Sunday, June 23, 2013


I just finished boards. I took the USMLE (for MDs) a week before taking the COMLEX (for DOs). Since our unique training makes us eligible for both sets of boards and both the MD and DO residencies I figured I'd take both to keep as many doors open as possible.

The tests were similar in the length of time required to complete (about eight hours.) The USMLE had about 320 questions over seven 42 question blocks and the COMLEX had 400 in eight 50 question blocks. Each block lasts an hour. I liked the format of the USMLE break system which gave you an hour to use as needed in between blocks. The COMLEX was more structured in that you could take ten minutes after the first two blocks, a forty minute break for lunch two blocks after that, and a ten minute break between the sixth and seventh blocks.

I thought it would be a good idea to take the USMLE first since I would need time to study the additional material that the COMLEX requires: osteopathic principles, treatments, and diagnosis. Additionally, I had heard that the COMLEX covers the more obscure bugs of microbiology (nematodes, cestodes, and trematodes). I was glad I took the extra time, but instead of seven days between them, I think five would have been perfect. As it was, I got a little burnt out and had less time to prepare for rotations.

Preparing for the boards I went almost twice through all of UWorld's question bank of 2,200 questions. I found that doing questions along with studying really helped nail down the testable questions, and especially get used to the format. There are only so many questions you can get asked about adrenergics, etc before you have covered every approach to receptors, pharmacology, and effects. UWorld questions were fairly comparable to the actual USMLE, but I'd say were generally a bit more difficult and required more obscure knowledge. The ethics questions were not comparable in that they didn't seem to test the same principles. I don't remember any specific questions, but I do remember struggling with them. If residency directors get a breakdown of my exam they might conclude I'm unethical.

During the week between tests I did an additional 1,000 questions from the COMQuest bank. There were quite a few piece-of-cake-don't-waste-my-time questions, but that turned out to be fairly representative of quite a few questions on the COMLEX. It was a good thing I had focused on the obscure bugs because it seemed like I was tested more on that than on the more common pathogens. There were a few questions that seemed to test obscure diagnoses. They were never covered in any of our regular course work so I think the purpose of them was to see if we could exclude everything else. An example is something I got asked about on a practice question: proctalgia fugax. I had never heard of it mentioned before that question. Turns out it's an severe, episodic cramping of the rectal muscles. Another example is the diagnostic criteria and treatment for fibromyalgia.