Two months, two weeks and a No.2 pencil – the myth that still plagues medical students around the country, some of whom will sit for COMLEX Level 2 CE exams over the next few months. Given that Level 2 CE testing season will soon be upon us, we wanted to take some time to discuss various aspects of the Level 2 CE experience and give some insight into when you should expect to see on test day.

The Gameboard:

Let’s start with the game board. Anyone testing this year has already successfully completed Level 1. The COMLEX Level 2 CE set-up, format and interface will be structured in the same way – even down to the procedural aspects of checking into and out of the Prometric center. The exam will consist of 400 items in total, in a predictable format of eight 50 test item blocks separated by two optional short breaks in the morning and late afternoon, in addition to one longer break for lunch. You’ll be allotted precisely 72 seconds for each test item but can, of course, take more or less time on specific questions as needed. Just as with Level 1, you’ll be permitted to navigate freely between the specific test items within the block, but once it’s complete and submitted, or the timer runs out, you’ll never again have access to see or modify those test items. So make it count!

COMLEX Level 2 CE Exam Blueprint

If you’re preparing for COMLEX Level 2 CE, you’ll certainly want to become familiar with NBOME’s two-dimensional blueprint model for COMLEX-USA, which is grouped by Patient Presentation and Physician Tasks. Although Patient Presentations are not demarcated by exam level, the “Physician Tasks” section is. Unlike COMLEX Level 1, where 70-85% of all test items are grouped by the NBOME in the category of “Scientific Understanding of Health and Disease Mechanisms,” the focus shifts in Level 2 CE to a more clinical exam containing a higher percentage of questions in areas related to patient diagnoses. Specifically, test items grouped in the category of “History & Physical Examination” alone consist of 30-40% of the questions in the entire Level 2 CE exam. These questions are further grouped into two subcategories consisting of “Examination and Recognition (including neuromusculoskeletal examination) and Gathering Patient Information. COMBANK groups all of it’s test items according to this same blueprint model and by taking lots of questions in COMBANK’s “blueprint mode,” you’ll become very familiar with the types of questions in each of the Level 2 CE categories. For a deep dive into the NBOME’s exam blueprint for COMLEX-USA, visit their website or click on the following link: Link to full COMLEX-USA Blueprint.

The Questions

Although you’ll recognize many aspects of Level 2 based on your prior experience with Level 1, one thing you won’t recognize are the questions! Rather than testing one basic science concept after another, you’ll now be faced with diagnosing and managing patients. Fortunately, you should have a bunch of rotations under your belt by now, so in theory this should be easier. But so do your colleagues across the nation. So it’s an equal playing field. Unlike in the hospital where you sometime do many things at once, COMLEX will force you to think in a very sequential manner. This is particularly challenging with patients who present with emergent or critical disease processes in the setting of the ED or ICU. In reality, all hands are on-board in the hospital where oxygen is being applied, IVs are being places, labs are being ordered and EKG leads are being secured – a lot is happening at once. COMLEX will require you to think through priorities, even in critical scenarios, to assess your ability to prioritize treatment and management protocols. This is also challenging at times when deciding when and where to prioritize OMM into your patient management. Although much of Level 2 is based on using History and Physical findings to make diagnoses, you should expect to management patients in 10-20% of all of the questions, and up to 40% of the time when you sit for COMLEX Level 3. COMBANK is specifically designed to mirror every aspect of the COMLEX Level 2 testing experience so on test day you should feel like you are at home taking practice questions on your couch.

Take Lots of Practice Questions

When you took COMLEX Level 1, you had just completed two years of medical school, consisting of thousands of hours lecture and time spend in the library (or at the beach for NOVA students). Testing was something that you did regularly and so did your classmates. Things are different now. You have been out of the classroom and on rotations for quite some time now. You may be spending your days in the OR on your surgery rotation or writing detailed notes on your medicine month. Regardless of the rotation you are on when test day rolls around, you’ll likely be one of the only people on your service testing on that day. It can also be intimidating or overwhelming to ask for any time off from attendings or senior residents to even take the exam, let alone study for it. If you can relate to this statement, just remember – the residents and attendings on your service all took their boards at some point themselves and should be accommodating to your needs. Be sure to assert yourself. Another challenge is that because you are busy in the hospital now taking care of real patients, it can be difficult to find time to study for your Level 2 CE exam. Furthermore, even if you have down time to study in the hospital, where do you find a computer to sit down and take a practice test?

Regardless of your arsenal of board review materials, practice testing should be an essential component of your Level 2 preparation efforts. We recommend that students test very consistently in the months leading up to their COMLEX Level 2 CE exams. A good rule of thumb is the closer the exam, the more questions you should be taking – and the better you should be scoring. It’s important to get back into the habit of taking tests and you will train yourself to think sequentially when managing patients by working through practice test items. Remember to download COMBANK’s mobile app to be able to take questions in the hospital during periods of downtime, even if it’s only for ten minutes. As always, we recommend that students test in “random” and “timed” modes to simulate the exam itself. To be even more reflective, you can test in 50-item blocks if you have the time.

Day at the Prometric Center

Since you’ll likely be testing at a different Prometric Center than you went to for COMLEX Level 1, we recommend that you take a trip to the physical location before test day and preferably on the same day of the week and time of day as your actual exam. The last thing you want is to have the added stress of scrambling to find the testing location the morning of your exam or being surprised with a traffic jam that you could have anticipated.

Once arriving at the testing center, you’ll be faced with the same rigorous check-in process you encountered when taking Level 1. We highly recommend that you call the specific Prometric Center where you will be testing to clarify their policies. Even though standards are set in place for Prometric locations, there are some nuances with each one.

Prior to starting your exam, you will be given a couple of items to assist your test-taking. One of these items is a headset to use for multimedia questions containing audio components (Don’t worry, we have lots of these within COMBANK). The headset you will be given is bukly and very annoying. The good news is that Prometric allows you to bring your own, however they will only allow you to use ear buds so don’t make the mistake of bringing your gold-plated Beats!

The second item you will be provided with at the Prometric Center is a writing tool – some sites have dry-erase boards (you’ll get two of them), while others will provide you with a pencil and a four-page notebook. Unfortunately, you won’t have a choice – it will depend on what’s available at the specific Prometric site.

The Match

Last but not least, lets talk about the weight that COMLEX Level 2 CE has in The Match. While it’s true that Level 2 CE does not carry as much weight as Level 1 in The Match, it’s certainly very important and can make or break your matching outcome for sure. In the most recently published NRMP Program Director survey (Link to Survey), COMLEX Level 2 CE performance ranked number 4 out of all factors considered when selecting candidates for residency interviews (all specialties included).

Just as important as your raw score, keep in mind that drastic changes in score from Level 1 will get noticed. For some, this could be a good thing in the case of a dramatic improvement from Level 1. Or, it could be harmful to high-performing Level 1 students who take a hit on Level 2 CE. Remember, just like Level 1, you’ve only got one shot if you pass. For all exams taking from June of 2014 – May of 2015, the mean score on COMLEX-USA Level 2 is cited on NBOME’s website as being a 3-digit score of 532.

So in conclusion, don’t underestimate your upcoming opponent! COMLEX Level 2 CE is a tricky exam that requires disciplined focus and preparation. Taking lots of practice questions will allow you to approach the test with confidence and will force you to think in sequence when treating patients both acutely and in the outpatient setting. Show up prepared!