Advice Level 1
The COMLEX Level I is one of the most important exams of your ENTIRE LIFE! After two long and grueling years in the classroom, it’s finally time to put your knowledge to the test and see how you match up against other medical students from around the country. What’s at stake – your ability to move on to clinical rotations, your opportunity to match into the specialty of your choice, your eligibility to move on to subsequent COMLEX levels, and ultimately your dream of becoming a physician. Although a “passing” score is a must, it may not be enough for competitive specialties you may want to pursue. Therefore, taking this exam seriously and maximizing your potential is of pinnacle importance. It’s always surprising to us how uninformed Osteopathic medical students are regarding the COMLEX Level I and what it means in the scope of their medical education, even in the months leading up to the exam.Regardless of what others may tell you, the COMLEX Level I exam CAN be the rate-limiting step in your quest to become a physician. Depending on the specialty to which you are applying, the exam may impact your chances of securing a residency spot. For most competitive specialties, doing well on the exam is an absolute must for maximizing your chances of matching and you will need to meet a “minimum score” to avoid elimination during the initial screen process.
We have created a resource for you unlike anything else on the market. COMBANK is a high-yield testing system, strategically designed to focus on topics tested year after year on COMLEX exams. COMBANK offers a testing environment that simulates the COMLEX testing experience. Our authors have sifted through substantial amounts of material to put together a bank of questions, similar in both format and content, to what you will encounter on test day. Our goal is to create a testing environment that will enable you to feel confidant when you finally find yourself face to face with the exam.
How to be successful:
To be successful on the COMLEX Level 1, it is important that you remain focused and gear your study plan for a COMLEX-specific exam. We have put together a top 10 list of strategic points (in no particular order) that will help you succeed on test day.
1) 1. Recognize key word clues in the question stems and know their underlying meanings. When the NBOME provides you with information such as gender, age, or ethnicity, it is usually purposeful and can be helpful for answering questions correctly. A great example of this would be patient from Mississippi who presents with pulmonary symptoms. Histoplasmosis should jump to the very top of your differential.
2) Know your “most commons.” The NBOME loves to test your knowledge of most common etiologies, infectious organisms, and medication adverse effects, to name a few.
3) For the Biochemistry portion of the exam, know vitamin cofactor dependent steps and what labs an enzyme deficiency might cause. COMLEX is not likely to ask you about the lac-operon gene or obscure biochemical processes. However, the exam will contain some clinically relevant biochemistry such as Vitamin B12, Folate, VMA, Heme synthesis, etc.
4) Know descriptions of common and emergency pathologies. For example, they are more likely to describe coffee ground emesis or melenemesis as dark reddish-brown blood upon vomiting rather than just say “coffee ground emesis”. “Buzzwords” are still used from time to time on COMLEX, but are becoming less frequently seen on the exam, and instead, replaced with descriptions of what is being identified. A classic example of this is the presence of “clue cells” in patients with bacterial vaginosis. You are much more likely to see these identified by “epithelial cells covered with bacteria.”
5) Learn to understand the pathophysiology behind cardiac murmurs. Try not to memorize them. In general, valvular stenosis can be thought of in terms of a problem with opening. Valvular regurgitation is a problem with filling (gurgling). Then just break it down further:
- At S1:
- AV valves close… therefore regurgitation of the tricuspid or mitral valves would be systolic.
- At S2:
- AV valves open… therefore stenosis of the tricuspid or mitral valve would be diastolic.
6) Know some of the more common normal lab value ranges seen on standard blood analysis and metabolic panels. This will save you time during the exam. As demonstrated in the NBOME tutorial for the exam, there is a “normal labs” button that will give you normal lab values. You can pull this up for every question but scrolling through this guide can waste valuable time. This is especially important for students who generally take longer to complete exams. Use the “timed exam” feature on COMBANK to predict if you fall into this category. Normal labs you should know include:
- • Hemoglobin and hematocrit, platelets, WBC count• Sodium, potassium, chloride, bicarb, calcium, BUN, creatinine
7) Know second-line medications. Although first-line agents are primarily tested on COMLEX Level 1, you
will be presented with patients who do not meet the criteria for 1st line treatments. A great example this occurs in patients with bipolar disorder. By now you should know that lithium is the classic 1st line treatment for patients with bipolar disorder. But what happens when you are dealing with a patient in renal failure? You’d instead treat with a drug such as carbamazepine.
8) Know your OMM. Unlike the USMLE, the COMLEX is more ambiguous, less complicated, and laced with OMM questions. As much as 30% of your exam could involve OMM. Make sure you are comfortable with common OMM topics such as sacral, Chapman’s points, structural diagnosis, and most importantly viscerosomatic reflexes. You can’t afford to miss standard OMM questions.
9) Once you have selected an answer choice, DON’T change it unless you are ABSOLUTELY sure of this decision. It has been proven that your first “gut” feeling is usually your best. That said, approach difficult questions on an elimination basis. The more choices you can eliminate, the more likely you are to answer the question correctly.
10) Aside from OMM, Pathology, Microbiology, and Pharmacology will comprise the majority of your exam. Know these subjects well and prepare accordingly.
*For more “COMLEX insights,” sign up for our Level 1 Qbank today! COMBANK is filled with detailed insights that tell you how to approach different COMLEX topics and ways to avoid common pitfalls.
Approaches to different question types:
1) Stand-alone cases: The majority of questions on the COMLEX Level I will revolve around single scenarios. The most effective way to prepare for these is to practice, practice, practice. All of the disease processes, medications, and OMM that you have learned must now be applied to clinical scenarios. Questions dealing with drug pharmacology and microbiology are laced throughout the exam and should be a primary focus during your preparation. We suggest that you make a list of common medications and know all of their mechanisms and side effect profiles. 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 mechanism of action of the medication used for 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?). Fortunately, we have found that Level I of the COMLEX has less of these than subsequent levels of the test. 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 Level I. You should familiarize yourself and be prepared to recount such topics comprehensively. Such topics include (but are not limited to) sympathetic levels, rotator cuff anatomy, major depression, eating disorders, common ego defenses, gram-staining algorithms, organisms causing meningitis, medically-important protozoa/helminthes, patterns of disease inheritance, tumor markers, multiple myeloma, MOA of diuretics…and the list goes on. COMBANK was created to instruct and prepare you for 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. “Step Up” is also used frequently and is set up nicely in a subject/system-based format. Remember though…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 our Allopathic counterparts and us. 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 your grades are in the classroom, this is a new exam and a new opportunity for you to succeed. The slate is clean right now and you are on the same playing field as your peers. The COMLEX Level I is arguably the most important level of COMLEX because it benchmarks your knowledge of the basic sciences and is used by residency programs as a marker to screen applicants. The better you score, the better your chances are of matching into the specialty of your choice. You have to believe you ARE going to do well on this examination and you must prepare accordingly. Put your future in the best hands – your own.