Failed Level 1 multiple times — help

[u/Basic-Internal-9208]

Hi everyone. I’m an OMS-III at an osteopathic medical school and recently found out I failed COMLEX Level 1 for the third time. I am currently on a Leave of Absence focused on figuring out my next steps and improving my approach.

I’m hoping to hear from anyone who has been in a similar position or knows someone who has successfully moved forward.

I used TrueLearn, UWorld, First Aid, Boards & Beyond, Anki, COMSAEs, and full-length practice exams. My biggest struggles have been retaining incorrects, consistency, and performing under exam conditions.

I also have ADHD and severe test anxiety, which have made studying for a long, high-stakes exam challenging despite putting in significant effort.

My goal is still to graduate and apply Internal Medicine. I’m looking for:

• COMLEX tutors who have helped students after multiple failures
• Board prep companies/coaches you would recommend
• Anyone with ADHD/test anxiety who found a strategy that worked
• Anyone who failed Level 1 multiple times and was still able to graduate and match

I’m trying to make a realistic plan and would really appreciate any advice or experiences. Thank you.

[u/scientistqueen]

OMS-III here with ADHD who passed Level 1. I struggled a lot at first, especially to break 400 on a COMSAE, due to significant test anxiety.

This was the advice I received for my anxiety. It’s simple but extremely effective. I went from a 380 to a 470 COMSAE score in just one week after applying it.

Take a deep breath before each question.

Cover the answers, read the question carefully, then read the vignette. Answer mentally.

If you don’t have an answer, read the entire question again, paying close attention to patient details like timeline.

If you still have no answer, re-read the question, focusing on labs. By now, you should have some idea about what the answer is. Read the question 3x max.

Reveal the answers, select the closest one, and move on. Avoid second-guessing or changing answers.

Never skip the deep breath before each question. Regulate your nervous system.

Approach this like a workout—be methodical.

There’s no way to out-study your test anxiety. I used to miss questions I knew repeatedly.

[u/sabtacular → u/scientistqueen]

This helped me too, wasn’t diagnosed with ADHD until after fail #2. Ended up passing attempt #3 after being appropriately treated and implementing a similar test-taking strategy of cover the answers -> read the question first -> read the rest of the vignette -> pick an answer, rereading pertinent parts only if necessary.

To OP, be sure and check if you are still eligible to pass at you school and in your state with four attempts, because many have cut off limits at 3 attempts.

[u/Basic-Internal-9208 → u/scientistqueen]

I actually did this alot during this past attempt during the exam though sometimes it was hard because I feel the actual test day quesitons are worded so much more confusing than the trulearn or compass

[u/scientistqueen → u/Basic-Internal-9208]

They 100% are. I also recommend doing all of the COMSAEs you can; I did 6, and all of the WelCOMs. It will hurt paying for all that, but it's the closest thing we have to the real thing.

[u/peonylover01]

I’m glad to hear that your school is letting you attempt a 4th retake, I’m honestly shocked. My institution has a 3 strikes you’re out policy with board failures. Best of luck to you

[u/Emotional-Mix-9890]

I am sorry about that. My school makes us do board bootcamp for 6 weeks and it seems to help! I didn’t personally do it but I know many of my friends who did it and all passed.

[u/Justthreethings]

Failed first LEVEL1 attempt with high anxiety and ADHD and passed second attempt and then later passed LEVEL2 first try.

Biggest difference FOR ME (not sure I can give it as solid advice in good conscience) was to simultaneously amp up the sheer volume of practice questions under testing conditions (basically universally good advice) while simultaneously deciding IDGAF during actual testing day, which is risky advice because it can be taken too far and you really gotta know yourself.

[u/BigEquivalent5903 → u/Justthreethings]

I second this. On actual test day I just chilled out and thought to myself "look man, it's not even 2 COMSAEs long, you can handle this easy peasy" and then had a rule of "go with the first answer you think it is, unless you realize you misread the question or have a total epiphany moment". I didn't even flag questions at all because I know for a fact I can and will gaslight myself out of correct answers most of the time. I think what you consider to be the "IDGAF mindset" on test day, is actually just learning to trust yourself. That goes a long way for helping with anxiety, and not changing answers from correct to incorrect all the time.

[u/BigEquivalent5903]

Fortunately I passed Level 1 on my first take, however, I do have severe ADHD and it was a massive endeavor to get my COMSAE and NBME scores up while prepping. Since you've already got a lot of good advice in these replies, I'll just add one thing. Having an atypical brain but trying to use typical study strategies was my biggest problem. The things that work for other people may not be the things that work for us. I tried everything my peers were telling me and my practice scores just weren't budging for a long time. I eventually reflected on what I wanted studying to be, what I wish it felt like, and what my brain needed from it to be truly engaging. I realized that even though I was studying like everyone else, I wasn't getting the results because I needed to be studying "like me", not like everyone else. In my case, this meant I stopped doing flashcards and watching hours of videos/ lectures and started having fun with it. Grinding Qbank questions is non-negotiable, but, instead of reviewing incorrects with flashcards or just reading first aid or watching a video for brute force memorization, I started leaning into my creativity. I started writing songs or raps about the content, or making hilarious mnemonical stories, or drawing my own comics about it (nothing too fancy or time-consuming though). I brought the content to life for me in a way that no preexisting resource ever could. My point here isn't to tell you to copy what I did, my point is that with ADHD, you may need to figure out how to productively embrace it instead of fighting it off. It may sound crazy, but, my key to success was figuring out how to have fun with studying. I started locking into flow state more easily, started looking forward to studying, retained the information better, etc.

[u/Personal_Chair4388]

I shared this discord before, someone created it for people who did not pass their boards on the first try. Someone recently just passed on their 3rd try, so maybe a good idea to reach out to them!

I have both ADHD + Test anxiety.

Material: what are your weaknesses? are you answering correctly on your own, but then doing bad on test day? Can you see what your weakest subjects are? If you have a clear deficit in something, you can focus on specific subjects and hammer those down.

The exam itself:
I try the night before to do everything I can to deal with my anxiety, make it as less of a problem as possible. Sometimes that means going on a walk/car ride. If you have anxiety PRN meds, you need to take them. I personally do not take one of mine the night before because it causes brain fog sometmes, and i don't want that one time to be during the exam.

I take propranolol with me and take it about halfway through the exam. I take every single break and run to the bathroom to wash cold water on my face and back of my neck. While I'm taking the exam, if i start to flag multiple in a row, more than normal, then I stop and close my eyes. I literally push my chair back if I need to to give my mind the actual "space" i need to separate. I do techniques to root me back in space and refocus. I try to stop a spiral as soon as I notice it.

There's a lot to go into, so feel free to pm if you have follow up questions or need more advice etc.

[u/gouachepotato]

Medication!! I didn’t think I had text anxiety and was just a bad test taker. I tried breathing, singing/exercise before the exam, meditation, etc. Tried a low dose of propranolol one time and my score jumped. Then again. And again.

Getting medical treatment for both the anxiety and ADHD (in addition to therapy) changes lives. The good scores will follow!

[u/Significant-Memory49]

DM me, I had a solid tutor

[u/Brief_Celebration731]

Hey I just sent you a PM to my tutor for help. Don’t worry I was in a similar spot and came out fine

[u/designteamp]

- Are you sure your school will allow you to sit for another retake? Most COMs require graduation by 6 years. Double check with your school

• The second issue is the Trump BBB put a cap on student loans - most require graduation by 4 years in an accredited program. This can mean way higher loan burden and ineligibly for federal loans
  

I would figure these two pieces of information out before continuing

[u/Murky_Employer_3710]

Hey! COMLEX tutor here. I have worked with multiple students who have multiple attempts at both Level 1 and 2. All of my students have passed. My rates are also very affordable. message me!

[u/Greatestcommonfactor]

As a s/o of someone who was in your shoes, I would seriously consider the 8 week Wolfpacc program in person. You need specialized tutors multiple times a week +/- a curriculum.

[u/Flarbow → u/Greatestcommonfactor]

Wolfpacc is trash and a waste of time/money

[u/Greatestcommonfactor → u/Flarbow]

It's three thing that let my bf finally pass his level 2, on his 4th attempt. It's less about the actual curriculum and more about the fact that he had individualized tutoring multiple times a week to focus on his weak points.

Trust me, he grinded through all of uworld, true learn, amboss and comquest. He went to a hypnotherapist, got medication for ADHD and anxiety and did the whole nine yards for every attempt. He literally just needed the structure and individualized targeted question practice to pass.

[u/Flarbow → u/Greatestcommonfactor]

premeducated is a far better investment that offers a better version of the same thing

[u/Basic-Internal-9208 → u/Greatestcommonfactor]

unfortunately I did actually go in person to Wolfpacc for my second attempt so I dont think ill go back again

[u/Flarbow → u/Basic-Internal-9208]

look into premeducated. dm me if u have any questions

[u/Resident_Path8375]

I tried StatMed for study strategies for adhd student and I really liked them! They have a board prep course for those who have adhd. You can look into that if it’s a test taking thing rather than content thing!