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Here are the perennial questions asked by osteopathic medical students: Should I take the USMLE? Or is it enough to take only the COMLEX Level 1? So what should you do?

The answer is simple: In almost every case, take both!

At Med School Tutors, we hear all sorts of excuses for why students do not want to take USMLE and COMLEX. Some fear that they will need two separate courses of preparation. Other DO students fear the USMLE because they feel that they have not been adequately prepared for the exam in their osteopathic medical school curriculum. Sometimes, there is even fear related to a student’s marginal MCAT performance leading her to believe that she is academically inferior to her MD counterparts and, therefore, unable to be successful on the USMLE. Other times, medical school faculty will tell students there is no need to take both the USMLE and the COMLEX, and that it is just a waste of money.

Unless you are completely sure and 110% confident of the field you want to pursue, and know for certain that field does not require the USMLE, we strongly encourage you to take both exams. And, if you’re worried by any of the concerns above, consider these pearls of wisdom aggregated from hundreds of student experiences.

Fear of Two Exams

There is no doubt about it. COMLEX Level 1 and USMLE Step 1 are very different exams in terms of structure and question style. However, when it comes to content, the exams are actually much more similar than they are different. 

Both exams cover the basic sciences and clinical sciences that are traditionally covered in the first two years of medical school, and both use things like graphs, tables, and images to test your knowledge. There are differences in the two exams that need to be accounted for in your study plan (covered in a different post), but these differences account for no more than about 10% of your total preparation. Therefore, we can say confidently that you will really be doing about the same amount of preparation that you would be doing if you were only taking one exam.

Fear of Inadequate Medical School Preparation


After having gone to a DO school, and tutoring many DO students as well as MD students (both US trained and FMGs) for licensing exams, I can tell you that most people are not prepared for the licensing exams in medical school – regardless of which medical school they attended.

The first two years of medical school are not designed to prepare students specifically for the USMLE or COMLEX. What they are designed to do is to teach a core curriculum that will be tested on those exams. The specific preparation for the actual exams, including testing style, however, is up to the student. That is why we have spent so much time perfecting exam preparation. We believe that anyone with basic knowledge, good work ethic, and a solid study plan can be successful on both the USMLE and COMLEX. 

Fear of So-Called “Inferiority” to MD Students

There are many reasons a person may end up attending a DO school as opposed to a U.S. MD school, including a simple preference for the school and family tradition. There are those people who end up attending DO schools in the US because historically, DO schools accept students with somewhat lower MCAT scores and college GPAs. This leaves many DO students with an “inferiority complex,” especially when it comes to standardized test taking and the USMLE. 

However, it must be remembered that the USMLE has several differences from the MCAT. The most important of those differences is that the USMLE is a much more predictable test than the MCAT and is much easier to prepare for. While test-taking skills are important for both exams, the MCAT is somewhat more heavily weighted towards test taking skills, while the USMLE is more heavily weighted toward knowledge. In our experience, if a DO student has paid their dues with a properly designed and well-executed study plan, they should have no problem being successful on the USMLE.

Fear of Wasting Time and Money

In terms of being a waste of money, I will not mince words with you. There are residency programs out there that are very happy to accept DO graduates, but would like a method for comparing applicants in a head to head manner. If an applicant has taken a different exam than all of the other applicants, they may feel that it is too difficult to make the comparison and just not bother. The cost of taking an extra exam is a drop in the bucket when looking at the totality of your medical education, and miniscule if it will allow you to get your dream position that you might otherwise be unable to obtain. 

You will not be wasting time by taking both exams either. We have already discussed above how the actual preparation for one exam is not much different than it is for taking both exams. Therefore, the extra time needed for taking the USMLE is basically one extra day for taking the actual exam. If this allows you more options in your training, and perhaps your future career, it is more than worth the time.

Should Everyone Take Both Exams?

Ideally, yes. That said, we understand that there are circumstances that may make it difficult for you (or your peers) to do so. In fact, there are times when even we would recommend that you concentrate on either the COMLEX or USMLE. Sometimes it is essential to focus only on the COMLEX since it is the required test for osteopathic residency and graduation from med school. There may be other exceptions too, but it is impossible to cover all of them in a blog post like this one. If you have any questions about medical licensing exam preparation, please feel free to reach out to us for a free consultation.

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Dr. Tzvi Doron

Dr. Tzvi Doron

Tzvi has been teaching, tutoring and training others to achieve their personal best for the last 11 years. After excelling on his Board exams, Tzvi brought his broad range of experience to Med School Tutors, where he has helped other aspiring doctors to achieve their own medical dreams. He is a graduate of Brooklyn College and Nova Southeastern University College of Osteopathic Medicine. He is currently practicing as a primary care physician.
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