What are the USMLE Step 1 and COMLEX Level 1 Exams?

Apple Podcasts | Google Podcasts

Session 02

Once again, we’re joined by Dr. Andrea Paul from BoardVitals. In this episode, you will learn all you need to know about Step 1, how long to take it, when to take it, and what makes it different from the MCAT so you know what to expect before we jump right into the actual test prep!

[01:10] More About Board Vitals

If you need more help, check out Board Vitals and you get everything you need to expect from a board prep company including challenging questions, time and untimed question banks, progress tracker and advanced analytics and reports to help you direct your studying. This is something most students don’t take enough advantage of. You really need to know what you’re doing or missing, or what you’re getting right to be able to know what to do tomorrow.

Plus, you get to see how you rank with your peers. With over 1,750 questions in their USMLE question bank, BoardVitals will make sure you have access to the questions you need to be prepared and confident going into your USMLE exam. Don’t worry DO students! They’ve also got over 1,500 questions in their COMLEX Qbank.

Get 15% using the promo code BOARDROUNDS when you sign up for BoardVitals and they will donate a vaccine to a child in need through the Give Vacs Program. If you’re not ready to use it yet, just buy now and you can start up to 6 months after purchase.

[03:15] How Important is USMLE Step 1

Going through medical school, Andrea eventually realized that this was something she needed to pay attention to and start to prepare for quite early. And the stakes have gotten much higher since then.

The goal for everyone is to get a residency they want in the specialty area they want. And for many students, that means being in a competitive location and a competitive medical specialty. So the scores serve as a gateway to get an interview for one of those positions.

'It's a very high stake particularly if you're someone who is interested in a more competitive area, geography or specialty-wise.'Click To Tweet

In fact, the NRMP match data suggests that those Step 1 scores are the determining factor if whether or not you’re going to get an interview.

[06:20] MCAT vs Step 1

Both are completely different tests in many ways. Andrea says that until you start preparing for it and seeing what format of questions are like, you wouldn’t expect that people think of it as a more intense basic science exam similar to the MCAT. But in actuality, the new Step 1 exams are clinical and really require a lot of correlation between those basic sciences and actual medical practice.

The MCAT is a test to see how well you can take the MCAT but when you get to Step 1/ Level 1, it’s knowledge that you have to have to be a competent physician. You have to have that base knowledge so you can learn how to be a physician once you’re out in residency.

Moreover, the exam has changed a lot since. They have slowly transitioned now to a more practical and clinical correlation with basic science.

[07:55] Breakdown of Step 1 Exams

The USMLE Step one covers Anatomy, Behavioral Science, Biochem, Microbiology, Pathology, Pharmacology, Physiology. And they try to integrate those into a way to asses your knowledge of those things within the constricts of clinical medicine. COMLEX is similar as they do most of the subjects in addition to tests on some osteopathic-specific areas as well.

They’re now focused more heavily on “triple jump questions” or tertiary type questions where they could give you a clinical presentation but they’re not telling you, not only what the disease entity is and what you would treat it with, but also something about that medication. These are a classic type of questions you need to practice.

[10:00] Duration of the Exams

Step 1 or Level 1 is a one-day exam. People usually take them at the end of their second year. They have some time off before they take the exam usually during the summer. USMLE Step 1 has 7 60-minute blocks that comprise a full eight-hour day. The exam has about 280 questions of an intense, rigorous full day of testing.

COMLEX is similar with more questions of about 400 questions. It’s taken in one day and it’s broken down to 4-hour exam sessions with a break in between. You still need to know the various levels and anatomy involved in performing manipulative techniques which are often theory-based and in a straightforward format.

You can select your day and location so there are flexibility and variation in as far as when people choose to take it. Just your personal preference as to what amount of time your school gives you.

[13:00] Beyond Step 1

After Step 1, there’s also another exam,  Step 2. The COMLEX Level 2 is taken during medical school which most people take Step 3 afterward. Those are similar in the format of question-type based. They’re more focused on the tertiary or three-jump types of questions and more in-depth on the clinical side.


BoardVitals (Get 15% using the promo code BOARDROUNDS when you sign up for BoardVitals.)

NRMP match data

MedEd Media Network