COMSAE vs. COMLEX: Everything You Need to Know

How COMSAEs and the COMLEX-USA Exams Compare

Osteopathic physicians can use COMSAE to evaluate their readiness for the all-important COMLEX levels. However, they are not the same test.

COMSAEs

COMSAE exams are self-assessments designed specifically for students in osteopathic medical school (DO-granting programs). They’re tailored to help you prepare for the COMLEX examinations.

There are three phases on COMSAE to correlate with the three levels of COMLEX.

We recommend you start with an initial COMSAE practice exam to begin your COMLEX studying journey. This establishes a baseline, so you’re able to regularly assess your progress to stay on track toward exam readiness.

COMLEX Exams

COMLEX-USA is a three-level series of licensure examinations for osteopathic students and doctors.

• Level 1 assesses basic medical knowledge to ensure that med students can effectively start their clinical years. It’s generally taken in your sophomore year of medical school. In recent years, Level 1 has moved to a Pass/Fail grading system.
• Level 2-CE (Clinical Evaluation) assesses your patient care and clinical knowledge in your junior or senior year of med school, meant to ensure you can practice medicine under supervision (residency). A good Level 2 score is critical to acceptance into residency.
• Level 3 assesses your clinical competencies in preparation for independent practice after residency. You take it during medical residency. Passing Level 3 is one of the main requirements for getting a state medical license.

Note that COMLEX is officially called the COMLEX-USA, though everyone abbreviates it because there are zero non-USA-based COMLEX exams.

The Similarities & Differences

The COMLEX is a three-level, national standard licensure exam. There is a COMSAE practice self-examination for each of the three phases.

There is a COMSAE Phase 1 testing experience to help students prepare for the COMLEX-USA Level 1 examination, a COMSAE Phase 2 assessment for the COMLEX-USA Level 2 Cognitive Evaluation (Level 2-CE) exam, and a COMSAE Phase 3 self-assessment exam for the COMLEX-USA Level 3 exam.

Similarities include:

• Both are developed by the National Board of Osteopathic Medical Examiners (NBOME) and are separated into three distinct levels/phases focused on osteopathic medicine.
• Each COMSAE is similar to the format of each respective COMLEX exam level, providing a good practice for the real deal.
• Like the COMLEX, each section on a COMSAE consists of multiple-choice, stand-alone questions that may include audio, visual, or video components. However, some students report that COMSAE questions are clearer than the real test, while COMLEX questions can be more overwhelming and vague.

Differences include:

• The COMLEX is a high-stakes series of exams, while the COMSAE is a low-stakes practice test. Residency programs and state licensure boards look at your COMLEX scores, but it doesn’t matter what you make on COMSAEs.
• There is no limit to how many times you can take the COMSAE, whereas there is a 4-time limit on taking the COMLEX.
• COMLEX Level 3 includes Clinical Decision-Making (CDM) cases, which pose a clinical scenario followed by 2-4 accompanying questions. COMSAE Phase 3 does not include CDM cases, even though they appear on the actual exam.
• The scoring process differs significantly. While COMSAEs include a numerical score for results, COMSAE scores are not accurate predictors of what your COMLEX score will be. Instead, COMSAEs help you know if you’re in a position to pass the test.

Are COMSAEs Accurate in Predicting COMLEX Results?

COMSAEs are most accurate at predicting whether you’ll pass the respective COMLEX level or not. They are less accurate at predicting exact COMLEX scores.

The raw score on your COMSAE often under-predicts your ultimate COMLEX score. This disparity is probably due to COMSAE’s scale being 200-800, while COMLEX Level 2 and Level 3 are scored on a scale of 9-999.

In general, COMSAE questions tend to be slightly easier to understand than the actual COMLEX questions. However, the different numerical ranges make the COMSAE seem harder since the scores are lower than your real-life COMLEX scores.

A Good COMSAE Score

A really good COMSAE score is 650+, and a 400 on the COMSAE is considered average.

Many osteopathic schools require students to take a COMSAE before sitting for the COMLEX, and the target COMSAE score may range from 400 to 500.

According to NBOME, COMSAE score interpretation rankings are as follows:

• Lower than 400: Low performance
• 400 to 649: Average performance
• Higher than 649: High performance

The maximum score is an 800 on all phases of the COMSAE. Aim to get above 600 on your COMSAE for a good COMLEX score.

The COMLEX-USA exams are scored as follows:

• COMLEX Level 1 is based on getting a passing score or failing.
• COMLEX Level 2-CE is graded between 9-999 (400 is passing; 550 puts you in the 50th percentile).
• COMLEX Level 3 is graded between 9-999 (350 is passing; 500 puts you in the 50th percentile).

Study and Prepare Strategically

When it comes to studying for the COMLEX, you’ll want to utilize COMSAEs to get prepared. That said, incorporate the COMSAE strategically, not randomly.

Let’s take a look at the best ways you can prepare for your COMLEX-USA exam through key study practices.

Take a Baseline Practice Exam Early

Your first attempt at taking a COMSAE tells you where you need to focus your time on studying. Therefore, take this baseline self-assessment at the beginning of your study schedule.

We recommend taking your first COMSAE 48-60 days before you take the COMLEX.

Create a Study Plan

It is typical to study for COMLEX Level 1 or Level 2-CE for 6-8 weeks, and we suggest you take a COMSAE to get started. Use your baseline to curate a study plan that works for you.

Be realistic. Don’t start off studying random osteopathic subjects for 3 hours a day. Start small — maybe 60 minutes a day for 5 days; study specific subjects that performed poorly on when taking your initial COMSAE. Add study time as you hone in on what you most need to study.

For Level 1 studying, we recommend the gold-standard study book, First Aid for USMLE Step 1. For Level 2-CE, there are some superb question banks available.

Of course, there’s a debate on how often you should take COMSAEs. We’ve gathered insights from successful students who’ve navigated their exam prep using COMSAEs:

• Some found that taking a COMSAE every two weeks helped maintain study momentum while allowing ample time for focused review.
• Others said that simulating real exam conditions during practice sessions was more important than a strict two-week rule in helping build exam endurance and reducing their test-day nerves.
• We recommend taking at least 3 COMSAEs, two weeks apart from one another, starting about 48-60 days before your COMLEX test date.

Simulate Real COMLEX Conditions

It can greatly benefit you to simulate real COMLEX conditions when studying for COMLEX-USA:

• Take the full COMSAE practice test in one sitting. The real test takes 8 hours, and you are allotted a total of 60 minutes of optional break time spread out over 7 designated break opportunities. Don’t take unnecessary breaks that you won’t get on the test day.
• Wear noise-canceling headphones, and take the practice test in a quiet, secluded environment. Let your roommates or family know that you’re trying to go “off the grid” for several hours, in order to reduce interruptions. Don’t let yourself get distracted just because you’re not taking the real thing.
• Take an official COMSAE, not a low-quality test that has no correlation with the real COMLEX test day. Don’t waste your time on poorly-made self-assessments.

Discovering Your Strengths & Weaknesses

Use the COMSAE to discover where your strengths and weaknesses lie with COMLEX subjects.

Adjusting study plans based on practice exam results is crucial for medical students preparing for the COMLEX. This is because the practice tests will help you identify where you need to spend more study time (weaknesses) and where you can spend less (strengths).

For example, if you find yourself struggling in certain areas, like pharmacology, but thriving in others, like microbiology, consider ramping up your study time in pharmacology and not focusing too heavily on microbiology.

Incorporate Question Banks

Question banks (Qbanks) are essential to COMSAE/COMLEX studying success. Take advantage of practice COMLEX question banks on sites like Truelearn and UWorld, which all have broad COMLEX practice Qbanks in addition to area-specific practice questions.

Here are our top options for Qbanks:

• COMBANK offers an enormous question pool with detailed explanations, making it vital for reinforcing clinical reasoning and osteopathic principles. Use it as your primary question bank.
• COMQUEST is known for its intuitive interface and practice test simulations, which closely mimic the format of real COMLEX exams. COMQUEST works best for timed practice sessions or targeted review of your weaker areas.
• UWorld/AMBOSS is traditionally geared toward USMLE prep. Still, UWorld and AMBOSS can help dual USMLE/COMLEX takers, providing high-quality practice questions and explanations to strengthen your clinical decision-making.

Also consider using flashcards with a friend or family member, or look into joining a group study session.

COMSAEs & COMLEX vs. NBMEs & USMLE

The COMSAEs are similar to the self-assessment exams that allopathic and international medical graduates take, known as National Board of Medical Examiners (NBME) self-examinations, before taking the three steps of the United States Medical Licensing Examination (USMLE) — generally considered a more difficult set of tests than COMLEX.

Unlike NBME’s self-assessments, which cover broad medical knowledge without any emphasis on osteopathic principles, NBOME’s COMSAEs contain content aligned with osteopathic medicine principles, including Osteopathic Manipulative Medicine (OMM) and Osteopathic Principles and Practice (OPP).

There has been discussion around the notion that DO students should possibly take the USMLE Step 1 in addition to the COMLEX Level 1. Ideally, osteopathic students should incorporate both the COMSAE and USMLE prep into a holistic practice schedule.

Program directors are more familiar with USMLE scores, so osteopathic medical students could gain a competitive edge in applying to residencies by taking both exams, especially since there’s no widely accepted conversion formula between COMLEX and USMLE scores.

However, if that’s untenable for you, stick with COMSAEs.

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