The first two years of medical school are hard because you are learning how to pass USMLE Step 1 and COMLEX Level 1 if you are an osteopathic medical student, and just Step 1 if you are are an allopathic student. The hardest question that osteopathic medical students ask themselves is if they should take both USMLE Step 1 and COMLEX Level 1.
I took both exams, and I passed both exams. Here, I’m going to outline the 10 things I did to stay sane and help me pass them. Of course everyone is different, and someone else will have a different method that worked better for them. I personally am not the best “study bug”. So if you are moderately motivated to study, then this is for you. If you are a gunner…then I’m sorry you have the wrong page.
This post is for both allopathic and osteopathic students, but because I’m an osteopathic student I will also address the question of whether or not to take both. So, here are 10 great tips for how to pass USMLE Step 1 and COMLEX Level 1.
Should I take both?
If you are an allopathic medical student, you most likely will just take USMLE Step 1. USMLE Step 1 is the competency board exam for allopathic (M.D.) schools. COMLEX Level 1 is the competency board exam for osteopathic (D.O.) schools. M.D. students are often not required, or even expected to take both. Osteopathic students may be encouraged to depending on a few factors:
- Competitiveness of the specialty or residency program
- Application requirements of desired residency programs
- Strength of reputation of medical school
If you know for sure what you want to do, and to which programs you would like to apply, you can determine right away if you need to take both. For more competitive programs, it will likely improve your prospects if you have a USMLE Step 1 score. For traditionally less competitive programs, then you may not need it.
If you do not know what you want to do, then you may want to take it just in case you need it down the road. Alternatives include skipping Step 1, since it and Level 1 are both pass/fail, and taking Step 2 CK since it is the first scored exam. However, ensure that programs you like do not want all three exams. Also, to do some away rotations or subinternships, some programs may require a Step 1 score. So just do your research to make sure you meet the requirements of programs that are of interest to you.
Another alternative is to take Step 1 later, as it is not required to move into your third year if you are an osteopathic medical student. This may require some backtracking in studying, but if it works best for you, then that is an option. Once you decide what you want to do, you can implement these 10 tips!
Tip #1: Do well in your classes
The first thing that can help you pass USMLE Step 1 and COMLEX Level 1 is to do well in your classes. The majority of things you learn in your first two years will help you with your test prep. Some things you learn are just of interest to your professors. But once you start taking practice exams, you will start to see the same material.
Take you classes seriously from day one and use them as test prep. Don’t get overwhelmed if you struggle early. It doesn’t mean you’re going to do poorly on your exams. But when you learn the material, try to retain it because it will come back up on your exams.
Enjoy the learning process. It will feel like you don’t have time to dive into each topic. And you’re right. You don’t. But, you will get several touches of the same topics. So, each time you do, try and add that to your existing knowledge bank instead of starting from scratch.
Study hard, and get good grades. This will teach you positive study habits and give you less to re-learn at the end of your second year. Try to connect topics to one another as you learn them as this will also help you retain the information. As you learn new things, review the old, and try to avoid a major information dump each time you move to a new subject.
Tip #2: Create a plan early
Your first year, all you need to worry about is learning how to do medical school. Honestly, I didn’t even study the summer before my second year because I needed a break. But, once you get to your second year, you need to start thinking about how to pass USMLE Step 1 and COMLEX Level 1. Before or at the beginning of second year, begin creating a plan.
This plan should start with your desired test date. Then work backwards and determine what you need to do to be successful. You may not stick to this plan, exactly. But, at least having it in your mind can help you generally stay on track. Throughout your second year, you still have to do well in classes. That is the year when a lot of things start clicking. So don’t abandon your grades to start studying for boards.
You also do not want to start studying too early. You will burn out. I took about 4 weeks of dedicated time where I did NOTHING but study. That was the perfect amount of time to feel pressed, but not out of time. When you create your plan, have target dates of finishing certain resources. By the time you finish your second year, you should be pretty much done with a primary review and heavily into practice questions.
Here is a sample study plan:
Tip #3: Identify resources you like
It is very easy to get overwhelmed by resources when you are trying to figure out how to pass USMLE Step 1 and COMLEX Level 1. There are so many excellent resources, and you may feel the pressure to use them all. Don’t.
To some degree, they all say the same thing. They just present them in different ways and with different levels of detail. Use the first year, year and a half, to really try out different resources. Then decide which ones you like ad stick to those. Everyone will have an opinion about which one you should use.
I used First Aid, Sketchy, UWorld, and Kaplan (all of which I will detail below). Even though I was advised to use others like Pathoma and Boards and Beyond, I felt as if I didn’t have enough time to figure out what those were and how I wanted to use them. So I stuck to the ones I already used, and that worked out fine for me. If you use to omany resources, you get to a point where you are so overwhelmed trying to get through them all, you actually don’t accomplish much.
If you want to use several resources, then get through some of them earlier in the year, and do the others later in the year. But do not try and tackle all of them during your dedicated time. Here are some common resources so you can make the best choice for you.
Tip #4: Methodically work through them
After you have created a plan, and found the resources you like, then it’s time to start studying. The plan can be excellent, but if you don’t follow it, then you may end up weeks before the test feeling extremely underprepared. Even though you may get discouraged, it’s important to trust the process.
For example, when I was reading First Aid cover to cover, I thought the book would never end. It was so long, and reviewing information I hadn’t seen in over a year was challenging. But, if I had given up, I couldn’t have established a baseline knowledge necessary to move on to practice questions.
During my dedicated time, I had a goal of getting through UWorld twice. During my first (and only) pass, the questions seemed never ending, and they were so long. But I had to get through them all, one 40-question block at a time.
Hearing others’ progress can help you feel like you’re behind. Or counting the days to your exam can cause you to panic. However, if you just stick to your plan, and motivate yourself on days you don’t feel like studying, you will be fine. Trust the study skills you’ve developed to this point, and if you need assistance, find those resources at your school to help you develop a study plan.
Tip #5: Have a check-in circle
Studying for boards it the most isolating thing I think I’ve ever done in my life. When school was over, we weren’t required to go back to campus. We were given a few weeks to study and take our exams. During this time, I was so busy studying, I had very little contact with friends or family. It was just me in my apartment doing practice questions non-stop.
I like my quiet time as much as the next person, but it got too quiet and too isolating. However, all of your friends are busy studying too, so there’s not a lot of opportunity to have a social gathering. Plus, if you’re like me, then being at school or at home can be too distracting.
Make sure to establish a group that checks in on each other throughout this time. It can be a very trying time for even the smartest of students. This may not seem like an important factor in how to pass USMLE Step 1 and COMLEX Level 1, but it is. And you don’t know the special kind of hell dedicated studying is until you’re in it.
Your check-ins don’t have to take a lot of time. But text your friends once a week and say, “Hey, just checking into see how you’re doing.” Occasionally, you will get a meltdown session. But just encourage them to stay positive. Most likely your words won’t help, but sometimes, just having someone to vent to is the best therapy.
Try not to go through this process completely alone. Imposter syndrome and self-doubt can really sneak up on you if you let it. Study at home with family or grab dinner with a friend. Do whatever you have to do to keep yourself in a positive mental state.
Tip #6: Don’t get discouraged
UWorld is the gold standard question bank for preparing to pass USMLE Step 1 and COMLEX Level 1. There are other great supplementary qbanks, but UWorld truly helps people pass. In saying that, it will have you doubting that you ever learned anything. I can’t tell you how many times I got excited about scoring above 60% on the question blocks. That’s how tough the questions are.
They are extremely specific. Seem completely random. And may even push you to cry (I did…twice). But, UWorld is like a really tough practice session before the game. In practice, you run way more than you would in a game. You practice situations that are much more difficult than in-game situations would be. But when the game comes, you are overly prepared, and that’s what you want.
UWorld, in my opinion, is more convoluted and specific than the actual test. So, if you take UWorld seriously, then the real exam may be A BIT less challenging. Don’t score 40s consistently and think you will do well on the real exam. But if you are trending upwards and scoring mostly 60s, 70s, and above, then you should be fine on the real exam.
Don’t get discouraged. Keep practicing the questions, and studying the content you get wrong. If you repeatedly get something wrong, then take a break from questions to just study it. The closer you are to your exam, the more targeted your approach needs to be. But, if you let those wrong questions discourage you, then you may be missing out on an opportunity to really strengthen your weaknesses. It’s uncomfortable, but will be worth it when you get a pass!
Tip #7: Take practice tests
The best confidence booster to pass USMLE Step 1 and COMLEX Level 1 is to take a practice test. Practice tests provide you with sample questions and a chance to test your endurance. These exams are long and the material is random. These exams are everything you’ve learned over the past two years…and then some. It’s imperative you take several practice exams throughout the year to really gauge your preparedness.
Our school had us take five exams throughout the year. Our performance on the first two was really for our own knowledge. They also helped drive the development of our review course. The last three exams indicated how many review sessions we had to take, and if we were cleared to take the real exam.
In addition to these, I took an NBME. If I could do it over again, I would have probably taken two. However, I didn’t have enough time and did not want to take a practice exam the week before my real exam. If you get a result you don’t like, it can shatter you confidence. That is the last thing you want before going into an exam. Positive vibes only!
Therefore, when you are creating your plan, include time in there for practice exams. These can be NBME, UWorld Self Assessments (UWSA), Kaplan full length, AMBOSS, NBOME, etc. Find the one that is the most cost-effective for you. None of them will be exactly like the exam, but they are quality representatives.
Take the exam in a test-like environment with the exam timing. When you finish, review it and identify the overarching topics you are struggling with. It doesn’t help to study each individual question as it’s not going to be on the real exam. You just want to see which topics you need to spend extra time on.
Tip #8: Take care of yourself
This may seem like an unimportant tip for how to pass USMLE Step 1 and COMLEX Level 1, but if you do not take care of yourself, you will not do well on the exams. This time of your life is so intense, you may lose out on some healthy habits you had established. Sleeping, working out, eating healthy, and de-stressing are all still important. And it’s important you make time for them in your study schedule. Of course you can use that extra 30 minutes to go through one more UWorld block.
But, you can also use that 30 minutes to go on a quick walk. There were several days I didn’t even leave the house. Not having sunlight can have such a negative impact on your mental health. I noticed I would get into these gloomy moods. Everything upset me, and I wanted to cry at the drop of a hat. When I got to this point, I would shower, shave, do my hair, get dressed and study at a coffee shop. I felt so much better when I did that, and I actually scored better on my qbank blocks.
Do not shut yourself away for two months. Wash your face and hair, continue to work out, and try not to eat your feelings. I’m all for an ice cream run after scoring 30% on a UWorld block. But, making a habit out of eating bad foods can make you feel bad. And nothing is more unmotivating or energy draining than not feeling good physically.
I also got sick while studying, and even though I tried to push through, my body was not having it. So I took a time out for a day, let my body rest, and got right back to it the next day. It’s better to rest and work efficiently when you’re feeling better, then half-assing it just so you don’t miss a day.
Tip #9: Don’t psych yourself out
As you get closer to exam day, you may begin to doubt if you’re truly ready. I had two study buddies who were much more stressed about the exams than I was, making me think that maybe I wasn’t stressed enough. I think all three of us were in a space of self-doubt. We were so close to the exam and had covered so much, yet still felt like we hadn’t covered enough.
If you want to pass USMLE Step 1 and COMLEX Level 1, then you cannot freak out. Overwhelming yourself is easier to do than you think. Maybe your NBME score comes back as a low pass, or you’re still scoring 65% on some UWorld blocks. That’s okay. This is not representative of how your entire test is going to go. Only you can truly gauge your preparedness, but make sure to really think about how prepared you actually are before you start changing test dates.
Changing dates is expensive, can put you at risk for not finding a seat, and can cause you to extend your study period much longer than you want. If you start feeling like a flight risk, talk to your friends or mentor about why you feel that way to get a sense of if you’re just psyching yourself out, or if you truly need some extra time. Whatever you do, just don’t make a rash decision that you will regret later on because you didn’t have faith in yourself.
Tip #10: Take breaks
I am in a group chat with other Black medical students in my year, and one girl gave the advice “Make sure to schedule sick days into your study schedule.” I thought that advice was so simple, yet never done. If you’re type A like me, then every second of everyday is planned. If you’re not type A, then you may still have some type of schedule that doesn’t include rest time.
But, it’s so important to take breaks when studying. You may think you don’t have time, but it’s like training for a marathon. You will injure yourself and burnout if you train every single day all day. Your brain is a muscle, and studying nonstop without giving yourself breaks can lead to burnout, migraines, stress, depression, anxiety, and a host of other issues.
This will not help you pass USMLE Step 1 and COMLEX Level 1. Instead, you will create other problems, while still lacking in information necessary to pass both exams. When creating your plan, plan for a full rest day at least once every two weeks. If you are diligent about following your schedule, then you may even be able to afford one day a week.
I would wake up at 6 am every morning, and study until about 4 or 5 in the afternoon. Then I would work out in my house and watch my shows before making dinner and hanging out for the evening. Some days, my questions would take me into the night. The closer I got to my exam, the shorter my study days became so I could preserve some stamina for the exam.
Bottom Line
The second year of medical school is very busy. But, if you plan early and stick to your plan, then you should have no problem passing USMLE Step 1 and COMLEX Level 1. The most important thing is to stay in your own lane. Everyone’s prep process will look different. That’s okay as long as you are on the right track and making changes when something is not working.
Follow me on TikTok (@student.doctor.queend) and YouTube for stories about my own board prep process, and if you have any stories to share or questions to ask, please leave them in the comments!
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