COMLEX / DO students
Draft · not yet reviewed by AlexCOMLEX for DO students: Level 1, Level 2 and how they fit with the USMLE
The short answer
COMLEX is the board exam series for DO students, written by the NBOME, and you need it to graduate. The topics overlap heavily with the USMLE, but the questions are shorter and lean more on recall, plus osteopathic manipulation. If you take both, study primarily for the USMLE and mix COMLEX-style questions into dedicated rather than saving them for the end.
What is COMLEX?
COMLEX is the board exam series for osteopathic (DO) students, written by the NBOME. The USMLE (NBME) is the series MD students take. Many DO students take both.
| USMLE (NBME) | COMLEX (NBOME) | |
|---|---|---|
| Phase 1 | Step 1 | Level 1 |
| Phase 2 | Step 2 CK | Level 2 |
| Required for DO graduation | No | Yes |
| Osteopathic manipulation content | No | Yes |
Level 1, like Step 1, is reported pass/fail. Level 2 is scored. Exam formats, components and policies change, so check the NBOME's current information when you register.
How is COMLEX different from the USMLE?
The topics are pretty much the same, and both exams stress the same nuances. The bigger differences are in how the questions are written.
- Shorter stems. COMLEX questions get to the point faster.
- More recall, less reasoning. Some questions turn on whether you know a specific detail, not on whether you can reason your way there.
- Osteopathic manipulation. OMM questions are part of the exam.
The full comparison is in USMLE vs COMLEX.
Should I take the USMLE too?
That depends on your specialty goals and the programs you're aiming at. I took both, and for a competitive field like orthopaedics I'm glad I did. The reasoning is in should DO students take the USMLE.
How do I prepare for both at once?
Go all in on the USMLE. In my view it's the more important exam overall, and its questions require a deeper understanding. If you can handle USMLE-style reasoning, most COMLEX content follows.
Then protect yourself on the COMLEX:
- Mix COMLEX-style questions into dedicated regularly, so the shorter, recall-driven format isn't new on test day.
- Study OMM during dedicated, not after Step.
- Take a COMLEX-style practice exam before the real one. Mine went well and gave me a confidence boost when I needed it.
Don't let the USMLE crowd the COMLEX out entirely. It's easy to treat the second exam as a formality when the first one feels more important, but you need to pass the COMLEX to graduate, and doing significantly worse on it than you're capable of is avoidable with a little steady practice.
Everything else about prep is shared. Start with how to study for Step 1 or how to study for Step 2 CK.
What are the days between exams like?
Harder than they sound. You've just finished a full-day exam, you're replaying questions, and you know you have to do it again in a few days. After Step 2, I had no motivation to study, and I spent most of the gap just trying to get back to the mindset I'd had before the first exam. Then I drove three hours to take Level 2.
What I'd do and skip in those days is in the gap between exams.
When should DO students start planning for it?
Earlier than you'd think. The decisions that shape your COMLEX experience happen in first and second year, not in dedicated.
- First year: know that you'll take COMLEX, and that the USMLE is a choice. Build your study habits around board-style resources from the start.
- Second year: decide whether you're taking Step 1 as well as Level 1, and plan both dates with your school's calendar. See when to schedule Step 1.
- Third year: your rotations feed directly into Level 2. DO students often have more variable rotation sites, so the daily question habit matters even more when teaching is uneven. See shelf exams.
- Before Step 2 dedicated: decide again. Taking Step 1 doesn't commit you to Step 2 CK, but most people who take one take both.
Planning both exams together, from the start, is what keeps the second one from becoming an afterthought. And as a DO student, the COMLEX is the one you can't skip.
Key takeaways
- COMLEX is required for DO graduation. The USMLE is a choice.
- Same topics, different question style: shorter, more recall, plus OMM.
- Study primarily for the USMLE, and mix COMLEX-style questions in throughout dedicated.
- Don't plan to learn OMM in the days between exams.
- Plan both exam dates together from the start.
Everyone also asks
Do DO students have to take COMLEX?
Yes. COMLEX is the licensing exam series for osteopathic physicians, and your school will require it to graduate. Taking the USMLE as well is a separate choice.
Is COMLEX easier than the USMLE?
Not easier, different. I found USMLE questions harder in the sense that they demanded deeper reasoning. COMLEX questions were shorter and more detail-driven, which was frustrating in its own way.
How do I study for OMM if I'm focused on the USMLE?
Mix COMLEX-style and OMM questions into your dedicated period on a regular basis. Don't plan to cover it in the few days between exams. That time is much harder to use than it sounds.