Blog Post Focus
This blog post will focus on preparation for the COMLEX and USMLE exams. They are important exams. Changes have come about recently to pass/fail scoring on some exams, but preparation is important regardless.
Personal Story – COMLEX and USMLE During My Time
Preparing for the COMLEX and USMLE exams has changed since my time. When I was in medical school these exams had values associated with them for each COMLEX LEVEL and USMLE STEP. These were extremely valuable too. The higher the value the more likely to match into residency of any specialty. Why? Because it was something objective that every program had access to that could compare applicants.
These tests at each STEP/LEVEL were highly important for matching to residency. The first two STEP and LEVEL exams were particularly important as these exams and their scores would be available to residency program directors.
Students Were Responsible for Their Studies, and Schedules Varied Greatly by School
Every student was responsible for how they would prepare for the exams. Some medical schools and students would set up dedicated studying for months prior to these exams while some other medical schools and students would merely take weeks.
Most students’ schedules were highly dependent on their medical schools—some has built in periods of months of boards preparation, whereas some schools had none and required students to take vacations to study for these exams (such as my medical school—it was quite a shock to hear how much protected study time some schools gave their students for these exams).
Most People Passed, but Most Utilized Dedicated Study
From my personal experience I think anyone who employed good study habits throughout their schooling would pass no problem. However, those who have poor study habits would require at least a few weeks of dedicated preparation for these exams to pass, and anyone would need several weeks of preparation to expect to perform in the top percentiles.
These exams are unique to any you have taken before. It takes time to get used to these exams with regular question taking and to simulate the exam itself takes a full day. Note, changes have been made since I took these exams and prepared for them.
My Schedule
I had taken both the USMLE and COMLEX exams, generally within the same week of each other. For STEP 1 and 2 and LEVEL 1 and 2 I had not had good study habits and I generally felt like I did the majority of my learning during the 4 weeks of prep I had prior to STEP 1 and LEVEL 1 and 3 weeks of prep I had prior to STEP 2 and LEVEL 2.
Medical School Was a Barrier
Unfortunately, I felt my medical school was a large barrier to preparing well for these exams initially and then clinical rotations were a much bigger challenge. Ultimately, I look back and realize that I could have studied so much better for these exams during the four years of medical school, despite barriers that medical school itself and clinical rotations played.
My habits had improved for LEVEL 3 and by then I didn’t have to spend so much preparation time and felt much more confident going into these exams – just like I could have with STEP 1 and 2 and LEVEL 1 and 2.
Changes to USMLE and COMLEX
January 26, 2022 the USMLE STEP I exam became pass/fail rather than scored and on May 10, 2022 the COMLEX LEVEL 1 exam became pass/fail rather than scored.
Changes to Residency Importance?
Because the LEVEL 1 and STEP 1 exams are both pass/fail now they carry less weight for residency. Now, they come with different profiles. The STEP 1 exam report details how the exam was weighted per content area rather than how examinees compared to each other. The exams in the past potentially would give a sense of how strong one’s medical knowledge base was (barely passing vs a nearly perfect score is a huge difference).
Now, STEP 1 has a lesser interpretive value. See the example of the STEP 1 passing profile here. LEVEL 1 scores come with a formative performance profile (see more here) that give the examinee some sense of their overall performance compared to other test takers.
Advice
Regardless of whether the exams are scored or pass/fail, STEP 1 and LEVEL 1 exams ideally would give you a sense of whether or not your overall medical knowledge base is strong, which would give some sense of how good yours study habits are.
Note, the other LEVEL exams (2 and 3) and STEP exams (2 and 3) are scored as of the time of writing this article.
The Most Important Part of USMLE and COMLEX
The most important thing for LEVEL 1 and STEP 1 now is to simply pass the exams. However, for LEVEL 2 and 3 and STEP 2 and 3 it is still highly important to do well as these would show how well you have prepared and the strength of your foundational medical knowledge.
At every point in medical school, including board preparation, it is important to feel that you have a solid medical knowledge base. You should feel comfortable and confident going through practice exams and during test day itself.
Final Thoughts—Take The Exams Seriously and Prepare
I recommend anyone preparing for any of the COMLEX or USMLE exams take several weeks to prepare for these exams. Develop plans for that entire time you have decided to set aside for preparation for these exams. If you have good study habits, great! Now is the time to continue employing them and improving your medical knowledge and comfort with the setup of the test(s) you must take.
If you have poor study habits—figure out whatever you need to be comfortable for these exams at this time. Trying to dramatically change habits right before these incredibly important exams may not be beneficial. Instead, if this period feels like a wake up call that you need to make some major changes to your studying, then start doing so after the exam. If you are starting out well ahead of time though, check out some of our posts on good and bad studying habits in medical school here.
The Question Banks I Used for Preparation
USMLE: UWORLD. The classic USMLE study resource.
COMLEX: TrueLearn. I felt like this had decent OMM-style questions. Otherwise, I also felt my UWORLD USMLE studying prepped me for the COMLEX quite well outside of lacking OMM questions.