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USMLE vs COMLEX: Should you take both?

So, let me ask you something. As a D.O. student have you stopped to think about whether or not you should be taking both the USMLE step 1 or step 2 and the COMLEX level 1 or level 2?

This is a question that most do students struggle finding the answer to because taking both can be a great way to get noticed by residency programs, but if you do bad on the USMLE exams then this can backfire hard on you.

Having a set of good usmle scores can level the playing field for osteopathic medical students, much like it does for international medical graduates, but less so.

This article goes over the details of why osteopathic students should think long and hard about taking both and why it can be helpful for your residency applications if you do, lets get into it!

The Logistics of USMLE vs COMLEX

Here are the basic differences between the two exams.

As a whole they all cover the same material with the exception of OMM/OPP, so we will focus on the structural differences of the exams.


  • 280 questions
  • 7 40 minute blocks
  • 1 hour to be used whenever
  • No OMM on the exam


  • 400 questions
  • 8 1 hour blocks
  • 3 breaks every 2 hours (10 min, 40 min, 10 min)
That testing feeling

Why DO students should take the USMLE and the COMLEX

There are only a few reasons to say you have to take the USMLE, these are if you are interested in a super competitive specialty or want to go to a very specific region.

If you are dead set on a competitive specialty then it becomes a no brainer that you need to take the USMLE. Think about it, if I am a residency director for a dermatology program and I have 350 applications (probably not even close) to look at and they all have the USMLE score… I am in a program that has always been ACGME, I don’t have the time nor the care to figure out how the COMLEX is scored nonetheless, what a good score would be in comparison to the USMLE… so you put yourself at a disadvantage by only taking the COMLEX in these situations.

If you are wanting to go to only a specific location and you know that they will look at a usmle score over a comlex score, then you should plan on taking both.

The reason I give these two very specific situations is because board exams are tough, expensive, and time consuming, and honestly every single student doesn’t need to take both sets of exams if they don’t meet one of the criteria above.

The best way to figure out if you need to have both, is to look at the residencies you want to attend and see if they either require the USMLE or in the past have a history of only taking students with USMLE scores or another way to see that is to look at their current residents and see if they are primarily only md students.

When you don’t need to take the USMLE

Most osteopathic schools don’t really talk to their students much about this, but truth the residency program directors at predominantly DO residencies in a non-competitive specialty don’t really care if you have USMLE and COMLEX scores. If you score well on the COMLEX then your medical knowledge will be known.

The National Board of Osteopathic Medical Examiners (NBOME) the ones that write the comlex-usa level exams have put a ton of effort into getting the COMLEX accepted more widely in graduate medical education, and it has started to show.

Unless you meet the criteria above and have a very specific residency selection of specialty and location, then you likely don’t need to take both exams.

Another Factor to consider: Unsure future

In my opinion, for the extra $600 it is worth it to just take the USMLE if you are unsure of specialty as long as your practice test scores are where you want/need them. Now you may not need it, but for $600 and another test day the benefit can be huge if you do well. At the end of the day for me at least… I didn’t want to limit myself on my locations or opportunities because I didn’t take the USMLE.

With the only difference between the two content wise being OMM, if you prep for the USMLE and then take them both I really don’t think you can go wrong. Now some of you will probably say, “but Sean you idiot, I know somebody who did just that and ended up not doing so hot” and I would have to agree with you that these things happen, but all in all most people end up scoring around their practice test scores and most do well on the COMLEX if they primarily prep for the USMLE and add in some OMM on the side.

Another point to make is that you have spent a fortune on medical school so far, so don’t let the extra $600 be the reason you don’t take the test and sell yourself short. That small amount of money is so minimal in comparison to the tragedy of not matching and having to forgo another year of income.

Now, the USMLE may not have that big of an impact on everyone, but if you are a strong test taker and your practice test scores are in a range you feel comfortable then why chance it and limit your options??

On the Go studying

Prepping for the USMLE

If you decide that you need to take the USMLE, then obviously you want to get high scores. The trick to getting higher scores than everyone else 🙂 is to study consistently and efficiently.

Make sure you are using board review material like Boards and Beyond in addition to Pathoma and first aid.

Be sure that you are using these resources during your regular courses in medical school and then when you are prepping for the exams.

If you are looking to increase your step 2 ck scores then using online med ed becomes key.

Arguably the most important part of prepping for the USMLE is a good solid question bank.

UWorld is what I recommend for both the step 1 and the step 2 ck.

Since most of Step 2 CK is based on internal medicine, it is wise to use UWorld during that rotation in 3rd year.

Is USMLE easier than COMLEX?

The comlex exams are tough in general, but I would say that the content is similar or easier than usmle content.

The thing about COMLEX vs USMLE, is that the question style is different. On the COMLEX you are presented with scenarios and then in a way you either know it or you don’t, then when it comes to the USMLE you can think it through a lot easier.

The key differences when it comes to comlex and usmle that all test takers should know is the length of the exam and the style of questions.

The COMLEX is longer in general and has more questions than the USMLE, and then the question style as mentioned above should be taken into consideration.

Most students generally believe that the COMLEX is easier than the USMLE though, but this is all anecdotal and truly depends on which exam you get.

Then obviously one of the things that makes the COMLEX a little easier are the questions on osteopathic principles and practice, which can be simple questions that really help out your score vs the average scores if you spend enough time on OMM content.

DO all residency programs accept COMLEX?

Pretty much all residency programs will accept the comlex. Most osteopathic medical schools don’t tell the students this, but it is a good idea to just take time and look at the residency website.

They will list on the website all the important factors for applicants to know and there it will talk about if COMLEX is accepted or not. Then if it is, through the national resident matching program (NRMP) you can release your COMLEX scores to each and every residency you choose to send them to.

Most residencies understand that it is a similar exam when compared to the USMLE and that good performance on one indicates good on the other and poor performance on one will typically indicate it on the other.

How hard is it to pass COMLEX?

Passing comlex is not that tough as long as you put in the work. Each test has a minimum passing score and if you spend plenty of time studying in your courses and integrating review resources into your studies you will do just fine.

Make sure you take plenty of practice exams and put a greater emphasis on practice questions than review books in your board prep and you will end up doing just fine.

The tough thing about any board exam, comlex included is just having enough time, motivation, and consistency. From my personal experience if you just come up with a good study plan that utilizes gold standard study resources like pathoma and UWorld, then you will be good to go.


Well, there you have it. This article just gave you some practical tips that you can take into your board exams and hopefully it will lead to you crushing them and getting the residency of your dreams.

Before you go in to your test day though, be sure to get my free 10 test day tips to OWN your COMLEX and have a perfect test day without getting fatigued or frustrated.

So do you think you will take them both? Comment below with why or why not, I would love to hear everyone’s perspective.

Thanks for reading.


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