Exam Sequence and Timing as Predictors of COMLEX-USA and USMLE Performance in Osteopathic Medical Students.

PURPOSE

This study examined the impact of exam sequence and timing on the performance of osteopathic medical students on the COMLEX-USA Level 1 and Level 2 and USMLE Step 1 and Step 2 examinations.

METHODS

Two cohorts were analyzed: 364 osteopathic medical students who completed both COMLEX-USA Level 1 and USMLE Step 1 between 2020 and 2022 (prior to the implementation of pass/fail grading), and 734 osteopathic medical students who completed both COMLEX-USA Level 2 and USMLE Step 2 between 2021 and 2025. Student performance was evaluated based on the sequence of examinations and intervals between them. Because the scores did not follow a normal distribution, as indicated by the Shapiro-Wilk test, the Mann-Whitney -test was employed to compare the median scores between the groups.

RESULTS

Osteopathic medical students who undertook the USMLE examinations first consistently achieved higher scores than those who undertook the COMLEX-USA examinations first across most academic quartiles. Shorter exam intervals (1-7 days) were associated with higher scores, whereas longer intervals (≥8 days) were correlated with significantly lower scores. The effects of exam order and timing varied across performance quartiles, with lower-performing students deriving the greatest benefit from taking the USMLE examinations first and maintaining shorter intervals between the exams.

CONCLUSION

Strategic scheduling of exams may enhance performance on both the COMLEX-USA and USMLE examinations, particularly for lower-performing students. However, individual factors should be considered when implementing these strategies. These findings offer valuable insights for osteopathic medical students and educators in planning exam preparation and scheduling.