How to Study for COMLEX Level 1 and USMLE Step 1

Board examinations are a huge part of medical school. Even with the switch to a pass/fail grading system, it is essential to pass on your first attempt or risk the burden of a "red flag" once residency application season comes around.

Understanding Board Exams in Medical School

Types of Exams: COMLEX Level 1 and USMLE Step 1

Medical students typically take COMLEX Level 1 and USMLE Step 1 after their second year of medical school.

Allopathic (MD) medical students take the USMLE Step series (Step 1, Step 2, and Step 3).
Osteopathic (DO) medical students take the COMLEX Level series (Level 1, Level 2, and Level 3)

However, since the merging of allopathic and osteopathic residency programs, many DO students opt to take both to be competitive for traditionally allopathic residencies, which are greater in number than osteopathic residencies.

The Stakes of Board Exams

Medical students have been obsessively stressing over the Level/Step 1 exam for years. Residency and a future career as a physician are on the line. Students have struggled to balance their classwork with board review, but it is possible to succeed with both.

My Personal Success Story

I did well on COMLEX Level 1 and USMLE Step 1 while improving my class rank during my second year of medical school with the strategies I will share. You do not have to risk burnout or sacrifice your good habits (taking breaks, exercising daily, spending time with loved ones) if you plan with a study schedule that works for you.

I was in the last medical school cohort (Class of 2023) with a three-digit score for COMLEX Level 1 and USMLE Step 1. I realize that subsequent cohorts now have more uncertainty in this process, so I hope to lessen the stress with 3 of my top tips that led to my success:

3 Essential Tips for Board Exam Success

1. Set a Realistic Schedule

Do your best and set a schedule, a template of what to aim for. You are going to have slower days than others. Things come up, but make sure you do not have slow weeks. Start the new day fresh.

2. Start Early with Board-Prep Resources

It’s never too early to start using board-prep resources alongside your classes. It should supplement your coursework.

3. Practice Timed Questions

No matter what question bank, always do timed questions. COMLEX and USMLE are timed exams, so you have to be familiar with that time crunch and how to pace yourself, being fast, efficient, and accurate as you go along. Starting this from the very beginning is going to pay off.

Must-Have Resources for Success

The following are resources that I often refer to as required for success:

Required Resources

First Aid (newest edition if possible): about $50 on Amazon
TrueLearn (COMBANK for Level 1 or SmartBank for Step 1): The price varies on the type and length of the subscription. I have a discount code you can find here.
Level 1 or Step 1 Anki deck: FREE. I used the Zanki deck, which can be found on Reddit.
A second question bank of your choice (or double up on TrueLearn if taking Level 1 and Step 1). Many schools pay for a question bank for their students, so check in with your admins before purchasing.
If you are an osteopathic medical student, you must read OMT Review, also known as the Saverese Green Book, for about $45 on Amazon.

Optional Resources

The following are optional resources that depend on your learning style:

1. Video-based resource: lecture-style, cartoon-style, or both

2. Textbooks

Study Routines for Each Semester

Here is a rough schedule that I followed throughout my second year of medical school to both prioritize classes and slowly incorporate board studying:

Fall Semester: Prioritize Classes, Start Thinking About Boards

Go to lecture, then review your lecture notes. Watching recorded lectures instead of attending live lectures may save time if you have that option.
Complete any school assignments first before moving on.
Annotate First Aid pages that correspond to lecture topics. High-yield material for boards was often also high-yield for my school's exams.
Unlock Anki cards relevant to lecture topics. Zanki is by organ system, similar to the organization of my classes.
Optional: textbook readings and video-based resources (again, pertinent to lectures that week)
At the very least, decide on which question banks to use. Most students start a subscription to at least one question bank at the start of the year with a year-long subscription (myself included with my TrueLearn subscription). If you decide to start a subscription, you can also do the questions relevant to your lectures if you have time after doing the above steps.

Spring Semester: Balance Classes with Board Review

Similar to Fall, go to lectures, review lecture notes, complete any school assignments, and annotate First Aid for lecture topics. Optional: textbook readings and video-based resources
Anki: new cards relevant to lectures + reviews. This method was the easiest way to add a quick daily review.
At least 20 questions a day (40 questions on weekend days). Prioritize relevant questions to lectures but start mixing in random questions from previous blocks. Increase questions to at least 40 questions a day (80 on weekend days) towards the end of the semester. Aim to finish your first question bank by April.

Dedicated Study Period: Full Board Review

Anki: Complete all the cards of whatever deck you use at least once. Try your best to keep up with daily reviews. (You are doing too much if you spend more time on Anki reviews than practice questions.)
Increase your daily questions to reach the total 8,000 question minimum but aim for 10,000 questions if you can. (I was between 10,000 and 11,000.) To calculate this, you can add the questions from all your question banks, practice exams, and any questions from video-based resources or textbooks. Figure out how many questions you have left. Divide by the number of days left before your test. Again, make sure these question sets are random and timed.
Review First Aid and make additional annotations when you get incorrect answers to your practice questions. TrueLearn makes this easy by including relevant page numbers on most question explanations.
If you are taking COMLEX Level 1, read through the entire Savarese Green book. I also recommend downloading an Anki deck with counterstrain points and Chapman's points.
Take half-length practice tests at least once every two weeks.

medical student studying for COMLEX or the USMLE

Additional Advice

Many students may have used prep courses or classes while studying for the MCAT. In medical school, there is no need to pay for a COMLEX Level 1 prep course or COMLEX Level 1 prep class. You will likely be more efficient with your time using these tips and studying independently.

Final Thoughts

Board exams may seem daunting, but with a solid plan and effective resources, you can achieve success. By staying organized and proactive, you’ll set yourself up for success in your medical journey.

Listen to First Line's episode "How to Study for COMLEX Level 1 and USMLE Step 1" for more information and tips. If you are in your dedicated period or preparing for it, check out this episode: Dedicated Studying for USMLE Step 1 and COMLEX Level 1

Frequently Asked Questions (FAQs)

1. When should I start preparing for board exams?

It’s best to start integrating board-prep resources into your classwork as early as the fall semester of your second year. This allows you to gradually build familiarity with the material without overwhelming yourself.

2. How many questions should I complete during my dedicated study period?

Aim to complete 10,000 questions, so you can subtract the questions you completed before your dedicated period. Break this down into daily goals based on the days remaining before the exam.

3. Are prep courses necessary for COMLEX or USMLE?

No, prep courses are not necessary. Most students find that independent studying using high-quality resources like the required and recommended resources I included above.

4. What are the best ways to balance board prep with classwork?

Prioritize your classwork while gradually incorporating board-prep resources like Anki and question banks. Allocate time each day for board prep without neglecting your school assignments.

5. Should osteopathic students take both COMLEX and USMLE exams?

This depends on your career goals. If you’re aiming for traditionally allopathic residency programs, taking the USMLE exams can enhance your competitiveness.