Failed COMSAE twice — what finally worked for my third attempt? — Forums

Tyler B.OP

May 27, 2026

I've been an osteopathic medical student for three years now and the COMSAE has been my nemesis. Failed it in January with a 375, retook in March and scraped a 385, and I'm staring down my third attempt in six weeks. I need a 400 to stay in good standing with my program and honestly I'm starting to panic a little.

What finally clicked for me was finding a decent COMSAE practice test that actually mirrors the real exam format — not just random COMLEX-style questions thrown together. The OMM sections were killing me specifically. I was treating it like Step 1 prep when it's clearly its own beast.

Anyone have a solid study guide recommendation or specific exam tips that helped them push past that 400 threshold? I'm putting in about 3 hours a day right now but I feel like I'm spinning my wheels. Particularly struggling with musculoskeletal and the cardiopulmonary OMM applications. Would love to hear from people who were in a similar hole and pulled through.

Ravi S.

May 28, 2026

I was in almost the exact same spot last year. What finally pushed me over was doing timed 40-question blocks instead of open-ended review — the COMSAE is brutal on pacing and I wasn't simulating that pressure. Also, Doctors In Training has a decent COMSAE-specific study guide module that breaks down the OMM counterstrain and muscle energy stuff in a way that actually stuck for me. Went from a 388 to a 412 on my third try.

Megan P.

May 28, 2026

Honest question — are you reviewing your wrong answers the same day or waiting? I made the mistake of flagging them and coming back two days later. By then the reasoning was cold and I wasn't actually learning, just recognizing patterns. Same-day review changed everything for my score. Also the cardiopulmonary OMM is heavily weighted on diaphragm mechanics, lymphatic pump, and rib somatic dysfunction — if you nail those three you're probably picking up 15+ points right there.

Jordan L.

May 28, 2026

Don't sleep on the NBOME's own practice materials. Their Level 1 practice exam has real predictive value for COMSAE performance and most people overlook it. Three hours a day is plenty — quality over quantity. You've got this.

Failed COMSAE twice — what finally worked for my third attempt?

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