September 12, 2023

COMLEX Level 1 vs USMLE Step 1

Written By: The TrueLearn Team | Share: | Last Modified: February 18, 2025

As an aspiring physician, COMLEX and USMLE have likely been on your radar for a while now! The COMLEX (Comprehensive Osteopathic Medical Licensing Examination) is traditionally taken by osteopathic medical students and the USMLE (United States Medical Licensing Exam) is traditionally taken by allopathic medical students.

There are circumstances where DO students may decide to take the USMLE on top of the COMLEX, which may be influenced by a range of factors. One reason DO students may choose to take the USMLE is that they plan to apply to a highly competitive residency (like neurosurgery) for which taking the USMLE is highly regarded. In such cases, taking both exams may be perceived as providing a competitive advantage. In this blog, we will cover the similarities and differences between USMLE Step 1 and COMLEX Level 1 so you can make an informed decision on which exam(s) you are going to take.

Differences Between COMLEX and USMLE

The biggest difference between the two exams is their content focus. While both exams focus on clinical fundamentals, Level 1 also incorporates osteopathic principles. Osteopathic manipulative medicine (OMM) is a very important part of an osteopathic student’s curriculum and a big focus of the COMLEX exams.

The USMLE focuses solely on allopathic medicine. On Step 1, you will find multiple-choice questions designed to test basic science principles, organ systems, patient care tasks, specific disciplines (pathology, immunology, etc), and more.

On Level 1, you will find multiple-choice questions related to osteopathic principles, osteopathic patient care, clinical presentations related to organ systems, and more. You can learn about Step 1 content on USMLE’s website and Level 1 content on NBOME’s website.

COMLEX vs USMLE Comparison

Exam Feature	COMLEX Level 1	USMLE Step 1
Cost	$730	$680 (International students may have additional fees.)
Length of Exam	352 multiple choice questions given over two four-hour sessions, with each session consisting of four blocks	280 questions given over one eight-hour session with seven blocks
Number and Length of Breaks	60 minutes worth of breaks	45-minute break, self-scheduled and must be taken between blocks
Topic Emphasis	Greater emphasis on microbiology, pharmacology, musculoskeletal, and neurology compared to USMLE Step 1	Greater emphasis on biochemistry compared to COMLEX Level 1. Step 1 also places a big emphasis on pathology (~ 50% of exam)
Osteopathic Manipulative Medicine (OMM)	Yes	No
Videos	Longer in length, some exceeding 60 seconds, almost entirely musculoskeletal and OMM	Some items have associated interactive video clips
Stems	COMLEX stems tend to be shorter and have been described by students as more vague than USMLE stems	USMLE stems may have a greater range of possible answer options and have a separate lab values sheet (instead of reference ranges being included in the stem)
Exam Interface	Preview the interface and prepare for exam day with this Tutorial	Preview the interface and prepare for exam day with this Tutorial
Content Outline	Follows the COMLEX-USA Master Blueprint	Follows the USMLE Content Outline

Last updated: February 14, 2025

How Step 1 is Scored vs Level 1

Both Step 1 and Level 1 are scored as pass/fail. Step 1 first moved to pass/fail in January 2022, with Level 1 switching in May 2022. So you will not receive a numerical score for either exam.

However, students who take Level 1 will receive some feedback in a document called a Formative Performance Report that shows how you did in each competency domain and clinical presentation. In contrast, only students who fail Step 1 will receive content-based feedback.

When Can You Take Each Exam

Both exams are taken near or at the end of your second year of medical school. Level 1 can be taken before you complete the year while Step 1 is usually taken after your second year. Most students take Level 1 anywhere between May and July. If you’re planning on taking both, be sure to look for study resources that cover both exams since you’ll take them so close together.

Best Way to Prepare for Each Exam

Here are 5 recommendations to consider when studying for each exam:

	USMLE Step 1	COMLEX Level 1
1	Thoroughly review basic biochemistry, genetics, physiology, and pathophysiology.	Dedicate time to review OMM diagnosis and techniques.
2	Spend more time focusing on pathology using a specific review source.	Spend more time reviewing microbiology with a dedicated resource.
3	Review the mechanisms and biochemistry of common medications and antibiotics.	Focus on making diagnoses and understand basic pathologic principles.
4	Familiarize yourself with images of normal anatomy and common pathology (x-rays, CT scans, histology, etc).	Be prepared for videos demonstrating physical exam maneuvers or OMM.
5	Be able to apply physiologic principles to theoretical situations or experiments.	Become comfortable with musculoskeletal injuries, pathology, and basic management.

Are you looking for a question bank for USMLE or COMLEX? We’ve got both! Our COMLEX Level 1 SmartBank has over 2,500 test questions with access to hundreds of OMM videos. Our USMLE Step 1 SmartBank has over 2,700 test questions. Both question banks are formatted to align with what you will experience on test day. With our first-time pass guarantee, you can rest easy knowing that TrueLearn has your back!