9 tips for crushing board exams

Around the end of your second year of osteopathic medical school, you’ll take COMLEX-USA Level 1. MD students, and some DO students, also elect to take USMLE Step 1, though most residency program directors use and the AMA and the ACGME support using COMLEX-USA for DO applicants. Making a game plan for test prep can be stressful and difficult, but you can approach exams confidently with these helpful hints.

Vanessa Halvorsen, DO, an otolaryngology resident, offered students her advice on these exams during the AOA’s House of Delegates meeting. Dr. Halvorsen aimed for high scores that would help her land a residency slot in a competitive specialty.

Here are 9 tips on board prep from Dr. Halvorsen and three test-prep experts.

1. Find ways to stay calm and confident

When taking boards, the No. 1 most important thing is to be in a sound mindset, Dr. Halvorsen says.

“Your preparation and mental health routines will help you feel confident and avoid self-doubt,” she says.

Think of techniques that will help you maintain a sense of calm and center yourself before and during the exam, she says.

Dr. Halvorsen’s favorite calming activity was dancing to Kanye West. She’d put a song on every morning and dance while envisioning the score she wanted and punching the air. But different things work for different people, she says, noting that her friend practiced yoga before her exam and during breaks.

2. Visualize the score you want

Many students are aiming for a specific score. Seeing this number in your mind’s eye can provide motivation and a confidence boost, Dr. Halvorsen says.

“I wrote down the score I wanted to get,” she says. “I would repeatedly tell myself that I was going to get that score.”

3. Choose a few study resources that work for you and stick with them

To avoid overwhelming yourself, don’t use too many different study resources, Dr. Halvorsen noted. Everyone’s learning style is different—try to find the resources that work for you and stick with them.

Here are the resources Dr. Halvorsen, current students and DO leaders recommend:

• UWorld and COMBANK (question banks): Dr. Halvorsen used COMBANK alongside UWorld during second year. She did a first pass of UWorld during her second year, then redid it in April.
• First Aid (book): “Everyone tells you to memorize First Aid,” Dr. Halvorsen says. “That’s your money-maker book.”
• Boards & Beyond (video series): “Boards & Beyond takes everything you’re learning in class and puts it in a 10-minute video,” says Jenna Campbell, OMS II, of the Philadelphia College of Osteopathic Medicine. “It’s good for visual learners because they have a lot of diagrams and pictures. It’s a really good tool for someone who doesn’t want all of their studying to be reading and book-based.”
• SketchyMedical (image-based learning): “Sketchy Micro/Pharm is a resource a lot of my cohort used to prepare for the exam,” Dr. Halvorsen says. “It provides pictorial pneumonic devices to help you memorize and learn high-yield topics.”
• COMSAE: NBOME’s low-cost practice exams allow students to experience authentic COMLEX-USA content and test-taking timing.

4. Don’t pay too much attention to what your classmates are doing

Dr. Halvorsen suggests taking all board prep advice—including her own—with a grain of salt.

“I recommend putting on blinders to what everyone else is doing,” Dr. Halvorsen says. “What works for you is probably going to be different than what works for your classmates. Applaud their efforts, but do your own thing.”

Also remember that everyone has different goals for the exam, she notes, with various target scores in mind.

5. Develop a schedule and stick to it

“Write in your planner what you want to do each day and give yourself time restrictions,” Dr. Halvorsen says. “You can easily spend too much time studying one thing.”

For example, you might put 6-11 a.m., GI, and 12-5 p.m., ob-gyn. Force yourself to move on when your allotted time is up, even if you’re not done, to make sure you’re covering everything you need to.

Make sure to schedule mental health breaks in your planner as well, including time to eat and work out, Dr. Halvorsen notes.

6. Choose the amount of dedicated study time that works for you

Dr. Halvorsen started studying for boards at the beginning of second year, then did a month and a half of dedicated board prep time leading up to the exams. Others might need more or less time to prepare, depending on their learning style and their goals.

“One of my friends only needed three weeks of dedicated study time,” she says.

With exam prep, it’s common for students to underestimate their weaknesses, says Niket Sonpal, MD, a recognized test prep expert and internal medicine associate program director at Brookdale Hospital Medical Center.

“Add 15% to the amount of time you think you should study,” suggests Conrad Fischer, MD, a board test prep expert and associate professor of medicine at Touro College of Osteopathic Medicine.

7. If you are advised to take both exams, take USMLE before COMLEX

COMLEX is required for both graduation and licensure, experts note, and the AMA and ACGME support use of it for DOs applying to residency programs. “I recommend taking USMLE first,” Dr. Halvorsen says. “I wanted to finish USMLE and then have dedicated time to focus on osteopathic concepts.”

Dr. Halvorsen took COMLEX Level 1 a week after taking USMLE Step 1. In between the exams she took a few days to relax and then did COMBANK questions for five days and brushed up on osteopathic manipulative medicine. Be sure you understand the differences between the two test blueprints and also allow enough time to rest before taking COMLEX-USA.

8. Take practice exams

Affordable practice exams are available and highly recommended by Dr. Halvorsen.

“If you do this, you’ll know how long it takes you to get to the testing center, where to park, and what the testing environment will be like,” she says. “You can eliminate a lot of the potential stressors of exam day this way.”

NBOME’s website offers free online tutorials, and students can schedule a practice run and tour at Prometric testing centers in advance. This is especially helpful if you are anxious about the test center environment.

9. Set expectations with your family and friends

Many students go home to study for their board exams.

Talk to your family and friends about the intensity and importance of the exams, and explain to them that you’ll need to spend time by yourself studying, says Amanda Deel, DO, assistant dean for clinical education at New York Institute of Technology’s Jonesboro, Arkansas, campus.

“If you’re around people who are not in the medical education frame of mind, you need to help them understand that you can’t take an afternoon off,” Dr. Deel says.

Related reading:

Failed COMLEX or USMLE? What it means for matching into residency

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