Should DO Students Take Both USMLE and COMLEX?

  • /Reviewed by: Amy Rontal, MD
  • Here’s what med students are saying.

    You’re making your way to being a doctor, and those infamous board exams are looming on the horizon. As a med student at an osteopathic college of medicine, you’ve probably heard about taking the COMLEX-USA Levels (as they are known) for graduation and admittance into residency programs. The COMLEX Levels are effectively the osteopathic analog of the USMLE Steps for licensing MD physicians. In the past, students from osteopathic medical schools were required to take the Step exams to qualify for MD residencies. This can leave DO students wondering if they wouldn’t be viewed as competitive applicants to MD residencies without the USMLE Steps. Will they need to juggle a study load for two licensing exams or will they make themselves ineligible for allopathic residencies by only doing the COMLEX Levels?

    To compound the confusion, US medical residencies for DOs and MDs have been integrated into a single residency accreditation system with the intention to create equivalency between DO and MD students. Technically speaking, this change allows DO students to take only the 3 COMLEX Levels for licensing and residency placement. It no longer requires them to also take the USMLE Step exams. However, the integration of the two residency accreditation structures (osteopathic/DO and allopathic/MD) did not reconcile the differences in scoring systems between COMLEX and USMLE. There is no standardized way to convert between scores, so residency program directors who aren’t accustomed to the COMLEX scoring system may not have as much confidence in DO applicants without USMLE scores. Being a DO student with USMLE scores will put you on the same footing as MD students, something that even the American Association of Colleges of Osteopathic Medicine acknowledges.

    This reason is why many of Cram Fighter’s Campus Heroes attending DO schools suggest that osteopathic med students take the USMLE Steps in addition to the COMLEX Levels. Students Melvin, Kristen, and Osama found studying for both USMLE and COMLEX helpful because the material is so similar. According to Melvin and Kristen, studying for USMLE board exams gives a good baseline of medical knowledge that can also be applied to COMLEX, and from there, students just need to cover the additional osteopathic components. For Osama, taking both exams was a synergistic way to build his medical knowledge base and keep up the motivation to reach the finish line for both COMLEX and USMLE. Additionally, Osama was clear to emphasize that he found the main difference between COMLEX and USMLE not to be the material, but the question styles, so familiarity with both approaches is crucial.

    For other students who Cram Fighter heard from, though, the decision to take both exams isn’t quite as cut and dry. Joshua and Daniel both are also attending DO schools, but recommend considering which specialty you’ll be pursuing before plunging into both the COMLEX and USMLE. The more competitive specialities like surgery, radiology, and dermatology would warrant adding in the USMLE because you’ll want to make your capabilities clearly comparable to MD students when program directors will be reviewing your application. But for DO students interested in entering the less competitive fields, such as family medicine or internal medicine, there may be value in just taking the COMLEX Levels and forgoing USMLE Steps so that you can focus more deeply on COMLEX.

    The timing of when to take each exam is also a critical decision for how to manage your studying and prep. Kristen chose to space out taking the two exams only a week apart, with the USMLE first and COMLEX second. This allowed her the opportunity to emphasize studying the overlapping material for USMLE, and then do a strong review of osteopathic techniques for COMLEX. Juggling two distinct exams was manageable because “Cram Fighter let me set two different test dates, and have my list of what I had to do specifically for COMLEX once the USMLE was over.”

    With the huge range of possible topics covered on both the COMLEX Levels and USMLE Steps, you definitely need to have a game plan for which study materials to use. Anthony, another osteopathic med student who Cram Fighter interviewed, found a number of helpful resources for both exams that could be scheduled and organized for practice using Cram Fighter. For his Step 1 and Level 1 exams, Anthony used Pathoma, Boards and Beyond, Anki card decks from SketchyMicro and Pharm Anki, and the question banks from UWorld, which were all key resources for his success. In addition to the materials Anthony used, other 3rd- and 4th-year med students have largely suggested using Savarese OMT, First Aid, TrueLearn, and COMBANK question blocks as helpful study resources.

    While the thought of taking both the COMLEX and USMLE may feel overwhelming, actually completing the two exams is certainly a manageable task and may prove to be incredibly valuable when you’re up for the residency match. And whether you take both or not, Cram Fighter’s here to help you reach the finish line with whatever materials work best for you. You can build a study schedule for both the USMLE and COMLEX in parallel using the Study Blocks feature in Cram Fighter so you can set up two different study schedules for your different exam dates. To try Cram Fighter for yourself using this feature, sign up for a free, no-obligation 7-day trial here. Good luck on your exam(s)!

    About the Author

    Erica Forrette is the former Director of Marketing at Cram Fighter.