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Journal of the American Osteopathic Association


Background: The purpose of this study was to evaluate the current trends in study resources used by students to prepare for the COMLEX-USA Level 1 and Level 2-CE. Specifically, we aimed to answer the following questions: how many resources did students use, which resources did they use most often, and which resources did they find most helpful? To our knowledge, there have been 2 studies that have aimed to evaluate study strategies and resources used by students to prepare for COMLEX-USA Level 1 (“Level 1”) and COMLEX-USA Level 2-CE (“Level 2”). A 2013 study1 found that longer preparation time was correlated with higher Level 1 scores. It also found that the most helpful review book for Level 1 was First Aid for the USMLE, the most helpful practice examination was the COMSAE, the most helpful question bank was COMBANK, and the most helpful lecture video was Kaplan USMLE. Interestingly, those who did not choose COMSAE as the most helpful practice examination were more likely to get a score of 600 or higher on Level 1 compared with those who did choose COMSAE as the most helpful practice examination. A 2015 study2 found that First Aid for USMLE, UWorld, COMBANK, and Doctors in Training were the most helpful resources for Level 1, and COMAT examinations and clinical rotations were most helpful for Level 2. As more study resources become available each year, this information is apt to change, and we aim to look at the current trends COMLEX-USA study tools. This study is of significance to osteopathic medical students and osteopathic medical educators as an understanding of the most valuable resources will help students potentially improve their performance on the osteopathic medical board examinations. According to the NRMP Program Directors Survey, USMLE Step 1/COMLEX-USA Level 1 score is the most important factor in selecting applicants to interview across all specialties, and USMLE Step 2/COMLEX-USA Level 2 score is the fourth most important factor.3

Methods: This study was approved by the Kansas City University (KCU) Institutional Review Board. Participants were third-year (Level 1 survey) and fourth-year (Level 2 survey) medical students at KCU. This was a cross-sectional design. Students were given the opportunity to complete an optional anonymous online survey. Participants were asked to disclose their COMLEX-USA Level 1 or 2 score, as well as their USMLE Step 1 or 2 score (if applicable). Popular resources were listed and participants were asked to rank each resource they used on a Likert scale (1 to 10) in terms of how helpful they found that resource to be. Then, they were asked to identify the 3 resources that they found to be the most helpful. They were given the option to write in answers if they used something that was not included in the survey. Resources included various review books, question banks, practice examinations, video/audio lectures, flashcard tools, and review courses. Data were analyzed in SPSS using descriptive statistics.

Results: In total, 60 students completed the Level 1 survey and 66 completed the Level 2 survey. For Level 1, the mean number of resources used was 12.6. Of these resources, the 5 most commonly used in descending order were: First Aid for the USMLE Step 1 (review book), UWorld (question bank), Pathoma (video lectures), Sketchy Medical (video lectures), and OMT Review (review book). The 5 resources rated most helpful in descending order were: UWorld (question bank), First Aid for the USMLE Step 1 (review book), Sketchy Medical (video lectures), Pathoma (video lectures), and COMBANK (question bank). A popular combination of resources commonly used by students for Level 1 studying is UWorld, First Aid for the USMLE Step 1, and Pathoma, commonly referred to as the “UFAP method.” In our study, 58 of 60 students used this combination of resources. For Level 2, the mean number of resources used was 8.8. Of these resources, the 5 most commonly used in descending order were: UWorld (question bank), OMT Review (review book), UWorld Self Assessments (practice examinations), Kaplan (question bank), and COMBANK (question bank). The 5 resources rated to be most helpful in descending order were: UWorld (question bank), OMT Review (review book), COMBANK (question bank), OnlineMedEd (video lectures), and UWorld Self Assessments (practice examinations).

Conclusions: We found that students tend to use a variety of resources from several different categories in preparation for Level 1 and 2. OMT Review was a popular choice for both examinations. Our Level 1 results were consistent with the previous 2013 and 2015 studies1,2 in that First Aid for the USMLE Step 1 continues to be considered the most helpful review book used by students. UWorld and COMBANK were identified as the most helpful question banks when studying for Level 1. Sketchy Medical and Pathoma video lectures were also very popular and were identified as helpful by the students who used them. For Level 2 resources, question banks or practice examination resources encompassed 4 out of 5 of the most commonly used resources and 3 out of 5 of the most helpful resources, indicating that practice questions are a large part of Level 2 preparation. Because of the competitive nature of residency and the high importance of Level 1 and 2 scores, it is important to examine the current range of resources used by students. Because the amount of resources and categories of media continuously grows, this topic should be periodically revisited to aid students in making effective decisions for test preparation.



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osteopathic medicine