One of the major problems I’ve noticed students have when preparing for the COMLEX is that they underestimate the importance of Osteopathic Manipulative Medicine (OMM). It is absolutely high yield, and shouldn’t be ignored when studying for any part of the COMLEX. To avoid future suffering, I want to focus now on how to prepare for the OMM portion of the test. 

The 3 Ways OMM is Tested:

There are three prime ways OMM is tested on the COMLEX, and in all reality only 2 out of the 3 matter:

1. Giant vignette about disease X blah, blah, blah BAM! The patient has a posterior fibular head. Is the foot inverted or everted? This question type is annoying in that the huge amount of time you spent reading the vignette above had nothing to do with the question they ask you.

Another way this presents is a giant vignette after which they tell you the diagnosis and then ask where you might find a viscerosomatic reflex associated with that particular disease. My advice: read the answer choices first before you read the vignette to get an idea of what they are asking you for. If they sound OMM-ish, read the last sentence of the question before wasting your time brooding over the rest if the vignette.

2. A short vignette and a straightforward OMM-centric question. These are commonly sacrum or innominate questions.

3. Some sort of OMM finding mentioned in the vignette with a question that is not OMM-centric. These mostly can be ignored. Most of the time reading through the sidebent whatever, rotated whatever, flexed whatever is a waste of time. If you look at the answer choices before you read the vignette, you know that the question is not asking about OMM and the OMM findings in the vignette are usually irrelevant. Save some time and don’t even bother reading or considering them.

What to Study:

There are certain topics within OMM that are certainly more high yield than others. While there are more topics to know, here is a list of some of the most high yield ones:

1. Cranial: COMLEX loves cranial because it is easily testable and there is little controversy of what is taught at different schools about flexion, extension, and strain patterns.
2. Fryette’s Laws:  Because they are laws and therefore have little controversy, again, they are easy to test.
3. Rib Motion: There is some disagreement between which ribs are bucket handle vs. pump handle, but if you have a general idea of rib dysfunction/motion that’s what they test.
4. Sacrum/Innominate: Use the Mitchel Model for the sacrum.
5. Viscerosomatics: There are many varying opinions about which spinal levels correspond to which viscera, but if you have a general idea (e.g. T5-9 for everything that has blood supply from the celiac trunk) you should be fine.
6. Chapman’s Points: These are much more well defined than the viscerosomatics.
7. Counterstain: Know common point locations and treatment.

What Resources to Use:

There really isn’t a definitive resource for OMM review, although by far the best one out there is OMT Review by Robert G. Savarese. This book gives all of the high yield facts for COMLEX and also has many practice questions. Other less definitive resources are:

1. Doctors in Training OMM Review: A short video series that walks you through Savarese. This is a great resource for visual learners.
2. First Aid for the COMLEX: This is not nearly as definitive as its Step 1 USMLE counterpart, but this book helps fill in some of the gaps Saverese has.
3. Clinical Anatomy and Osteopathic Manipulative Medicine: This is a decent Q&A type of book.

(In addition, for your reference, here are some general COMLEX prep tips.)

In Summary:

OMM should, in the end, be easy points on your COMLEX test. There will be times when you get a question you have no idea about, but they are few and far between. Know the high yield topics, use Saverese, and you will be golden.

If you want to be well-prepared on your test day, plan your study schedule COMLEX level 2 & level 1 ahead of time.