Now that COMLEX level 1 is over, it’s time to utilize the material you’ve amassed in your mind and apply it to the clinical cases of COMLEX CE levels 2 and 3. First of all, it’s important to understand that these exams are similar in format and content, so be sure to retain your Level 2 resources to prepare for Level 3. The old saying about “Needing two weeks to prepare for level 1, two days to prepare for level 2, and a #2 pencil to prepare for Level 3,” is no longer true. Underestimating these exams is a misguided pretense. There is no substitute for hard work and the success it brings.Remember, you’re taking the COMLEX, not the USMLE. THESE ARE VERY DIFFERENT EXAMINATIONS and you’ll need to prepare for them accordingly. Having taken both exams, we can assure you that they do not resemble one another in any way. Friends and acquaintances that’ve scored well on the USMLE CK Steps 2 and 3 have sometimes scored poorly on COMLEX. Why? It’s not because the COMLEX is more difficult (in fact, it’s the opposite in our opinion); it’s because they DID NOT PREPARE FOR COMLEX. Although many of you will be applying to allopathic residency programs, and some of you will opt to take the USMLE steps, keep in mind that you MUST still pass all three levels of the COMLEX .
COMBANK is set up specifically to prepare you for the COMLEX levels 2 and 3. Our questions were composed to resemble the question-types you will see on the real test. We’ve sifted through generations of COMLEX material to provide you with the most highly-tested information available. COMBANK will equip you with the types of questions you can expect to encounter without any surprises on test day. As Shakespeare so eloquently asserted, “All things are ready, if our minds be so.”
Approaches to different questions types:
1) Stand-alone cases: Unlike COMLEX level 1, the majority of questions on levels 2 and 3 are presented in case formats. The most effective way to prepare for these is to study in the same manner. All of the disease processes, diagnoses, and treatments that you have learned must now be applied to clinical scenarios. Questions dealing with pharmacologic mechanisms of action are few and far between. Instead, you will be faced with scenarios asking when and when not to give medications. You will be given a list of medications in a case and asked to select the one responsible for side effect. For example, the case may present a 47-year-old male on a list of medications such as atenolol, hydrochlorothiazide, aspirin, simvastatin and metformin, and you may be asked to select the one responsible for exacerbating his gout. The answer to this would be hydrochlorothiazide, of course. The good thing about questions of this type is that they stand alone. If you get it right, you move on. If you get it wrong, you move on also. Each question is independent of the next.
2) Multi-step case studies: About half way through your exam, you will encounter question sets that revolve around a single case scenario. From our experience, there is usually an average of two to three steps to each case. However, we’ve seen as many as four questions referring to the same case. For example, you may be presented with a case and asked to give the diagnosis (first question), an associated physical exam finding (second question), and the most appropriate treatment (third question). The tricky part about these questions is that each subsequent answer choice corresponds to one of the diagnoses. So it’s easy to miss two or three questions if you don’t get the diagnosis right. Falling into this trap will lead to a number of missed questions. If you learn to make the correct diagnoses, however, you will be able to use this format to your advantage.
3) Matching: Matching questions are always at the end of each 50 question block. There are usually between two and five questions in each matching section. This is a good opportunity to use your test-taking skills to eliminate answer choices and gain some extra points. Personally, this is our favorite question type, because once you learn to piece the information together, you can dismantle the entire section.
COMLEX is renowned for asking ambiguous questions (i.e. A 34-year-old female presents with hypertension, what is the diagnosis?). The above example is somewhat exaggerated; but believe us, you will encounter questions with very little information in the question stem. This is one of the biggest differences between the USMLE and COMLEX. Cases on the USMLE are longer and more information is given, some relevant, some irrelevant. Reversely, COMLEX presents generalized situations with seemingly vague details. COMBANK is designed to prepare you for these types of questions and will direct you on how to answer them correctly.
No matter what year, what month, or what exam you are taking, there are certain topics that are ALWAYS tested on the COMLEX. You should familiarize yourself and be prepared to recount such topics comprehensively. Such topics include (but are not limited to) sympathetic levels, community-acquired pneumonia, intracranial bleeds, meningitis, sacral/innominate OMT, vaginal infections…and the list goes on. COMBANK was created to instruct and prepare you on these “must know” topics.
Medical students often inquire as to when they should begin preparing for COMLEX levels 2 and 3. We always recommend preparing early for these exams. Because you are busy on rotations it is difficult to find blocked time to study for these exams. Often, you are only given one or two days off-service to take the exam. Therefore, you must prepare early and steadily. We recommend that you begin studying two to three months prior to your exam. By far, the best way to prepare is to learn from the patients you see during your clinical clerkships. If you encounter a patient with specific diagnosis, read about it that night and come up with a differential and treatment plan. Ask yourself questions like…What study is diagnostic? What medications should be started acutely vs. long term? Who should I consult on the case? If you can be diligent in this regard, you will have no problem on test day.
Certain books are regarded by medical students as “gold standards” for board studies. For step 1, most students rely on “First Aid” as there primary resource. For step two, medical students use “CRUSH step 2″ and “Boards and Wards” and so forth. It is important that you remember: THESE BOOKS WERE WRITTEN TO PREPARE STUDENTS FOR THE USMLE. COMLEX has an entirely different focus. Although most subjects in medicine are consistent between both disciplines, COMLEX likes to focus on those subjects that distinguish it from allopathic medicine. Therefore, the correct answer on the USMLE may be the wrong answer on COMLEX. This is mostly true for questions asking for initial treatment modalities where “OMT” is often the answer, rather than traditional therapies.
Preparing for OMT questions:
Osteopathic manipulative treatment is the prominent feature of the Osteopathic world and the main distinction between us and our Allopathic counterparts. The boards are no different. Regardless of what level, when you actually take the COMLEX exam you will be faced with a large portion of OMT questions. Use this to your advantage and show up prepared for them. Although topics change each year, you’re likely to be faced with sacral questions, innominate questions, and a ton of sympathetic levels. In the past several years, we have seen a trend of more upper and lower extremity OMT questions and a larger number of cases requiring you to pick a modality of treatment (eg. counterstrain vs. muscle energy). OMT questions on COMBANK are formatted very similarly to resemble the material you’ll actually see on test day. We want you to feel entirely prepared for the OMT portion of your exam.
Regardless of what you scored on COMLEX level 1, this is a new exam and a new opportunity for you to succeed. COMLEX 2, in particular, is important during the match because it gives program directors a good idea of your clinical knowledge base. The better you score, the better your chances are of being ranked highly. In fact, we have asked several program directors this very question, and they all admit to using COMLEX level 2 to assess an applicant’s decision-making capacity. You have to believe you ARE going to do well on this examination. Put your future in the best hands – your own.