I have previously suggested that the vast majority of DO students take Step 1 of the USMLE, and why I think you should not be afraid to do so. The question that often arises is what is the best way to schedule the tests to maximize success on both? While there are many ways to do this that could work, I’m going to make a suggestion based on my own experience as well as that of many of my colleagues and students.
In general, my advice to most students is to take the exams somewhere between 2-7 days apart and to take the USMLE first. Remember that, since the vast majority of the content on both exams is the same, it makes sense that you would be at your peak knowledge for them at the same time. This leaves a relatively small window as nobody can peak for much longer than about a week.
I think generally taking the USMLE first is a good idea because the major difference between the two exams is that COMLEX has anywhere from 5-15% of the questions covering OMM. For most students, 2-7 days is enough time to prepare for OMM and do some additional mixed COMLEX style questions using COMBANK or COMQUEST to get some extra practice with COMLEX specific questions.
So, your study schedule will look something like this:
- 6-8 weeks of full time study covering the basic sciences like biochemistry, pathology, and physiology and how they apply to each system. During this time you will do questions from both UWorld and a COMLEX specific Qbank.
- Take the USMLE.
- 2-7 days studying OMM only and continuing mixed COMLEX-specific questions on all topics covered on the exam with a bit more focus on OMM than other subjects.
- Take the COMLEX.
While this strategy will work for most students, there are exceptions to this rule.
One exception would be somebody who has already failed one or both exams one or more times. For these individuals, it is more important to study hard for the COMLEX and not think about another exam because only the COMLEX is required for DO students to become licensed physicians. Such students can always decide to take Step 1 at a later date, but the specific preparation for this is beyond the scope of this article.
Another exception to the above advice is students who have such severe testing anxiety that even thinking about taking two high stakes exams close together gives them palpitations. This is another situation where I would suggest focusing on the COMLEX alone and only thinking about Step 1 of the USMLE once the COMLEX is behind you.
Lastly, students who are very sure of what they want to do, and already know that the USMLE will not be required of them can consider skipping Step 1 of the USMLE. The caveat to this last exception is that it is very difficult to be very sure of what you want to do after just the first two years of medical school. I can distinctly remember a classmate of mine who came from a family tradition of orthopedic surgery and had a practice waiting for him after residency. He was very sure that he was going to choose orthopedic surgery after his second year of med school until he did an ICU rotation in his third year of medical school and chose to do an internal medicine residency. This illustrates why almost nobody qualifies for this third exception.