just to drive the point home, here are my 2-digit scores:

Step 1: COMLEX 93, USMLE 99
Step 2: COMLEX 82, USMLE 99
Step 3: COMLEX 86.

Small sample size alert, but COMLEX doesn't seem that reproducible here either.

 

[JGimpel]

USMLE is, by far, way easier than COMLEX. It's not even close. Sure the USMLE has flaws, but it is so much easier because you can actually figure out what the question is asking. I had no clue for a good chunk of COMLEX questions. Also, COMLEX step 2 & 3 tests things like practice management, law and latin, things that aren't in any review book, anywhere. I actually got questions asking about what factors to consider when negotiating with insurance companies. I thought I was taking the wrong exam many times throughout my test.

Just to drive the point home, here are my 2-digit scores:

Step 1: COMLEX 93, USMLE 99
Step 2: COMLEX 82, USMLE 99
Step 3: COMLEX 86.

Small sample size alert, but COMLEX doesn't seem that reproducible here either.

This is the same score profile many have got, in my experience. If there is a DO that wants to tell us how he/she scored above 600 with specifics as to what sources were used to get the off the wall questions correct, it would GREATLY be appreciated. Sadly, I think many are keeping these sources to themselves.

 

[bleeker10]

This is the same score profile many have got, in my experience. If there is a DO that wants to tell us how he/she scored above 600 with specifics as to what sources were used to get the off the wall questions correct, it would GREATLY be appreciated. Sadly, I think many are keeping these sources to themselves.

I posted my experiences on level 1 and 2 (both ~650) in the COMLEX forums. For the off the wall questions, I used a combo of crossing out obvious wrong answers, very educated rationalizing, and past experience doing numerous practice questions with COMQUEST and COMBANK. Both tend to have some off the wall questions on it.

You don't have to know all the latin/legal terms to do well. If you know a few big ones (vicarious liability, res ipsa loquitor, maleficent, Volenti non fit injuria, etc) you will do fine. If they ask a term you don't know, more than likely the wrong answer choices will be those most common terms.

Medicolegal, ethics and OMM are such easy points on the COMLEX. There's no reasoning with them, no patient presentation you have to cipher through. Make a list as you are studying and go over them the night before the exam

 

[meltedbrain]

The COMLEX should be scrapped. In the late 90s the AMA was trying to get a section on the USMLEs geared towards DO students so everyone could in principle take the same test. Obviously that plan met resistance.

 

[DrPapa]

I used U-World and COMBANK for step 1 along with First Aid, Goljan, Rapid Review. U-World overestimated my score slightly while COMBANK way overestimated it. For the off the wall questions, I just laughed and cursed at the screen while I took an educated guess.

For step 2, I used U-World and COMBANK again. I was crushing both of them and U-World even underestimated my score this time. However COMBANK way overestimated it again. For anyone that argues against COMLEX being a crapshoot, I just cite my step 2 score (I know, small sample size again). I was obviously prepared because I rocked USMLE step 2 yet dropped 11 points on the 2 digit scale for COMLEX.

Step 3 I used COMBANK alone and was sweating bullets when I wasn't even passing the practice questions (below 60%). I came out of that exam fully convinced I had failed yet actually managed to do better than on step 2. I'm fully convinced that it's a crapshoot and not even an adequate representation of your knowledge base.

 

[cliquesh]

This is the same score profile many have got, in my experience. If there is a DO that wants to tell us how he/she scored above 600 with specifics as to what sources were used to get the off the wall questions correct, it would GREATLY be appreciated. Sadly, I think many are keeping these sources to themselves.

I used first aid and usmle rx, kaplan qbank, combank, and comquest for level 1. I used master the boads and combank, u world, and comquest for level 2. Got a low 600 on level 1 and a low 700 on level 2.

 

[DrBumblebee]

I used first aid and usmle rx, kaplan qbank, combank, and comquest for level 1. I used master the boads and combank, u world, and comquest for level 2. Got a low 600 on level 1 and a low 700 on level 2.

Did you use those prep materials while studying the 1st-2nd years or just start studying them at the end of 2nd year before the tests?

 

[cliquesh]

Did you use those prep materials while studying the 1st-2nd years or just start studying them at the end of 2nd year before the tests?

I started reading first aid during February of my 2nd year. I think a possible good, gunner strat would be to read the first aid chapter regarding cardiology when you are on your cardiology block and then do all of Kaplan qbank's cardiology question. Then do the same thing when you're on renal, pulmonary, and so on. You'd probably get a really good score if you did that. You do not need to do what I just suggested to get a good score, but I think it would actually work well and it wouldn't take too much time.

 

[meltedbrain]

I started reading first aid during February of my 2nd year. I think a possible good, gunner strat would be to read the first aid chapter regarding cardiology when you are on your cardiology block and then do all of Kaplan qbank's cardiology question. Then do the same thing when you're on renal, pulmonary, and so on. You'd probably get a really good score if you did that. You do not need to do what I just suggested to get a good score, but I think it would actually work well and it wouldn't take too much time.

So for the first 1.5 years just focus on class?

 

[MrBeauregard]

If there is a DO that wants to tell us how he/she scored above 600 with specifics as to what sources were used to get the off the wall questions correct, it would GREATLY be appreciated. Sadly, I think many are keeping these sources to themselves.

I got 717 on Level 1 and 255 on Step 1 with four resources: Kaplan Qbank, First Aid, Goljan Pathology, and UWorld. I did not do even a single question from a COMLEX-specific question bank. My best prep, by far, was studying as hard as I could for 2 years.

In my humble opinion, COMLEX was considerably easier than USMLE, and here's why:

• the USMLE asks about common diseases in an uncommon way. They ask about well-known diseases using language that no normal person would use. They make you think about the mechanism of a familiar disease in an unfamiliar context. They'll write questions where 4/5 answers could conceivably be rationalized as correct, and when you finally dwindle it down to two, which sound the exact same, you'll be forced to make The Gut Decision. The only good thing about the USMLE is that your score is *generally* somewhat proportional to the amount of work and/or time you put into studying; however, there are still questions you'll never be sure of simply because you have never looked at that disease through their lens.

• the COMLEX asks about common diseases using the weirdest presentations possible. They present one-liners with answer options that are completely unrelated. They ask about bioterrorism and medical ethics that no second year medical student would have ever thought to study. The only good thing is that, in my opinion, if you are very familiar with the content you can get many of the questions correct simply by narrowing down and crossing out the ridiculous answer choices. Be the master of deductive reasoning. I mean I had numerous answer choices where I thought to myself, "Wow. Only an idiot would actually choose this answer choice given the above stem." That's a bit harsh, but it was my thought at the time. I think that if you are well-prepared using USMLE-geared resources you have a good shot of doing very well. I can't comment on the non-reproducability of the COMLEX since I've only taken Level 1, but the above are my current thoughts on the matter.

I always advise friends of mine who are second years to study for the USMLE using USMLE-geared resources and forego COMLEX-specific resources. I saw some posters say not long ago that it makes no sense to study for a poorly-written test using poorly-written questions. Made sense to me. Aside from obvious differences in question style and amount of information provided in stems, the only differences in content lie in OMM questions. There are generally easy points. There will always be off-the-wall questions, but just think, if YOU think it's so off-the-wall, isn't it likely that your peers do as well? I never saw the point in getting all worked up about these stupid questions, as it's very likely that everyone is getting them wrong anyways.

The only suggestions for test-specific studying that I will personally make are the following:
-for USMLE, always ask yourself why. Why, why, why. It's all about mechanisms and symptom association. But I think mechanisms are key.
-for COMLEX, be very familiar with the Big Picture. They don't care so much about what makes a disease tick, they mainly just care that you can pick it out.

 

[Charlie Hustle]

I got 717 on Level 1 and 255 on Step 1 with four resources: Kaplan Qbank, First Aid, Goljan Pathology, and UWorld. I did not do even a single question from a COMLEX-specific question bank. My best prep, by far, was studying as hard as I could for 2 years.

In my humble opinion, COMLEX was considerably easier than USMLE, and here's why:

• the USMLE asks about common diseases in an uncommon way. They ask about well-known diseases using language that no normal person would use. They make you think about the mechanism of a familiar disease in an unfamiliar context. They'll write questions where 4/5 answers could conceivably be rationalized as correct, and when you finally dwindle it down to two, which sound the exact same, you'll be forced to make The Gut Decision. The only good thing about the USMLE is that your score is *generally* somewhat proportional to the amount of work and/or time you put into studying; however, there are still questions you'll never be sure of simply because you have never looked at that disease through their lens.

• the COMLEX asks about common diseases using the weirdest presentations possible. They present one-liners with answer options that are completely unrelated. They ask about bioterrorism and medical ethics that no second year medical student would have ever thought to study. The only good thing is that, in my opinion, if you are very familiar with the content you can get many of the questions correct simply by narrowing down and crossing out the ridiculous answer choices. Be the master of deductive reasoning. I mean I had numerous answer choices where I thought to myself, "Wow. Only an idiot would actually choose this answer choice given the above stem." That's a bit harsh, but it was my thought at the time. I think that if you are well-prepared using USMLE-geared resources you have a good shot of doing very well. I can't comment on the non-reproducability of the COMLEX since I've only taken Level 1, but the above are my current thoughts on the matter.

I always advise friends of mine who are second years to study for the USMLE using USMLE-geared resources and forego COMLEX-specific resources. I saw some posters say not long ago that it makes no sense to study for a poorly-written test using poorly-written questions. Made sense to me. Aside from obvious differences in question style and amount of information provided in stems, the only differences in content lie in OMM questions. There are generally easy points. There will always be off-the-wall questions, but just think, if YOU think it's so off-the-wall, isn't it likely that your peers do as well? I never saw the point in getting all worked up about these stupid questions, as it's very likely that everyone is getting them wrong anyways.

The only suggestions for test-specific studying that I will personally make are the following:
-for USMLE, always ask yourself why. Why, why, why. It's all about mechanisms and symptom association. But I think mechanisms are key.
-for COMLEX, be very familiar with the Big Picture. They don't care so much about what makes a disease tick, they mainly just care that you can pick it out.

Thanks for the insight!

 

[JediZero]

For purely selfish reasons, I'd pick the COMLEX, if only because I like OMM and it probably helped my score. I did above-average on COMLEX, and I'm sure that would not have been the case had I taken USMLE.

Ideally, I'd like to have everyone take the USMLE, with an OMM add-on for interested DO (or really interested MD) students, consisting of maybe 100 questions. We should have the chance to show how well we learned the unique portion of our curriculum, but there's no reason to have us rehash the rest of it either.

Of course, as helpful as it would be in saving us all $500, that would mean less money going to whichever testing authority loses their slice of the testing pie. Probably COMLEX. Yeah, that test isn't going anywhere. *sigh*