COMLEX vs USMLE (Meaning, Similarities & Differences, Exam)6 min read

COMLEX and USMLE have come to be two very common terms in medical schools.

They are the most recognized licensing tests to be taken by osteopathic medical students seeking to practice medicine in the United States and in some parts of the world where these tests are accepted.

COMLEX and USMLE share a host of similarities between themselves, but then, besides their different names, they have many differences.

You can barely search for one on the web without the other popping up along the line; that’s how related these two medical licensing tests are.

What is COMLEX? 

Comprehensive Osteopathic Medical Licensing Examination, popularly known by its abbreviation COMLEX, is a three-stage test taken to determine the knowledge and skills of osteopathic medical students.

COMLEX is administered by NBOME, which stands for National Board of Osteopathic Medical Examiners.

NBOME administers COMLEX to offer osteopathic medical licenses to those who are successful in the exam.

It is the most common means by which osteopathic physicians apply to get a medical license, and the test is recognized in all states in the US. The COMLEX is divided into three levels:

  • Level 1 – Taken after completing the second year of medical school.
  • Level 2 – Taken during either third or fourth year in medical school. It is divided into two parts: Cognitive Evaluation and Performance Evaluation.
  • Level 3 – Taken at the start of a residency program. 

What is USMLE? 

USMLE stands for the United States Medical Licensing Examination. Just like with the COMLEX, the USMLE is a 3-level medical licensing exam program.

It is administered by FSMB (Federation of State Medical Boards) and NBME (National Board of Forensic Pathologists).

It is also divided into three steps:

Step 1:

Examines if a medical student understands and can apply essential principles of basic sciences to medical practice.

Step 2:

CK (Clinical Knowledge): Examines if a medical student can apply medical skills, understanding, and knowledge of clinical science vital for the provision of patient care while being supervised.

Step 3:

Examines if a medical school student can apply medical knowledge and understanding of clinical and biomedical science important for the unsupervised practice of medicine, with a focus on patient management in ambulatory situations.

COMLEX vs USMLE: What Differentiates them?

If you’re simply beginning the process of obtaining a license to exercise medicine in the United States, be very ready:

Earning a medical license in the United States can seem very confusing. For US-based allopathic students, the course ahead, in all fairness is straight forward.

But in case you do not belong to that category, the course ahead is probably a bit more convoluted.

Let’s take into account an easy case first: International Medical Graduates (IMG).

For all physicians certified to exercise their profession in the United States, you will need to go into a residency match program (both osteopathic and allopathic programs) and finish extra medical training.

Currently, international medical graduates are best eligible for the allopathic National Residency Match Program (NRMP).

They have only to consider sitting for the USMLE, not COMLEX (the licensing examination for osteopathic physicians).

So, today, it’s a relatively straightforward answer for international medical graduates; sit for the USMLE examination, not the COMLEX.

Read this: Top 10 Jobs For Doctors Without USMLE

COMLEX vs USMLE: Similarities and Differences?

The COMLEX and USMLE are typically identical tests in that they examine students on the basics of medicine using identical materials.

The primary factor differentiating these two tests is that COMLEX additionally tests on osteopathic manipulative medicine by integrating it into questions.

No of Questions:

Students taking the USMLE are required to attempt all 280 questions, which are placed into seven blocks.

For the COMLEX, students taking the exam must answer all 400 questions placed into eight blocks.


The COMLEX exam is stricter in the amount of time it allows for breaks compared to USMLE.

It permits 10 minutes of break time after blocks 1 and 2 have been completed, a 40 minutes break at lunchtime, and another 10-minute break after blocks 5 and 6 have been completed.

In the USMLE, candidates are permitted to go on breaks after each block.

The USMLE offers 45 minutes of break time and an additional rollover time if you complete a block before the designated time for the block runs out.

The USMLE offers a better time rate per question compared to COMLEX. It gives its candidates 60 minutes to complete each block, consisting of 40 questions.

The COMLEX allows candidates 60 minutes to complete each block, with each block containing 50 questions.

Subject and Style:

The USMLE examines its candidates on an evenly vast number of subjects while the COMLEX focuses its questions more on primary care pathology. 

The USMLE offers a direct question and answer style where candidates pick the correct answer from a list that includes completely wrong options.

But in the COMLEX, there is usually more than one correct answer to a question, but the candidate must select the most correct one.

A reason the COMLEX is question style is referred to as vague.

COMLEX vs USMLE: Which exam should I take?

Traditionally in a separate residency accrediting system, Osteopathic college students have had the choice to take the USMLE tests relying on their future objectives and preferred area of expertise.

Students reaching for greater competitive areas of expertise typically take both COMLEX and USMLE tests, while the ones who seek to specialize in primary care only do take the COMLEX.

With the current merger, this question will become extra nuanced, and typically, the response nonetheless relies upon several things, which include:


Board exams and study resources cost a lot of money. Some students might also be required to travel to a different state to take the test, making it even more expensive.


COMLEX and USMLE are difficult exams that take a long time to finish and have a significant impact on a candidate’s future career.

Sitting for one of the COMLEX or USMLE tests is stressful enough, and planning to take the two tests would even be more stressful.

Confidence in Scores:

Candidates who score low in either COMLEX or USMLE and score high in the other might be frowned upon. Candidates should have to confidence to do well in both exams.

Preferred Area of Expertise:

Most programs only used to accept the USMLE, but now, some of these programs do consider the COMLEX.

The area you desire to specialize in would determine which of either COMLEX or USMLE tests to take.


Taking licensing examinations is most definitely stressful; however, stress can be controlled with the proper practice.

While you can’t possibly know what precise questions would be set for the exams, you may have an idea of the duration of the exam, the scope of the examination items, and style.

For the candidates taking each of the COMLEX and USMLE assessments, preparation has to consist of both the what – clinical knowledge – and the how – the fashion and peculiarities of both examinations.

Apply the recommendations above, and you may be on your way to earning your medical license.

Awesome one; I hope this article answered your question.

Share this Information.

Editor’s Recommendations:

Leave a Comment

Your email address will not be published. Required fields are marked *