COMLEX vs USMLE: Which Is More Difficult?

Osteopathic students have to complete a difficult board exam in order to practice medicine in their chosen fields. MD students are required to take the USMLE, while DO students can choose between taking the COMLEX, the USMLE, or even taking both. But how do they know which is the right decision to make?

In this article, we’ll be assessing which of these examinations is the most difficult.

We’ll go over their main differences, explain why some people decide to take both tests, and give you a few tips on what to consider before choosing to do so.

COMLEX vs USMLE: Which Is More Difficult?

Many students agree that COMLEX is more difficult than the USMLE. The main reasons for this include the length of the exams, the availability of different break options, and the types of questions asked.

Let’s take a closer look at each of these points.

Number of Questions

The COMLEX Level 1 exam has 400 multiple-choice questions. It is divided into two testing sessions of four hours that must all be completed on the same day. Once the student moves on from one section to another, they’re not allowed to go back to the previous section to review their answers.

The USMLE Step 1 exam has approximately 280 multiple-choice questions and is divided into seven blocks. Each block takes about an hour to complete and all of them must be taken on the same day. Students usually take about eight hours to complete this examination. Much like the COMLEX, once a student finishes and moves on from a specific section, they can’t go back for any revisions.

There are much fewer questions in the USMLE exam. This gives students the opportunity to spend more time on each question, thinking about and reviewing their answers.

Having some extra time for complex exams such as these might make a huge difference in the final score.

Related: UFAPS: The Only Thing You Need For Med School? (Study Secrets Of USMLE Students)

Test Break Options

All students taking the COMLEX are granted 15-minute breaks every two hours and a 30-minute break for lunch. The schedule for the COMLEX exam is strict and predetermined. Students are not allowed to take any more breaks aside from the ones mentioned.

The USMLE is more flexible with its schedule. Students have 1 hour of break time and can use it as they want. Whether they prefer taking a small break at the end of each testing block, or a big break in the middle of the examination, it’s their decision to make.

Question Types

COMLEX questions are quite vague and can include some random topics. Although both exams cover mostly the same material (except for Osteopathic Manipulative Medicine questions which are reserved for the COMLEX), the COMLEX also adds hard questions about ethics, medical jurisprudence, and microbiology. Also, COMLEX doesn’t distribute its question subjects equally. 

Not all students think the COMLEX exam is harder. The USMLE is also very demanding and has its own associated difficulties. These include more in-depth questions that require a lot of logic and critical thinking. 

The provided answers are also very similar to each other, making it seem like all of them could be the right one for a particular question. Choosing the correct answer comes down to very small details that students can’t afford to miss in order to finish this examination with a high score.

Who Are These Tests For?

The Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) is reserved for osteopathic students who want to become osteopathic physicians (DOs) and receive the required licensure for practice. They must’ve completed their first year at an accredited college of osteopathic medicine to be eligible for COMLEX Level 1.

Related: COMLEX Score Percentiles – How To Calculate & What It Means

The United States Medical Licensing Examination (USMLE) allows US or Canadian allopathic graduate students to become licensed physicians in their field. Osteopathic students can take this test as well if they decide to do so.

Regardless of the examination students take, as of 2018 both the COMLEX and the USMLE are equally accepted by all types of residency programs in the United States, according to the National Board of Osteopathic Medical Examiners (NBOME).

Can Students Take Both Tests?

Yes, students can take both tests. While the COMLEX is geared towards students pursuing careers in osteopathic medicine and the USMLE is mainly for those interested in careers as allopathic physicians, students can decide to take both exams.

This decision depends on each student’s goals and career aspirations. Those who choose to take both examinations are usually looking to get a competitive edge over the other students when it comes to being accepted in a specialty of their choosing.

Things to Consider Before Taking Both Exams

Taking both exams might seem like a good idea for some students, especially considering that the study materials don’t differ much from one examination to the other. However, there are a few things to consider before making that decision. 

  • High Costs. Both the COMLEX and the USMLE are expensive examinations. To take the COMLEX Level 1 students must pay $650 in examination fees. The USMLE Step 1 costs $645. Both exams come at a total of almost $1,300, which most would consider as expensive.
  • Added Stress. These examinations are hard, demanding, and extremely long. The tested subjects might be similar, but the types of questions are very different. The COMLEX also requires students to brush up on their OMM and microbiology knowledge.
  • All Scores Matter. When applying to any available residency program after completing both exams, both scores will impact the student’s chances of success. If one of the test scores is low, it may negatively influence a student’s entrance into the desired specialty.
  • Ultimate Goals. If a student already has an idea of the specialty they’ll want to pursue in the future, it would be a good idea to do some research on it. They can try figuring out which examinations were taken by the previously admitted students. Maybe there won’t be a need to take both exams at all.