Comsae Forms

[Nga Sagastume]

TheComprehensive Osteopathic Medical Self-Assessment Examination (COMSAE) is a self-assessment exam intended as an education resource and preparation aid for the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) exam series. Osteopathic students and residents use the three-phase COMSAE to prepare to take a COMLEX-USA cognitive examination.

COMSAE is not intended to predict performance on any of the COMLEX-USA examinations. However, candidates who have taken a timed COMSAE prior to taking their first COMLEX-USA cognitive examination at the corresponding level demonstrate greater performance, on average, relative to candidates who did not take a timed COMSAE prior to their first COMLEX-USA examination.

LUCOM student-doctors are required to take COMSAE exams twice: once in January and once in June of their OMS-II year. A third COMSAE may be required if the student is not able to be released to take the COMLEX Level 1 exam.

There are different forms, or versions, for COMSAE phase exams. For Phase 1, which corresponds to COMLEX Level 1, there are two forms (D and E) that must be administered by a COM. The other forms (A, B, and C) can be purchased and self-administered by individual students.

Medical students can take these self-administered COMSAE forms timed or untimed. LUCOM recommends that students take the COMSAE timed when testing their readiness to take a COMLEX-USA examination. When assessing how best to approach test items, it is recommended that students take the COMSAE untimed.

The Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) is a three level national standardized licensure examination for the practice of osteopathic medicine. The Comprehensive Medical Self Assessment Examination (COMSAE) is a three phase self assessment tool designed to gauge the base knowledge and ability of candidates preparing for COMLEX-USA.

The significant correlation between Phase 1 and Level 1 performance provided validity evidence for Phase 1. Moreover, our results suggested that candidates, especially those with lower performance on their initial Phase 1 attempt, might improve their Level 1 performance by taking multiple Phase 1 forms to monitor their academic improvement and gauge their readiness for Level 1.

The Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) is a three level national, standardized, high stakes licensure examination for the practice of osteopathic medicine. COMLEX-USA Level 1 (Level 1) assesses the knowledge of foundational biomedical sciences and other medical knowledge relevant to solving clinical problems and promoting and maintaining health in providing osteopathic medical care to patients [1]. It is administered in a timed setting and typically taken by the candidates of accredited osteopathic medical schools at the end of their second year. There are multiple test forms administered every test cycle. All forms are comparable in content and statistical specifications.

Since COMSAE is designed as a self assessment tool for COMLEX-USA and the Phase 1 examination was ranked by 113 students among the most helpful preparation tools for Level 1 [3], we studied how Phase 1 was used by the candidates and how taking Phase 1 impacted their performance on the Level 1 examination. We hope the findings from this study can provide guidance to candidates regarding how their practice through Phase 1 can assist with their Level 1 preparation. In this study, we intended to answer the following questions: How many Phase 1 forms did candidates take prior to Level 1? What was the correlation between Level 1 and Phase 1 scores? Did Phase 1 performance improve as more forms were taken? Did the Phase 1 test taking experience help with the preparation for Level 1?

Figure 3 shows that first attempt scores were negatively correlated with the number of forms taken. While the group of candidates who only took one form (n=2,414) had a mean first attempt score of 546, the group of candidates who took five forms (n=145) had a mean score of 351. Within each subgroup, the mean Phase 1 score increased as another form was taken. We also observed that the mean score on the last forms taken was over 500 for all subgroups. In other words, the candidates seemed to target a score of 500 on Phase 1 as a threshold to stop taking another form. The linear regression results of Phase 1 score improvement are displayed in Table 3. The sequence of the forms taken was a significant (t(6,273)=29.35, p

As shown in Table 4, taking extra Phase 1 forms showed either significantly positive effect (Models 1 and 3; p1) had an expected increase of 0.5 in the log odds of passing the Level 1 examination than those who took only one form (n.comsae=1). In comparison, based on Model 2, holding other variables constant, the candidates who took more than two Phase 1 forms (n.comsae>2) did not have significantly higher log odds of passing Level 1 than those who took exactly two forms (n.comsae=2).

Figure 4 exemplifies the probability curves for the two groups of candidates (n.comsae=1 vs. n.comsae>1) based on Model 1 when the time gap was fixed at its mean value of 0.21 (77 days). In this example plot, for the candidates who scored 400 on their first Phase 1 exam, those who stopped taking new forms had an 85% probability of passing the Level 1 examination, while those who took more forms had a 90% probability of passing Level 1. One can also notice in the plot (Figure 4) that candidates with lower scores benefited from taking extra forms more than candidates with higher scores.

There is scant research exploring how medical students use COMSAE self assessment tools to prepare for the COMLEX-USA examinations. The purpose of this study was to investigate the candidate experience with Phase 1 to determine whether and how it helped them prepare for the Level 1 examination.

Most candidates in our study took one or two Phase 1 forms and the mean Phase 1 last attempt score was over 500 among all the subgroups taking different numbers of Phase 1 forms. We infer that students tended to continue taking the Phase 1 examination until they reached a score of 500 or above; thus, it seems that the candidates used Phase 1 as a tool to monitor their academic progress until they felt confident that they would pass or reach a certain score (i.e., a target score for the application of certain competitive residency or training programs) on Level 1.

For the candidates in our study with the same recent Phase 1 performance, taking more forms was generally related to an increase in the probability of passing Level 1. However, note that this relationship does not indicate causality. It may not be that taking Phase 1 alone helped with better Level 1 performance. Instead, the candidates chose to keep studying, monitored their progress through more Phase 1 forms, and achieved better Level 1 results, as suggested by the improvement in Phase 1 scores. We encourage future candidates, especially those with lower performance on their initial Phase 1 attempts, to utilize Phase 1 to gauge their readiness for Level 1 and monitor their improvement.

This study examined how candidates used COMSAE Phase 1 as a self assessment tool to prepare for the COMLEX-USA Level 1 examination. The significant correlation between Phase 1 and Level 1 performance provides validity evidence for Phase 1. Moreover, results suggested that candidates, especially those with lower performance on their initial Phase 1 attempt, might improve their Level 1 performance by taking multiple Phase 1 forms.

The authors would like to thank National Board of Osteopathic Medical Examiners staff members, Robby Biegalski, Caitlin Brown, Lisa Mysker, and Evelyn Ronkowski, who provided comments on prior versions of this manuscript.

Author contributions: All authors provided substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; all authors drafted the article or revised it critically for important intellectual content; all authors gave final approval of the version of the article to be published; and all authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Competing interests: The authors are employees of the National Board of Osteopathic Medical Examiners and therefore have a financial stake in the success of the Comprehensive Medical Self-Assessment Examination.

Many Osteopathic students approach their COMLEX Level I exams with trepidation. They have heard horror stories about ambiguous questions, blurry x-rays, exam unpredictability, and even grammatical errors, which make it difficult to determine the correct answers on test questions.

I learned this lesson, myself, the hard way. For COMLEX Levels I and II, the only Qbank I used was USMLE World. Although I did quite well on both exams, I improved my score for Level III by using COMBANK, and scored the highest possible score on th

Probably the biggest difference between USMLE Step 1 and COMLEX Level I is the inclusion of OMM as one of the subjects tested on the COMLEX. It is easy to neglect this subject, especially for students who are taking both exams. I always stress to students how important it is to study OMM before taking the COMLEX. There are two main reasons for this.

The first is that OMM is not an insignificant portion of the exam. It often makes up about 10% of the exam which can easily be the difference between passing and failing, or a mediocre score and a solid score.

The second reason is that the return you can get from OMM for the amount of time put in is very high. Many of the OMM questions on the exam are actually quite easy as long as you have put in the time to cover the material during exam preparation. This is not always true with other subjects like physiology and pathology. For the relatively few hours it takes to learn the material for the OMM portion of the exam, the payoff is quite high.

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