It was amazing at how different the character of the two exams is.
The COMLEX 1 is much much more clinically oriented. A lot of the
biomedical science detail/minutiae occurs on the COMLEX, but it is
generally contained w/i the vignette as a part of the patient
description. For example, Mr. Joe Blow has x, y & z symptoms & a & b
histopath findings – what is the most likely DX? Or, in light of
Mr. Blow’s clinical scenario, assume his most likely Dx is correct
and how would you treat that?
On the other hand, the USMLE Step 1 strongly emphasized the stuff
that intrigues lab-dwellers and bench-researchers vs what I would
deem to be important to a practicing clinician. I buffed up big time
on abxs, cardiac drugs and drugs in general – focusing on clinical
usage and indications. I had not one single Q on how the effects of
the classic anti-arrythmics [nothing about changing the action
potentials or side effects or do not use with stuff] – all I had was
2 questions about drug-induced SLE-like sydrome: answers - 1 each:
procainamide & hydralazine…and 1 other Q regarding what drug class
given with a beta blocker can yield bradycardia. There was only a
handful of abs questions, of which the overwhelming majority focused
on what bact-genetic mutations convey resistance to abx - x.
At the end, I felt like I had taken a test for someone who wished to
a professional microbiologist, pharmacologist or collector of medical
trivia instead of someone working toward my license as a physician,
who will be caring for HUMAN BEINGS – not lab rats and petree
dishes. If that was my goal, I would be in a Ph.D. program and not
How did I prepare? I read & re-read both Step Up to the Boards,
First Aid for the USMLE Step 1 & the Kaplan Q-bank. After taking the
test, I feel that the Q-bank was by far the most representative of
the actual test – actually, the Q-bank questions were even a bit
tougher. Step Up & First Aid were both excellent in targeting
preparation for the COMLEX, Step Up had a small edge over First Aid.
But the content of neither of them, in my humble opinion, was a
satisfactory representation of what I encountered on the USMLE.
Since there no books specific to the COMLEX, DO students use USMLE
prep stuff for our boards. Ironically, I think that the very same
books that provided excellent preparation for the COMLEX really left
a lot to be desired in preparation for the exam they are designed to
Did I pass? Yeah, I feel confident that I passed…but, I am equally
certain that I did not achieve anywhere near as strong a score as I
got on the COMLEX.
And, I feel that the UMLE’s emphasis is misdirected. It is almost as
if the authors still have a fetish for intragroup rivalry,
stratification of the class and grade-grubbing…much like the
traditional pre-med world…that they just can’t let go of. Like the
MCAT, it seemed to focus on topics that are not of real significance
to clinical medicine. But it REALLY has a stiffie for lab/research