Will have to agree with above. This may be (probably is) an exaggeration, but I felt like 40% of my exam was OPP. Realistically it was probably 25%. The questions ranged from straightforward to bizarre set-ups that really stretched the imagination.
My exam was fairly neuro heavy, although I wouldn't go so far as to say that the exam was entirely focused on the subject as others have (luck of the draw). The exam did have a fairly decent amount of anatomy, repro, and micro. I had fairly specific (read low yield) head and reproductive anatomy. There were only a few of these, but I highly doubt you could actually prepare for them. Your anatomy grade would probably be most predictive and even then it may come down to luck of the draw. I had 5 or so biostatistics questions, although none required calculations. No pharm calculations. Biochem was generally reasonable, with the exception of maybe one question. First Aid is certainly more than sufficient for biochem. Pharm ranged from straight recall to more complex integration. There were certainly entire classes of drugs that were never mentioned.
Interesting tidbits: I had MULTIPLE subjects repeat, sometimes to the point of the question being only mildly different. I had a single bacterial species repeat itself numerous times. I actually started to think the test was finding errors in judgment and giving me a second chance…or something. I had to remind myself that the exam isn’t like that, so far as we’re told. The exam also had a few questions that were incredibly similar to questions I had on USMLE. Same subject, same context, etc.
Length: Not at all like COMSAEs. The vignettes were much more similar in length to UWorld, although I would say that it was still shorter than the recent USMLE. But, as a word of caution, I found the exam much more similar to the USMLE than I would have ever guessed by historical precedent, SDN, or COMSAEs. BUT…it’s still not the same thing. I had a lot of questions with mind-boggling levels of unnecessary detail, especially when they’d eventually get around to asking a strictly OPP question. The reading really became tiresome and the exam started to drag in the 7th and 8th sections. Ideally, they should have decreased the amount of questions as the USMLE did this year to accommodate the increased length of question stem. I used up anywhere from 50-55 minutes per section.
OPP: Heavy, heavy on visceral innervations/Chapman’s, followed by classic dysfunctions, and then a few straight diagnosis questions. Be careful how you read things.
Lastly, I had several questions that relied on knowing very specific terminology for things that would otherwise be described differently by any other sane person. Basically, the old adage of COMLEX loving buzzwords holds true. They’d also find convoluted ways to describe pathology that would make you pause and really have to think things through. In one case, the name of a specific anatomic part was given an alternative name that we certainly didn’t use regularly in class, if at all. This was my biggest gripe about the exam: the difficulty sometimes came from the presentation or wording of a question and not the underlying concept. You wouldn’t even know what the question writer was asking, let alone how best to answer it. You could often narrow things to 1-2 choices. Certain subjects seem to lend themselves to this type of question writing, which is why I think they traditionally show up year after year. I had a few microphotographs where the presentation was less than ideal. Basically straight up ID with some mild context provided in a sentence or two. No heart sounds. No videos. Several ECGs, all of which were 12-Lead ECGs. Only 2-3 were straight rhythm interpretation. Several required nuanced knowledge of structural pathology causing a particular issue. One was pretty tricky, I think. This very much surprised me, as I’ve found ECG interpretation to be pretty obvious on most medical school exams, COMSAE, and NBMEs.
