COMLEX Step 3: Pale Horse of the Apocalypse

COMLEX Step 3. The last licensing exam and then you’re done with NBOME for good! Afterwards, you can focus on your specialty and forget about all the junk you could care less about. But if you don’t pass the last one, all your work up to now was for nothing.

I have a personal confession to make … There was a good chance I was never going to write this article. Why?

It was not because I was so busy that I didn’t have time to write.

It was not because I lost interest in writing for my site.

It was not because I have nothing to say.

Rather, it was because I thought I will never take my last and final COMLEX — Step 3.

I was out of medicine for good; I had enough.

Life is funny. God is funny. What I thought 9 or 10 months ago (in August 2014) is so different from what I think today. There have been have so many changes and I have learned so many things.

I will share with you one of the changes: I am back in and passed Step 3 (with a lot of help from God). I did not touch any NBOME exam for almost two years and did not have exposure to medicine for almost a year. And by God’s grace, I passed on the first try. (Hopefully, with the tips here, you can do the same.)

The Pale Horse — the last Horse of the Apocalypse — is done and over with. Before I tell you about my experience and my study methods, let’s answer the same questions I’ve answered for the previous COMLEXes …

COMLEX Step 3: Pale Horse of the Apocalypse

Pale Horse of the Apocalypse (aka COMLEX Step 3)


When Will You Take It?

You can take COMLEX 3 any time after you graduate from medical school. A few people take it before starting residency, but most people take it during the first or second year of post-graduate training. Most residencies reimburse the cost of the exam, if you pass. So if you’re light on cash, it pays to wait … literally. But if you can afford it, I would recommend taking it before residency starts.

What Will Be on the Test? (What Resources Should You Use?)

Step 3 is very much like Step 2-CE. Therefore, everything will be on the exam. However, the questions will heavy favor some specialties more than others: OB/GYN, pediatrics, and OMM.

Try to study everything, but make sure you put more emphasis on studying the aforementioned specialties. I used the same resources I used to study for Step 2:

(For a more in-depth review of some of the books, see my medical school books section and my COMLEX Step 1 resources section.)

Combine those resources with Combank or COMQUEST … and you should have everything you’ll need to pass the boards on the very first try.

Warning! COMLEX is always following in the footsteps of USMLE. Because USMLE implemented the CS, COMLEX  implemented the PE. And because USMLE Step 3 has Clinical Case Scenarios, COMLEX 3 may get the same in the near future.

The COMLEX version of the Clinical Case Scenarios is called “Clinical Decision-Making” (CDM). For the last block, instead of answering another set of 50 multiple choice questions, you will answer maybe 10-ish cases. Each case will have multiple steps:

– data acquisition (obtaining history and physical findings, order labs)
– data interpretation (including diagnosis)
– treatment

The questions could either be open-ended or multiple-choice. If multiple-choice, there could be more than one correct answer.

I cannot give you more details because I didn’t have CDM on my exam. I lucked out. Going into the future, you will likely have CDM on the exam. When you get a chance, take a look at what NBOME has to say about it. Don’t get caught off guard on test day.

How Is the Exam Scored?

You will need at least 350 to pass. The median score is 500. And around 95% of the test-takers pass the exam. Therefore, it is very, very likely you will pass.

If you are not applying to a competitive fellowship, your COMLEX Step 3 score shouldn’t matter. 350 = licensed doctor.

How Long Is COMLEX Step 3?

It is as long as COMLEX Step 1. I hate re-typing the same thing, so if you need a refresher, go check it out.

This time, it took me almost 8 hours to finish. Even though I was a bit rusty with taking tests, I still had enough time.

How Much Will COMLEX Step 3 Cost?

A whole lotta money. This COMLEX is quite a bit more expensive than the other two written exams. I paid $775 for Step 3. Compare that to $570 for Step 1 and Step 2 each.

Since COMLEX Step 3 is the final licensing exam, it seems NBOME wants to extract a bit more than normal before letting you go for good.

My Experience

When I took COMLEX 3, I did not touch any NBOME exam for almost two years and did not have exposure to medicine for almost a year. And yet, by God’s grace, I passed on the first try. (And did much better than my goal.)

I spent almost 3 weeks preparing for the exam, less than the time I spent for any of the previous written COMLEXes. I used only one question bank, COMBANK. I did questions in tutor mode and by specialties. For example, I finished the cardiology section before moving on to gastroenterology.

I did not practice on timed mode because running out of time was never a factor for me.

I used the same resources I used for studying Step 2. (See the What Will Be on the Test? section above for a list of books I’ve used.) Since my study system is electronic, it was very easy to store, retrieve, and review my notes … even if they were from years ago. The notes I took when studying for Step 2 was still inscribed into my study resources.

Thus, a lot of studying was reviewing old materials, rather than learning new things. This was why I spent a relatively small amount of time studying, even though I was out of medicine for quite some time.

I walked out of the testing center with a feeling I failed. But when I read other people’s experiences, I’ve learned that many people felt the same way and did well. But there was always the chance I would be the 20th person … among the 5% that bombed.

That was why I prayed about it almost every day. I even asked my friends and family to pray for me. You usually get the test results back in a month. But NBOME was being such a big tease to me; I had to wait 2 months … wondering if I passed or not.

Once I got my score back saying that I passed, I was so relieved and overjoyed. Between God (the biggest factor for me in passing on my first try) and my study system, I am finally done with NBOME for good! Even though I was disadvantaged compared to my peers, there were no hiccups.

I am done. I am free. And I am starting a new chapter of my life with the big bad NBOME off my back!

More About COMLEX Step 3

How to Study for COMLEX Like a Rockstar
You seriously cannot miss this section. I reveal loads of study techniques to rock the COMLEX without rote memorization. This is my personal study technique to effortlessly pass my first 2 licensing exams. (I’ve heard that the Step 2 had one of the highest fail rates, too!) This was so good, I should have charged for it.

This article is part of The Complete Guide to COMLEX. Click on the link if you want more tips and hints about the osteopathic medical board exams.

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