USMLE vs. COMLEX: Understanding the Key Differences

Navigating the medical licensing process in the United States can be complex. A key decision is choosing between two major exams: USMLE vs. COMLEX. These exams are crucial milestones for aspiring physicians. The right choice depends on whether you’re pursuing an allopathic or osteopathic medical degree. Students in U.S. allopathic (MD) programs must take the USMLE to get a medical license. Osteopathic (DO) students take the COMLEX instead. This exam includes osteopathic principles and Osteopathic Manipulative Medicine (OMM).

The decision-making process becomes more complex for international medical graduates (IMGs) and U.S. osteopathic students exploring residency options. Understanding the differences between the USMLE and COMLEX is essential. This includes their structure, requirements, and strategic advantages. Making an informed choice can shape your medical career.

Key Takeaways

The USMLE is primarily for allopathic (MD) students and international medical graduates (IMGs), while the COMLEX is required for osteopathic (DO) students.
Some osteopathic students opt to take both exams (USMLE and COMLEX) to broaden their residency options, especially for highly competitive specialties.
The exams cover overlapping content but differ in structure and inclusion of osteopathic principles, so strategic timing and resource selection are crucial for success.
The future of medical licensing may shift with a unified residency match process, but understanding the current requirements remains essential for planning your path.

What is the USMLE?

The United States Medical Licensing Examination (USMLE) is a comprehensive, three-step examination system required for allopathic medical students (MDs) who wish to practice medicine in the U.S. The exam is also a necessary hurdle for international medical graduates (IMGs) who seek to apply for U.S. residency programs. The USMLE tests a medical professional’s ability to apply scientific principles, clinical knowledge, and patient care strategies in real-world medical scenarios.

The exam is recognized as a critical part of the licensing process and residency match programs. It is one of the most significant examinations in the U.S. medical education system, ensuring that only qualified candidates enter residency and, eventually, practice medicine in the country.

USMLE Structure & Steps

The USMLE consists of three distinct steps, each assessing a different level of medical knowledge and application. Below is a breakdown of each step and its focus:

Step 1: Basic Medical Sciences

Step 1 primarily tests foundational knowledge of basic medical sciences. These include physiology, biochemistry, pathology, microbiology, and pharmacology. This step assesses understanding of the science behind human health and disease. Since January 2022, the exam has been pass/fail. However, it still holds weight in residency applications. It serves as an early benchmark of a student’s readiness for clinical training.

The material in Step 1 is essential for later medical education. Despite being pass/fail, residency programs often consider strong performance to gauge an applicant’s preparedness for clinical practice.

Step 2 CK (Clinical Knowledge)

Step 2 CK evaluates a candidate’s clinical knowledge and ability to manage patient care. It involves multiple-choice questions focused on patient-centered topics such as diagnosis, treatment strategies, preventive care, and clinical decision-making. This step is scored numerically, and the results play a significant role in residency applications. The Step 2 CK score provides residency programs with a more focused look at a candidate’s clinical reasoning abilities and their readiness to take on more complex, patient-focused responsibilities in a residency setting.

Step 3: Clinical Applications

Step 3 assesses a medical student’s ability to apply their knowledge to patient care in real-world scenarios. It focuses on diagnosis, treatment, and patient management in the context of daily medical practice. Step 3 is typically taken after the first year of residency when candidates have accumulated some clinical experience. This step is divided into two components: one focused on basic clinical knowledge and one focused on patient management in actual clinical settings. A passing score in Step 3 is often required for the full licensure to practice medicine without supervision.

Who Takes the USMLE?

The USMLE is primarily designed for:

U.S. allopathic (MD) medical students: These students are required to complete all three steps of the USMLE as part of their journey toward obtaining a medical license in the U.S.
International medical graduates (IMGs): Medical professionals who obtained their medical degrees outside of the U.S. must take the USMLE to be eligible for U.S. residency programs. The exam serves as a credentialing mechanism to ensure that IMGs meet the same standards as U.S. medical students.
U.S. osteopathic (DO) medical students: Osteopathic students may choose to take the USMLE if they wish to apply to allopathic residency programs, which may be necessary if they want to practice in fields that primarily offer allopathic training opportunities.

For IMGs and U.S. osteopathic students, taking the USMLE may be a necessary step to ensure eligibility for a broad range of residency programs, especially in competitive specialties. Many osteopathic students opt to take both the USMLE and the COMLEX (the osteopathic exam), as it opens up additional residency opportunities, such as those in allopathic residency programs, which are more abundant than osteopathic programs.

If you are an IMG, find detailed guidance on the USMLE process for IMGs on the ECFMG (Educational Commission for Foreign Medical Graduates) website.

Key Points about USMLE

The USMLE is an essential exam for allopathic students, IMGs, and osteopathic students seeking to enter allopathic residency programs.
Step 1 focuses on basic sciences but is now pass/fail, making it less of a determining factor for residency but still important for background knowledge.
Step 2 CK is a critical numerical score that plays a significant role in residency applications.
Step 3 is typically taken during or after the first year of residency and is a key step in gaining full medical licensure.
Osteopathic students interested in allopathic residency programs must take the USMLE in addition to COMLEX.
IMGs are required to take the USMLE for entry into U.S. residency programs.

Overall, the USMLE is a vital part of the U.S. medical education and residency application process. Whether you are an MD, DO, or IMG, passing the USMLE is a key requirement for becoming licensed to practice medicine in the U.S., with each step representing a milestone in a medical professional’s development.

What is the COMLEX-USA?

The Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) is a multi-level examination required for students in U.S. osteopathic (DO) medical programs. It serves as the primary licensing exam for osteopathic physicians and is designed to evaluate their medical knowledge, clinical skills, and understanding of osteopathic principles.

Unlike the USMLE, the COMLEX-USA incorporates Osteopathic Manipulative Medicine (OMM), a core component of osteopathic training that emphasizes a holistic, hands-on approach to diagnosing and treating patients. The exam ensures that DOs are proficient in both general medical knowledge and the unique osteopathic techniques that differentiate them from allopathic (MD) physicians.

COMLEX-USA Structure & Levels

The COMLEX-USA consists of three levels, each assessing a different stage of medical knowledge and clinical competency. These levels are comparable to the three steps of the USMLE but integrate osteopathic principles throughout.

Level 1: Foundational Biomedical Sciences

Level 1 tests fundamental biomedical sciences, including anatomy, physiology, microbiology, pharmacology, pathology, and biochemistry, with a specific focus on osteopathic principles. This level emphasizes the understanding of disease mechanisms and the application of osteopathic manipulative treatment (OMT) in clinical scenarios.

As of May 2022, COMLEX Level 1 is pass/fail, aligning with the change made to USMLE Step 1. Despite this, strong performance in Level 1 remains important as it reflects a candidate’s foundational medical knowledge.

Level 2 CE (Cognitive Evaluation)

Level 2 CE assesses clinical sciences, patient care, and clinical decision-making. It is comparable to USMLE Step 2 CK and evaluates a student’s ability to apply medical knowledge to real-world patient scenarios. This level includes topics such as diagnosis, treatment, disease prevention, and patient management, with a continued emphasis on osteopathic principles and manipulative techniques.

Previously, Level 2 had a separate Performance Evaluation (PE) component, which tested hands-on clinical skills. However, this portion was discontinued in 2021, leaving only the written Cognitive Evaluation (CE) exam.

Level 3: Advanced Clinical Knowledge & Decision-Making

Level 3 is taken during residency and evaluates a DO’s ability to independently manage patient care across various medical settings. This level includes complex case management, clinical decision-making, and treatment planning, integrating osteopathic philosophy and practice. Level 3 is required for full medical licensure, ensuring that DOs are competent to practice without supervision.

Who Takes the COMLEX-USA?

The COMLEX-USA is specifically designed for:

U.S. osteopathic (DO) medical students: The exam is mandatory for graduation from DO programs and for obtaining licensure as an osteopathic physician in the U.S.
DO students applying for both osteopathic and allopathic residency programs: Some DO students choose to take both the COMLEX and USMLE to expand their residency options, as many allopathic residency programs prefer or require USMLE scores for admission.

Key Points about COMLEX-USA

COMLEX-USA is required for DO students and assesses both general medical knowledge and osteopathic principles.
Level 1 focuses on foundational sciences and is now pass/fail, similar to USMLE Step 1.
Level 2 CE evaluates clinical knowledge and patient care, playing a significant role in residency applications.
Level 3 is taken during residency and is necessary for full licensure.
Unlike the USMLE, COMLEX-USA incorporates Osteopathic Manipulative Medicine (OMM) throughout all levels.
DO students who wish to apply for allopathic residencies often take both COMLEX and USMLE to remain competitive.

The COMLEX-USA is essential for osteopathic medical students pursuing licensure and practice in the U.S. It ensures that DOs are equipped with the necessary medical knowledge, clinical skills, and osteopathic training to provide comprehensive patient care.

Key Differences Between USMLE and COMLEX

The USMLE (United States Medical Licensing Examination) and COMLEX (Comprehensive Osteopathic Medical Licensing Examination) are both essential for medical professionals seeking to practice in the United States. However, these two exams cater to different groups of medical students and have distinct requirements, structures, and applications. Below is a more detailed comparison of the key differences between the two:

Who Takes It?

USMLE: The USMLE is primarily designed for students from allopathic medical schools (MD students) in the U.S. However, International Medical Graduates (IMGs), who have completed their medical education outside the U.S., are also required to take the USMLE for eligibility to enter U.S.-based residency programs. Some osteopathic students (DOs) may also take the USMLE to broaden their options for residency, particularly if they are interested in pursuing an allopathic residency.
COMLEX-USA: The COMLEX is specifically tailored for students from osteopathic medical schools (DO students). It is required for DO students to graduate from their osteopathic medical programs and to apply for osteopathic residency programs. While COMLEX is not generally required for MD students, some DO students opt to take the USMLE in addition to COMLEX to gain access to both osteopathic and allopathic residency programs.

Required for Graduation?

USMLE: The USMLE is not a graduation requirement for MD students. However, it is a mandatory step in the process of applying for residency programs. The USMLE is necessary for anyone aiming to pursue an allopathic residency or become licensed to practice medicine in the U.S. International Medical Graduates (IMGs) are required to take the USMLE for residency applications.
COMLEX-USA: COMLEX is required for DO students to graduate from osteopathic medical schools. It is a key component of their training and is essential for eligibility to apply to osteopathic residency programs. Without passing the COMLEX exams, DO students cannot complete their education or enter an osteopathic residency.

Number of Steps/Levels

USMLE: The USMLE consists of three main steps:
- Step 1: This tests the foundational science knowledge of medical students.
- Step 2 CK (Clinical Knowledge): It assesses students’ clinical knowledge in various medical disciplines.
- Step 3: This evaluates the medical knowledge and clinical skills needed for independent practice.
COMLEX-USA: COMLEX also consists of three main levels:
- Level 1: This tests the foundational biomedical sciences and clinical concepts.
- Level 2 CE (Clinical Examination): It focuses on clinical knowledge, similar to USMLE’s Step 2 CK, but with a stronger emphasis on osteopathic principles and practices.
- Level 3: It is designed to assess the ability to practice medicine independently, particularly focusing on osteopathic medical principles.

Scoring

USMLE:
- Step 1: It is currently scored as Pass/Fail, meaning students will either pass the exam or fail. The score is not reported numerically anymore as of recent changes.
- Step 2 CK and Step 3: These steps are scored on a numerical scale, with a passing score required for each. The specific passing score varies each year.
COMLEX-USA:
- Level 1: Like the USMLE Step 1, Level 1 is scored as Pass/Fail, meaning the student either passes or fails the exam, without a numerical score.
- Level 2 and Level 3: These are scored on a numerical scale, similar to the USMLE’s Step 2 and Step 3. Passing scores for each level are set by the National Board of Osteopathic Medical Examiners (NBOME).

Includes Osteopathic Principles?

USMLE: The USMLE does not include specific osteopathic principles or practices in its exam content. The focus of the USMLE is more aligned with allopathic medicine, which does not incorporate osteopathic manipulative treatment (OMT).
COMLEX-USA: The COMLEX explicitly includes osteopathic principles, particularly osteopathic manipulative medicine (OMM), which is a key part of osteopathic training. This includes testing knowledge and application of OMT, which is unique to osteopathic medicine and a distinguishing feature of COMLEX.

Residency Application Compatibility

USMLE: The USMLE is required for allopathic (MD) residency programs. International Medical Graduates (IMGs) must take the USMLE to be eligible for allopathic residency matches in the U.S. In contrast, osteopathic residency programs accept the COMLEX, but MD residency programs generally do not.
COMLEX-USA: The COMLEX is required for osteopathic residency programs. However, some DO students choose to take both the USMLE and COMLEX in order to broaden their options and apply for both allopathic and osteopathic residency programs. The COMLEX is not typically used for allopathic residency applications, but it is mandatory for DO students who plan to pursue osteopathic residencies.

Question Format

USMLE: The USMLE uses clinical case scenarios and multiple-choice questions to test the breadth of medical knowledge across different disciplines. The format is based on presenting clinical situations in which students need to apply their knowledge and reasoning skills to diagnose and recommend treatment. The USMLE’s questions are centered on allopathic principles, with a strong emphasis on evidence-based medicine and modern clinical practices.
COMLEX-USA: While the COMLEX also includes multiple-choice questions, it incorporates osteopathic principles into the clinical case scenarios. These questions test not only clinical knowledge but also the application of osteopathic principles and the use of osteopathic manipulative treatment (OMT) in patient care. This makes the COMLEX uniquely focused on osteopathic medicine, blending traditional clinical knowledge with osteopathic approaches.

Choosing Between USMLE and COMLEX

The decision to take either or both exams depends largely on your career goals and medical training path. For MD students, the USMLE is a clear choice, as it is required for allopathic residencies. For DO students, the decision is more nuanced. While COMLEX is required for osteopathic residencies, many DO students choose to take the USMLE as well to expand their residency options, especially if they are interested in allopathic specialties or programs that might offer broader opportunities or geographic flexibility. Taking both exams requires careful planning to manage the overlapping content, but it can be a strategic choice for students aiming for competitive specialties or locations with fewer osteopathic residency programs.

Should You Take Both the USMLE and COMLEX?

For osteopathic medical students (DOs), taking the COMLEX is mandatory for licensure, but many choose to take the USMLE as well. The decision to take both exams can significantly impact residency options, career flexibility, and competitiveness. Below, we explore the key reasons for and against taking both exams to help you determine the best path forward.

Reasons to Take Both the USMLE and COMLEX

1. Increases Residency Options

Taking both exams expands your opportunities by making you eligible for both allopathic (MD) and osteopathic (DO) residency programs. While osteopathic students can apply to MD programs with COMLEX alone, some allopathic residency programs prefer or require USMLE scores for consideration. Taking both exams ensures you can apply to the widest range of programs and increases your chances of securing a residency in your desired specialty and location.

2. Improves Competitiveness in Competitive Specialties

Residency programs in highly competitive fields—such as dermatology, orthopedic surgery, plastic surgery, and neurosurgery—are often dominated by allopathic applicants. Many of these programs prefer to use USMLE scores as a benchmark when evaluating candidates. A strong USMLE score can improve your application’s strength and help you stand out against MD candidates.

3. Better Recognition Among Allopathic Residency Directors

Many allopathic residency program directors are less familiar with COMLEX scoring and its interpretation. The USMLE provides a standardized metric that they are comfortable using to compare applicants. By submitting a USMLE score, you avoid potential confusion and ensure your performance is understood in a context that aligns with their expectations.

4. Provides a More Flexible Career Path

If you are uncertain about whether you want to pursue an allopathic or osteopathic residency, taking both exams keeps your options open. Some osteopathic students initially plan to enter a DO program but later decide to apply to MD residencies. Taking the USMLE ensures that you won’t be limited in your choices later in your medical career.

5. Strengthens Your Application for Fellowship Training

If you plan to pursue fellowship training after residency, having a USMLE score can be beneficial. Some competitive fellowships, even within osteopathic residencies, may consider USMLE scores when selecting candidates. A high USMLE score could enhance your chances of securing a prestigious fellowship, particularly in subspecialties like cardiology, gastroenterology, or surgical specialties.

6. More Opportunities for Research and Academic Medicine

If you’re interested in research-heavy programs or academic medicine, many prestigious institutions prefer USMLE scores. Institutions with strong research programs often recruit residents from a broad pool of applicants, including MD and DO students. A strong USMLE score could make you more competitive for programs with a strong emphasis on research and teaching.

Reasons to Skip the USMLE

1. Additional Cost

Taking both exams comes with significant financial costs. In addition to registration fees, students often invest in additional study materials, question banks, and review courses for each exam. There may also be costs associated with travel and lodging, especially for students who take the USMLE at a location different from their COMLEX testing site.

2. Requires Extra Study Time

Although there is significant overlap between the USMLE and COMLEX, preparing for both exams requires additional study time. The USMLE focuses more on clinical case-based reasoning, while COMLEX includes osteopathic manipulative medicine (OMM). Some students find it challenging to balance studying for both exams while maintaining coursework, clinical rotations, and other responsibilities.

3. Not Necessary for Certain Specialties

If you plan to enter a primary care specialty such as family medicine, internal medicine, or pediatrics, most osteopathic residency programs do not require the USMLE. Many MD programs in these specialties accept COMLEX scores, making the additional exam unnecessary for matching into a residency program.

4. Risk of a Lower Score Hurting Your Application

If you take both exams, residency programs will likely see both scores. A low USMLE score, even if your COMLEX score is strong, could negatively impact your application. Some students choose to focus solely on COMLEX to maximize their performance rather than risk having a lower USMLE score that could hurt their chances in competitive programs.

5. Focus on Osteopathic-Specific Training

If you are committed to practicing as a DO and plan to enter an osteopathic residency, focusing on COMLEX may be the best use of your time. Studying for the USMLE takes time away from mastering OMM and other osteopathic principles that are crucial for excelling in COMLEX and becoming a well-rounded DO.

Key Question: Should You Take Both the USMLE and COMLEX?

Ultimately, your decision should be based on your career goals. Consider the following question:

Do you want to apply to allopathic (MD) residencies?

If YES, taking both the USMLE and COMLEX is highly recommended, as it will increase your chances of matching into an MD program and enhance your competitiveness for prestigious residencies and fellowships.
If NO, and you plan to pursue an osteopathic residency, COMLEX alone is sufficient, and taking the USMLE may be unnecessary.

Deciding whether to take both exams requires careful consideration of your specialty interests, career aspirations, and financial and time constraints. If you’re uncertain, consulting with an academic advisor or mentor can help you develop a strategy that aligns with your goals.

USMLE vs. COMLEX: When to Take the Exams and Timing Considerations

For osteopathic medical students (DOs) who are considering taking both the United States Medical Licensing Examination (USMLE) and the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA), timing is a crucial factor. Because the two exams have overlapping content but different question styles and emphases, planning when to take them can significantly impact performance and study efficiency. There are three common approaches to scheduling these exams, each with its own advantages and drawbacks.

1. Taking the USMLE First

Some osteopathic students choose to take the USMLE first, focusing on the content covered in this exam before shifting their attention to osteopathic-specific concepts tested in COMLEX. This approach has several benefits:

Focus on High-Yield Material – The USMLE emphasizes clinically relevant basic sciences and medical decision-making, while COMLEX includes additional content on osteopathic principles and manipulative medicine (OMM). Taking the USMLE first allows students to focus on mastering the high-yield material common to both exams before adding osteopathic concepts.
Aligns with Allopathic Residency Goals – Many competitive allopathic residency programs strongly prefer USMLE scores, and some may not consider COMLEX scores alone. Taking the USMLE first ensures that students present a strong application early on if they are considering these programs.
Considered More Difficult – The USMLE is generally regarded as more challenging due to its exam format, question style, and grading structure. Completing the USMLE first allows students to devote their initial preparation period to this more rigorous exam before transitioning to COMLEX.

Challenges of This Approach:

Requires an additional study period for COMLEX-specific material after the USMLE.
Might lead to fatigue from prolonged test preparation if COMLEX is taken much later.
Schools may have specific exam deadlines that require students to prioritize COMLEX first.

2. Taking USMLE and COMLEX Together

Because the two exams have substantial content overlap, some students opt to study for both simultaneously and schedule them close together. This approach maximizes efficiency and minimizes total study time.

Advantages:

Minimizes Redundant Studying – Since both exams test foundational medical knowledge, students can prepare for both using similar study resources. This reduces the need for an extended study period.
Efficiency in Test-Taking – Studying for both at the same time allows students to remain in peak testing condition without long breaks in between, which can improve performance.
Maximizes Flexibility for Residency Applications – By completing both exams close together, students keep their options open for both osteopathic and allopathic residencies without delay.

Challenges of This Approach:

Requires careful planning to ensure that both exam formats and unique question styles are well understood.
Intensive preparation can be overwhelming, as both exams require slightly different test-taking strategies.
Requires balancing COMLEX-specific content, such as OMM, with USMLE-style question formats.

3. Prioritizing COMLEX First and Taking USMLE Later

Because COMLEX is a graduation requirement for osteopathic medical schools, some students opt to complete this exam first and then assess whether they need to take the USMLE later. This strategy is commonly chosen by students who are unsure if they will apply to allopathic residencies or those who want to focus on their required licensing exam first.

Advantages:

Ensures Compliance with Graduation Requirements – Since osteopathic medical students must pass COMLEX to graduate, focusing on this exam first ensures they meet academic and licensing requirements.
Allows Flexibility for Decision-Making – Students who are unsure about applying to allopathic residency programs can wait until after COMLEX to decide whether to take the USMLE.
Less Financial and Time Burden if USMLE Is Not Needed – If students later determine that their specialty or residency of interest does not require a USMLE score, they can save money and study time by forgoing the exam.

Challenges of This Approach:

If a student ultimately decides to take the USMLE, they may need to revisit foundational material months after their initial study period.
Studying for COMLEX first might result in a more challenging transition to USMLE-style questions later on.
If a student later decides to pursue a competitive allopathic specialty, delaying the USMLE may limit available testing opportunities before residency applications.

Final Thoughts on Timing Strategy

There is no single best strategy for every student. The ideal timing depends on several factors, including individual study habits, residency goals, financial considerations, and school requirements. Before making a decision, students should consider:

Residency Interests – If an allopathic residency is a strong possibility, taking the USMLE early may be beneficial.
Study Efficiency – Some students prefer to take both exams close together to minimize study time, while others prefer a staggered approach.
Personal Strengths and Weaknesses – If a student struggles with COMLEX-specific content, it may be beneficial to take USMLE first and dedicate separate time to osteopathic concepts later.

For students uncertain about their path, speaking with academic advisors, residency mentors, and upperclassmen who have taken both exams can provide valuable insight into the best approach. You can also explore additional study resources such as question banks, practice exams, and review materials for both the USMLE and COMLEX. For IMG students, there are advisory services available through US-based companies that help develop a plan and prepare applications for the residency match program. Many of these services also assist with exam preparation.

It’s also worth noting that the ACGME and AOA (the governing bodies for allopathic and osteopathic residency programs, respectively) have reached an agreement that will allow a single application service and match program across all types of residencies. This program is set to go into effect in the near future, though it is still unclear how this will impact COMLEX and USMLE examinees, both US-based and abroad.

How to Study for USMLE & COMLEX

Studying for the USMLE and COMLEX requires strategic planning, time management, and the right resources. While the two exams share some overlap in content, there are differences in structure and areas of focus, particularly with the inclusion of Osteopathic Manipulative Medicine (OMM) in the COMLEX exam. Below, we will break down how to approach studying for both exams, detailing recommended resources and offering tips for success.

Study Resources for the USMLE

The USMLE tests medical knowledge in a variety of domains, including basic sciences, clinical knowledge, and patient management. The study resources available are tailored to these domains and are designed to help you master both the content and the format of the exam.

1. UWorld QBank

UWorld is one of the most widely used question banks for USMLE preparation. It provides high-quality, board-style questions that mirror the difficulty level and format of the USMLE. The detailed explanations for both correct and incorrect answers are invaluable for understanding not only the correct answers but also the reasoning behind them. Many students recommend completing multiple passes of UWorld to solidify their knowledge. It is particularly useful for Step 1 and Step 2 CK preparation.

2. First Aid for the USMLE Step 1

First Aid is the cornerstone resource for Step 1 preparation. This book covers high-yield topics and organizes them in a way that allows for efficient review. It should be used alongside UWorld and Pathoma to reinforce foundational knowledge. The book is especially helpful for subjects like microbiology, pathology, and pharmacology, and is often referred to as “the bible” of Step 1 preparation.

3. NBME Practice Exams

The National Board of Medical Examiners (NBME) offers practice exams that simulate the actual Step exams. These are highly recommended for tracking progress and assessing exam readiness. The NBME exams are essential for providing insight into the types of questions that will appear on the test, as well as the overall difficulty level. These practice exams offer a good predictor of your performance on the real exam.

4. Kaplan QBank & Kaplan Videos

Kaplan offers comprehensive QBanks and video lectures that cover the full spectrum of Step 1 and Step 2 CK topics. The Kaplan QBank is another great resource for question practice, and their video lectures help clarify complex concepts, providing a more in-depth understanding of key material. The Kaplan study materials are excellent for covering gaps in knowledge and reinforcing weak areas.

5. Pathoma

Pathoma is an essential resource for mastering pathology for Step 1. Dr. Sattar’s concise explanations and high-yield pathology content make it a go-to resource. It also provides supplementary online videos that break down complex concepts into manageable lessons, making it easier to retain important material.

6. SketchyMedical

SketchyMedical is particularly valuable for microbiology, pharmacology, and pathology. The visual learning style through quirky and memorable sketches has helped many students grasp difficult subjects and retain key information. The images and stories tied to each subject provide a creative and efficient approach to memorizing complex concepts.

Study Resources for the COMLEX

The COMLEX-USA exam differs from the USMLE in its incorporation of Osteopathic Manipulative Medicine (OMM). It also places more emphasis on osteopathic principles, musculoskeletal medicine, and patient interaction from an osteopathic perspective. Therefore, preparing for COMLEX requires additional resources and focused study strategies.

1. TrueLearn QBank

TrueLearn is the most popular question bank for osteopathic medical students. The questions are designed specifically for the COMLEX exam and include osteopathic principles and OMM content. TrueLearn provides detailed explanations for each question, helping students not only to understand the correct answer but also to learn the reasoning behind it. It is highly regarded for preparing for the COMLEX Level 1 and Level 2 exams.

2. COMBANK

COMBANK is another widely used resource for the COMLEX. It offers question banks for both Level 1 and Level 2 and is designed specifically for osteopathic students. COMBANK is known for its large database of practice questions, which is a great way to get used to the test format and exam style. Many students find this resource useful for refining their knowledge of osteopathic principles and preparing for the OMM-heavy parts of the exam.

3. NBOME Practice Exams

The National Board of Osteopathic Medical Examiners (NBOME) provides practice exams that are essential for gauging your readiness for the COMLEX exams. These practice tests closely mirror the format and content of the real exam and help students become familiar with the question style. The NBOME exams are a vital tool in assessing weak areas and improving your test-taking strategies.

4. Osteopathic Manipulative Medicine (OMM) Resources

Osteopathic Manipulative Medicine is a critical component of the COMLEX exam, particularly for Levels 1 and 2. Students need to master OMM techniques and concepts, including how to apply them to clinical practice. Resources like Osteopathic Medical Board Review and Osteopathic Principles and Practice textbooks provide foundational knowledge. Supplementing these with videos, like those from Dr. Rocco’s OMM lectures, can be highly beneficial for mastering practical OMM concepts and understanding the rationale behind various techniques.

5. Kaplan COMLEX Review

Kaplan offers review materials tailored specifically for the COMLEX exam. This includes a comprehensive QBank and live or on-demand video lectures that cover all topics for Levels 1, 2, and 3. Kaplan’s resources help to clarify complex topics, including osteopathic principles, and provide practice questions that are reflective of the actual exam format.

Study Resources for Both USMLE & COMLEX

If you are planning to take both the USMLE and COMLEX, you will want to focus on resources that provide overlap between the two exams while also addressing their unique requirements. Here are a few resources that can help streamline your study process for both exams.

1. Kaplan QBank

Kaplan’s QBank is an excellent resource for both the USMLE and COMLEX, especially when studying for the clinical knowledge sections. It covers a broad range of topics and provides a good balance of clinical cases and basic science. Using Kaplan’s QBank allows you to tackle both exams using a single comprehensive resource.

2. Pathoma

Pathoma is indispensable for studying pathology, which is critical for both USMLE Step 1 and COMLEX Level 1. Its concise and high-yield focus on the key pathology topics will help you retain essential information. The use of Pathoma in both study plans ensures you are mastering the fundamental concepts of pathology and that you’re adequately prepared for the exam.

3. SketchyMedical

SketchyMedical is a visual study resource designed for microbiology, pharmacology, and pathology, which are all essential topics for both the USMLE and COMLEX exams. Sketchy’s unique method of combining visuals with stories helps make complex topics easier to understand and recall.

4. UWorld

UWorld is essential for USMLE Step 1 and Step 2 CK preparation, but it can also be used for COMLEX. The question bank offers a great mix of basic sciences and clinical questions that apply to both exams, though you should supplement your study with osteopathic-specific resources for OMM preparation.

Tips for Studying for Both Exams

1. Use a Primary QBank and Supplement with OMM-Specific Resources

If you are studying for both the USMLE and COMLEX, it is crucial to use a primary QBank such as UWorld or TrueLearn and supplement it with OMM-specific resources like Osteopathic Medical Board Review and Dr. Rocco’s OMM lectures. This approach ensures that you get a solid foundation in the basic and clinical sciences while also addressing the unique osteopathic focus of the COMLEX.

2. Start with High-Yield Topics and Build from There

Start with high-yield topics that are commonly tested for both exams. For the USMLE, these include pathology, microbiology, and pharmacology. For the COMLEX, focus on osteopathic principles and OMM, but don’t neglect the basic sciences. Once you’re comfortable with these topics, move on to more specialized subjects.

3. Study in Phases

Divide your study time into phases based on the level of the exams. Begin with Step 1 or Level 1 preparation, as this provides the foundation for both exams. Afterward, you can shift to Step 2 CK or Level 2 CE, which focus more on clinical knowledge. Step 3 and Level 3 focus on applying this knowledge in patient care settings, which is best tackled once you’ve finished your clinical rotations.

4. Simulate Exam Conditions

Practice taking timed practice exams to get used to the pressure of the real exam day. Both the USMLE and COMLEX exams are long and require mental endurance, so it’s essential to build this stamina beforehand.

Studying for both the USMLE and COMLEX exams requires careful planning and dedication. Using the right study resources and timing your preparation appropriately will help you navigate the content and question styles of both exams. While there is significant overlap in the subjects tested, focusing on OMM for COMLEX and understanding the distinct features of each exam will give you the best chance for success. Make sure to also stay consistent, track your progress, and adjust your study schedule as necessary to stay on track.

Future of Medical Licensing

In recent years, a significant change has occurred in the U.S. medical residency application process. There has been a shift toward a unified match system. Previously, the American College of Graduate Medical Education (ACGME), overseeing allopathic (MD) residency programs, and the American Osteopathic Association (AOA), overseeing osteopathic (DO) residency programs, ran separate systems for residency applications. MDs and DOs applied to different pools for residency spots, each with its own rules and timelines. However, a merger of the two systems has led to a more streamlined process. Now, MD and DO students apply for residency positions through the same application and match system.

This development is part of an ongoing effort to promote integration between allopathic and osteopathic training programs. The Single Accreditation System, which began in 2020, unified ACGME-accredited residency programs for both MD and DO graduates. As a result, all U.S. residency programs are now under the ACGME umbrella, and students from both MD and DO schools can apply to any residency program through a single platform: the Match Program.

A Unified Match Process

This shift toward a single match process has several key implications for students, residency programs, and the future of medical training in the United States:

Increased Opportunities for DO Students

For osteopathic students (DOs), the unification of residency programs provides greater flexibility and opens up more options. Previously, DO students had limited access to certain residency programs that were exclusively available to MD graduates. With the merger, DO students can apply to all residency programs, whether traditionally allopathic or osteopathic, which increases the range of specialties and locations available to them.

A More Inclusive Residency Match

The unified match system means that both MD and DO graduates now compete for residency spots within the same pool. This system allows for a more inclusive and comprehensive match process, in which program directors can review applicants without distinguishing between MD and DO students. While this is seen as a step toward greater integration, it also means that residency programs may now expect students to demonstrate broader competencies and qualifications, regardless of their training background.

Challenges in Residency Selection

Despite the increased flexibility for DO students, one question remains uncertain. How will residency program directors view COMLEX scores versus USMLE scores? The USMLE is the standard for MD students. It is widely recognized by allopathic residency programs and has historically been seen as the more competitive exam. COMLEX, required for DO students, includes osteopathic-specific content, like Osteopathic Manipulative Medicine. This content may not always align with the general focus of MD programs. The growing trend of DO students taking both the USMLE and COMLEX will likely influence this dynamic.

DO students aiming for competitive residency programs, especially in specialties like dermatology, neurosurgery, and plastic surgery, may benefit from taking the USMLE along with the COMLEX. Some residency directors still prefer USMLE scores, particularly for programs traditionally dominated by MD graduates. However, others may start recognizing COMLEX scores as part of a broader qualification package. The future direction of this issue remains unclear and may vary across programs.

The Changing Role of COMLEX in the Unified System

With the single accreditation system in place, COMLEX may see changes ahead. DOs and MDs now apply through the same Match, which could shift COMLEX’s role. The exam remains essential for DO students to graduate and obtain licensure. However, future residency programs may focus more on a broader skill set rather than comparing USMLE and COMLEX scores. Over time, program directors may rely less on licensing exams. Instead, they may prioritize clinical experience, letters of recommendation, research, and interview performance.

The Importance of Personal Goals and Residency Plans

For DO students considering both the USMLE and COMLEX, it is crucial to evaluate personal goals and residency aspirations. If a student is aiming for a specialty traditionally dominated by MDs, such as orthopedic surgery or dermatology, the USMLE may open doors to more programs. For students pursuing primary care specialties, COMLEX alone may be sufficient. Osteopathic programs tend to focus on COMLEX scores.

The Role of USMLE for IMGs

International medical graduates (IMGs) may also be affected by these changes. IMGs who want to apply for U.S. residency programs must take the USMLE. The COMLEX is not recognized by the National Residency Match Program (NRMP) for IMGs. With MD and DO residency programs now integrated under one system, future changes could impact IMG pathways. Currently, IMGs rely only on the USMLE for residency applications. However, the unified match system might introduce more flexibility or new considerations for IMGs.

Key Considerations for DO Students in the Unified Match System

Take Both USMLE and COMLEX: For DO students who want to maximize their chances of matching into highly competitive residency programs, taking both USMLE and COMLEX is a strategic move. This ensures eligibility for both allopathic and osteopathic residency programs, allowing for a broader range of options.
Focus on Program Requirements: When planning for residency, it is important for DO students to carefully research the requirements of their desired residency programs. Some programs may require or highly value USMLE scores, while others may be more focused on COMLEX performance.
Long-Term Considerations: As residency programs continue to evolve under the unified match process, it is essential to stay updated on any changes in the evaluation criteria. The ongoing trend of program integration may eventually lead to shifts in how exams like USMLE and COMLEX are viewed by residency directors.

The Future of USMLE vs. COMLEX

The shift to a unified match process has created a more integrated and flexible residency application system. However, it has also introduced uncertainty regarding the future role of COMLEX versus USMLE. While both exams remain essential for different groups of students, the evolving landscape of medical training in the U.S. means that residency directors may eventually place less emphasis on the specific exam scores and focus more on a candidate’s overall qualifications, including clinical skills, research, and other competencies.

For DO students, taking both USMLE and COMLEX remains a prudent choice for maximizing residency options, especially in competitive specialties. However, the future of COMLEX in the unified residency match system will depend on how program directors evolve their approach to evaluating applicants from diverse training backgrounds. Until more clarity emerges, students must carefully assess their individual career goals and make informed decisions about which exams to take based on their specialty interests and residency aspirations.

FAQs for USMLE vs. COMLEX

1. Can an osteopathic student apply for an allopathic residency without taking the USMLE?

Yes, osteopathic students can apply for allopathic residency programs without taking the USMLE. However, many allopathic residency programs prefer or require USMLE scores as part of their selection criteria. While the Accreditation Council for Graduate Medical Education (ACGME) recognizes COMLEX, some programs may still favor applicants with USMLE scores, especially in competitive specialties. Taking the USMLE alongside COMLEX can provide osteopathic students with more residency options and increase their competitiveness.

2. How do USMLE and COMLEX exams differ in terms of question style and content?

The USMLE and COMLEX exams cover similar foundational medical knowledge, but their question styles and emphasis differ. The USMLE follows a case-based, clinically oriented multiple-choice format that focuses on pathophysiology and medical decision-making. COMLEX, on the other hand, includes questions related to osteopathic principles, particularly Osteopathic Manipulative Medicine (OMM). Additionally, COMLEX questions often require second- or third-order reasoning, whereas USMLE questions tend to be more direct in their clinical approach.

3. Is it necessary to take both exams if I am unsure about my residency path?

If you are an osteopathic student uncertain about whether you will pursue an osteopathic or allopathic residency, taking both the USMLE and COMLEX can provide flexibility. This ensures that you meet the requirements for both types of programs, keeping your options open. However, taking both exams requires additional preparation time and financial investment. If you are confident in pursuing only osteopathic residency programs, then taking only the COMLEX should suffice.

4. What are the costs associated with taking the USMLE and COMLEX?

The costs of both exams include registration fees, travel expenses, and preparation materials. The USMLE Step 1 and Step 2 CK exams each cost approximately $1,000 for US students, with additional fees for international testing centers. The COMLEX Level 1 and Level 2-CE exams cost around $700–$800 per exam. Additionally, students often invest in study resources, such as QBanks and review courses, which can add several hundred to a few thousand dollars in expenses.

5. How will the transition to a unified residency match system impact the USMLE and COMLEX?

With the transition to a single accreditation system for residency programs, osteopathic and allopathic residencies now fall under the same match system. This change increases the acceptance of COMLEX scores in traditionally allopathic programs. However, some competitive specialties and programs may still prefer USMLE scores for standardized comparison. It is advisable to check specific residency program requirements and consult academic advisors to determine if taking the USMLE in addition to COMLEX is beneficial.

Conclusion

Navigating the USMLE vs. COMLEX decision can be challenging, especially for osteopathic students and international medical graduates (IMGs). While IMGs must take the USMLE, osteopathic students face the decision of whether to take both exams or only COMLEX. The best approach depends on residency goals, specialty competitiveness, and program requirements.

If you are considering taking both exams, strategic preparation is essential to minimize additional study time and financial burden. Reviewing question formats, leveraging overlapping study resources, and carefully planning the timing of both exams can improve efficiency and success.

Ultimately, the decision between USMLE vs. COMLEX should align with your long-term career goals. Consulting academic advisors, researching residency requirements, and evaluating your specialty interests will help you make an informed choice. With proper preparation and a clear strategy, you can optimize your chances of securing a residency in your preferred specialty and location.