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USMLE or COMLEX: Which Exam Should a DO Take?

Being an Osteopathic Medical Student is tough, especially when it comes to board exams. There are two different board exams depending on if you are an MD or a DO. 

MD students are required to take the USMLE, and DO students are required to take the COMLEX.

When I say required, I mean in order to practice medicine they have to take those to be licensed physicians. 

The tricky part is, DO students can take both if they want. 

There are some reasons why Osteopathic Students should take both, and there are some reasons why you shouldn’t!

I am a DO and I took both, and did very well on them. I hope this article can help you decide if both are really needed.

Why you should only take the COMLEX

There are plenty of reasons why DO students should only take the COMLEX. It can be daunting to take both the COMLEX and the USMLE, so before we dive into why you should take both, lets talk about why you should only take the COMLEX.

Focusing on Osteopathic “friendly” programs

There are a lot of residency programs out there that are very DO focused. If you notice that the program director is a DO, or possibly there is mention of the osteopathic recognition, or even if there are a ton of DO’s in the program, chances are that you can get away with only the COMLEX.

Going for primary care

Most family medicine, internal medicine, and pediatrics residencies take both exams. This is simply because many DO students pursue primary care, so most of those programs are familiar with the COMLEX and how it compares to the USMLE.

Don’t wanna spend the money

These exams can get expensive, and there are plenty of residency programs across the country that will happily accept just the  COMLEX. If you don’t want to spend the cash to take both exams, then be sure to research the programs that are DO friendly as mentioned above. 

USMLE test scores are not above passing

This is also one of the few reasons to not take the USMLE and the COMLEX. If you are doing practice exams and you notice that your scores on the USMLE are not a decent amount above the minimum passing score (194) then it would be wise to not take the USMLE if you can’t get your scores above passing.

Why you Should take both exams

There are a few reasons why you absolutely should take both the COMLEX and the USMLE. Lets dive into those.

Going for very competitive specialties

Specialties like Interventional Cardiology, Radiology, Dermatology, and many others  are very competitive. If these are the kind of specialties that you are looking into, then be sure to take the USMLE and the COMLEX to demonstrate how you compare to every applicant.

Programs aren’t DO “Friendly”

If you notice that a program doesn’t have any DO’s in it, doesn’t have a track record or taking DO’s, or even outright mentions that they require the USMLE. You better just take the USMLE if you really want to train at that residency. 

Undecided on specialty

If you aren’t sure what you want to do with your life, then you better not limit yourself.

Let’s say early on, you plan on going after a less competitive specialty and you only take the COMLEX. Then, in rotations you decide you like a more competitive specialty, but you didn’t take both exams.

If you are undecided, or 100% not committed to one specialty, then take both exams so you don’t limit yourself. 

Confident in your USMLE practice scores

If you are crushing it on your USMLE practice tests, then you can feel confident in taking both the USMLE and the COMLEX. Some students struggle more with the USMLE, and we will talk about it below. If your scores are well above passing, then by all means take both of them.

Confident in the tough topics (Like Felty Syndrome)

There are a lot of tough topics on the USMLE and COMLEX. If you know these and can recognize them then you will excel. One example is Felty Syndrome. If you recognize the nuances of topics like this one then it will set you above the rest. Picmonic does a great job with many of these finer details and can really be a difference maker for you.

Is the USMLE really harder?

Many students believe that the USMLE is a harder exam than the COMLEX. This section will break down why it is and isn’t harder.

Why the USMLE is harder:

More in Depth questions

The questions on the USMLE by far have more detail and can be solved in a stepwise approach when compared to the COMLEX. The COMLEX is a either you know it or you don’t kind of approach, wheras the USMLE questions are written in such a way that you can decipher an answer by logic and reasoning. This isn’t an absolute truth, but a generalization of the exams.

Requires more critical thinking

The fact that the questions will be such that you can think through them and solve them like a puzzle, means that you will be tasked to think more critically on the USMLE.

Not to say that the COMLEX doesn’t involve critical thinking, it is just that the USMLE requires a lot more of it.

There are questions on the COMLEX that are first order style questions, those just don’t exist on the USMLE.

Answers are more similar

When it comes to actually answering the questions on the USMLE, it can be tougher because almost all the answers could be the right answer if you missed one or two important details within the question stem. This means all the answers are in a broad sense, fairly similar.

Why the USMLE is easier than the COMLEX


The USMLE has less questions than the COMLEX, and is a shorter exam overall. There are less questions on each block, meaning you have more time to go through each question. 

Having more time on an exam like this can make a huge difference.

More break options

The USMLE just says that you have 1 hour of break time, you can use it as you see fit between all the blocks. If you want to take a small break between every block, then you can. If you want to take one long break in the middle of the exam, then you can do that as well.

The COMLEX tells you that you will take a 15 minute break every 2 hours, and that you will take a 30 minute lunch. You don’t get an option of spreading the breaks out as you want.

More standardized questioning

I am not sure of the individual processes for both the COMLEX and USMLE, but my personal experience is that the questions on the USMLE seem less esoteric and more standardized than the COMLEX.

There are some very random topics and questions on the COMLEX, wheras the USMLE typically had what was expected to be on it.

How can you prep for both at the same time?

Prep for the USMLE, and then add in OMM

If you work hard and get ready for the USMLE, then spend a little bit of time on OMM then you will be good to go.

Use resources like Picmonic to really nail down the details

Picmonic is a great way to nail down the finer details of a topic and really improve your score in a short period of time.

Be sure to check it out if you want to make studying a whole lot easier!

Thanks for reading,
Sean Kiesel, DO, MBA


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