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HealthFebruary 04, 2020

USMLE vs. COMLEX: What you need to know

By: Brian Wu, MD, PhD

If you aren’t already preparing for the USMLE or COMLEX, the time’s probably not far off. But do you know which test you need to take—or whether you should even consider taking both? Here’s a quick guide on what you need to know.


While the two exams share many similarities, they’re distinguished by some key differences.

Who is the test for?

The United States Medical Licensing Examination (USMLE) is a three-step examination for medical licensure for allopathic (MD) physicians, though osteopathic (DO) physicians can and do take it as well. To take this exam, you must be enrolled in or a graduate of a US or Canadian medical school. If you have graduated from a medical school in another country, you may take the exam if the school is listed in the World Directory of Medical Schools and meets criteria set by the Education Commission for Foreign Medical Graduates (ECFMG).

In contrast, the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) is a standardized licensure examination required for osteopathic physicians. It, too, is a series of three exams (or levels). To be eligible for Level 1, you must have completed your first year of study at an accredited college of osteopathic medicine and be in good standing in your program.

Both exams cover the same material with one notable exception—the COMLEX also covers osteopathic manipulative medicine (OMM).

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Who administers the test?

The USMLE is administered by two entities: the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). The FSMB is a nonprofit organization representing medical and osteopathic boards of the US and its territories; the NBME is a nonprofit organization designed to assess health professionals. A committee consisting of members of the FSMB, the NBME and the ECFMG govern the USMLE.

The COMLEX is administered by the National Board of Osteopathic Medical Examiners (NBOME). The NBOME is a nonprofit organization whose mission is to provide the means to assess competencies in osteopathic medicine and related healthcare fields.

How is the test structured?

Both the USMLE Step 1 and the COMLEX Level 1 are computer-based examinations administered at Prometric Centers worldwide.

The USMLE Step 1 has approximately 280 multiple-choice questions divided into seven 60-minute blocks. All seven sections are taken in a one-day testing session lasting about eight hours.

The COMLEX Level 1 consists of two four-hour testing sessions taken in one day. There are 400 multiple-choice questions in the exam.

Beyond Step 1 and Level 1, both exams include additional parts, taken later, that test higher-level areas of clinical knowledge and practice decision-making.

How is the test scored?

The USMLE Bulletin of Information notes that the USMLE board determines the recommended pass or fail outcomes for all steps of the exam. It does not predict beforehand what percentage of candidates will pass or fail. Though recommended passing levels are reviewed periodically and may be adjusted at any time, generally you must answer 60% of test items correctly to receive a passing score. The site’s Scores and Transcripts page notes that currently, the minimum score for you to pass the USMLE Step 1 is 194. It takes three to four weeks to score Step 1, according to the USMLE FAQ page, and scores are released each Wednesday and posted on the registrant entity’s website.

According to the COMLEX Bulletin of Information, minimum standards of competency for the COMLEX are reviewed at least every five years; however, standards may be reviewed at any time and adjusted without notice. Like the USMLE program, NBOME does not predetermine the percentage of candidates who will pass or fail. The current passing score for the COMLEX Level 1 is 400. Scores for Level 1 are available four to six weeks from the date of the exam. Candidates are notified by email when the scores are released and can then view them through the portal on the NBOME website.

Taking both tests

If the USMLE is mainly for students pursuing careers as allopathic physicians and the COMLEX is for those heading toward osteopathic medicine, isn’t it clear which test you should take? In certain situations, when considering USMLE vs. COMLEX, medical students actually choose to take both.

Who takes both tests—and why?

In the past, many osteopathic students took both the USMLE Step 1 and the COMLEX Level 1 (even though the USMLE is not required for licensure as a DO) because they wished to apply for certain residency programs offered through the Accreditation Council for Graduate Medical Education (ACGME). As of 2018, the American Medical Association (AMA) reports that about two-thirds of ACGME-accredited programs were accepting the COMLEX, but some still required the USMLE for you to be eligible. However, in December 2018 the AMA passed a resolution that all US residencies should now equally accept the COMLEX and the USMLE, according to NBOME.

Factors to weigh before taking both tests

Before deciding to take both tests, you should:

  • Factor in the costs. Both exams are expensive, and fees do not include the transportation, meals and lodging that might be necessary.
  • Be realistic. Realize that both tests are lengthy and demanding and thus require you to commit a substantial amount of time for preparation. Keep in mind that if you take both exams and apply for an ACGME residency, the scores for both exams will be reported. Scores below the range of your chosen specialty could undermine your chances of success.
  • Know your goals. How does taking both tests help you achieve your career goals? Answering this question will help you decide whether it’s worth the time, money and stress of preparing for both exams.

General advice on taking both tests

If you do decide to take both tests, it’s a good idea to keep the test dates fairly close together, suggests EM Resident. Many osteopathic students take the USMLE first, allow some time to study for OMM, and then take the COMLEX. Become familiar with the question styles for both exams; they are different, even though the exams cover similar material.

And be sure to equip yourself with the most effective study resources, like personalized digital tutor Firecracker, which has been shown to improve licensing exam scores. Firecracker is available for both the USMLE and the COMLEX.

Brian Wu, MD, PhD

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