Conquering COMLEX

Your COMLEX questions answered

Learn popular study aids and methods along with the answers to your other questions about this three-part licensing exam.

Editor’s Note: This story was updated on Nov. 13, 2018, to include new information and updated surveys.

Putting the DO initials after your name requires passing a three-part medical licensing exam. During your second year of medical school, you’ll come face-to-face with the COMLEX Level 1. Sometime during your third or fourth year, you’ll meet COMLEX again to take Level 2-CE and Level 2-PE. The third part, COMLEX Level 3, you’ll complete during your residency. Only then will you be a fully licensed physician, which will allow you the freedom to moonlight and more.

Ready to start thinking about the exam? AOA Trustee Sarah Wolff, DO, advised students on the COMLEX, U.S. Medical Licensing Exam (USMLE) and studying during the Mentor Cafe at the 2017 AOA House of Delegates. Here’s what she shared with COMLEX-conquering hopefuls.

1. Do I need to take COMLEX and USMLE?

In order to graduate from an osteopathic medical school, students are required to pass the COMLEX (Levels 1, 2-CE and 2-PE). Some schools, such as the Rocky Vista University College of Osteopathic Medicine, require students to take the USMLE Step 1 exam (beginning with the class of 2017) as well.

Before taking both exams, consider factors such as your desired specialty and preferred residency location, as well as the time and money required to obtain passing scores.

“You have to think for yourself about why you would take more than the COMLEX,” Dr. Wolff says.

2. Do residency program directors prefer one exam to the other?

About 70 percent of all residency program directors—including those at AOA-accredited and ACGME-accredited programs—use the COMLEX Level 1 for evaluating DO students, according to the National Resident Matching Program’s 2018 Program Director Survey. The COMLEX is also the only licensing exam that evaluates the distinctive osteopathic principles and practice you learned in medical school.

The main purpose of the USMLE and COMLEX is for physician licensure, but it’s also used by program directors to evaluate residency applicants, according to the American Association of Colleges of Osteopathic Medicine.  AOA and ACGME accreditation standards don’t require program directors to use either licensing board exam. Residency program directors determine which exam scores they will accept.

If you’re unsure how familiar a program director is with the COMLEX, Dr. Wolff suggests bringing brochures to residency interviews to help directors assess your score.

“If you are a strong candidate for a program and they want you, asking them to check your COMLEX is not going to exclude you,” Dr. Wolff says.

There is also a COMLEX percentile score conversion tool available online and an iOs app you can share with program directors.

3. How should I study?

The earlier students begin studying for the COMLEX-USA Level 1, the more likely they are to score 600 or higher on it, according to a study published in the Journal of the American Osteopathic Association.

Study board-like questions in conjunction with your class material and start at least six months out from your scheduled exam date, Dr. Wolff recommends. As your exam date gets closer, ramp up your studying.

There is no one plan that works for every student, so customize a study plan that works best for you. However you decide to study, make sure to include breaks in your schedule.

About a week or two out from your exam date, take a practice exam like the Comprehensive Osteopathic Medical Self-Assessment Examination to gauge your readiness, Dr. Wolff says. The score is a good indicator of how well you will perform on the COMLEX.

4. How do I find the right study aid?

With the plethora of resources available to prepare for the COMLEX, use a study aid that best fits your learning style.

“Use material that best suits your learning style. You don’t want to be studying and realize you didn’t get as much out of it,” Dr. Wolff says.

Trust your judgment and stick with the studying methods that have worked for you when you’ve prepared for tests in your classes.

“Don’t buy into a program because everyone around you is, know what worked for you as you studied your coursework,” Dr. Wolff says.

If you learned from listening to a lecture, then consider an online lecture-based course. If you studied better at home from books or actively engaged with others, use those techniques instead.

5. What resources should I use?

Dr. Wolff says many students decide to use question banks to help them prepare. Doing practice questions allows you to apply concepts instead of just memorizing them.

 Popular COMLEX Study Resources





Doctors in Training


OMT Review by Savarese – the standard OMM review book (“the green book”)

First Aid


If you do decide to use question banks to study for the COMLEX, make sure to use a COMLEX-specific question bank. While exam content for the COMLEX and the USMLE is similar, question styles differ. A COMLEX study bank will also have osteopathically focused questions.

 The most helpful study aids*

Review book: First Aid for USMLE

Question bank: COMBANK

Lecture videos: Kaplan USMLE

Practice examination: COMSAE

(*According to a JAOA study about the predictors of scoring at least a 600 on COMLEX Level 1) 


  1. DO From the Trail

    Taking the USMLE is a must… you cannot be competitive regionally if you do not take it. And bringing brochures explaining the COMLEX is a bad idea, most PDs will find that very very odd, comical at best, and mistrust the exam even more than they do.

    I suggest to the NBOME: Merge yourself with USMLE, add a “supplemental” section to the exam dealing with OMM. This will start the process of MDs seeing DOs as equals (as far as residency is concerned). There is a bias, I am recognizing this as I try to match, and the AOA and NBOME should be using all their time making sure we are competitive, and having separate exams is the wrong answer.

    -DO from the trail…

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