4-Week COMLEX Level 3 Sprint Plan After Graduation

The usual advice to “just wing COMLEX Level 3 during intern year” is lazy and expensive.

If you have a clean 4-week block after graduation, you can turn Level 3 from a nagging threat into a fast, contained project. But you have to treat it like a sprint, not background noise.

Below is a day‑by‑day, week‑by‑week COMLEX Level 3 plan for a fresh graduate with 4 dedicated weeks before intern year starts. I will assume:

• You passed Level 1 and 2 on the first attempt
• You are reasonably fresh on basic science but rusty on OMM and CCS-style cases
• You can give this 6–8 focused hours per day, 6 days per week

Adjust hours if you are working part-time or moving, but keep the structure.

---

Big Picture: The 4-Week Sprint Structure

Before we zoom into the calendar, you need the scaffolding.

Core tools (pick 1 from each line and commit):

Category	Primary Choice	Backup / Add-On
Qbank (main)	COMQUEST Level 3	TrueLearn Level 3
Qbank (extra)	UWorld Step 3 (targeted)	AMBOSS Step 3 style
Cases	COMBANK / COMQUEST CCS-like	UWorld CCS (for flow)
Rapid review text	First Aid for USMLE Step 3	Step-Up to Medicine

Plan structure:

• Week 1 – Systems sweep + OMM rebuild
• Week 2 – Bread-and-butter primary care + hospital flow
• Week 3 – Full exam simulation + cases + targeted weaknesses
• Week 4 – Sharpen + taper + test-day rehearsal

You are racing a very specific enemy: rust. Level 3 is not about esoteric minutiae; it is about messy real‑world decisions, safety, and order sets. If your plan does not include timed blocks and repeated exposure to CCS-style thinking, it is weak.

---

Pre‑Week: 1–2 Days Before You “Start”

You do not waste Week 1 figuring out your logins.

At this point you should:

1. Lock in your exam date.

   • Place it on Day 26–27 of the 4-week block (not Day 28; give yourself one buffer day in case of meltdown, illness, or moving chaos).

2. Activate all resources.

   • Qbank accounts, CCS/cases platform, digital or physical reference book.
   • Install mobile apps for quick review during errands or travel.

3. Set your daily schedule (and protect it). Typical model:

   • 08:00–10:00 – Timed block (40–44 questions)
   • 10:00–11:00 – Review
   • 11:00–12:00 – OMM / micro / pharm review
   • 13:00–15:00 – Second block
   • 15:00–16:30 – Review
   • 16:30–17:30 – Light reading / flashcards / cases

4. Do a 40-question baseline block (untimed, mixed).

   • Do not panic about score. Use it to find:
     • “I have no idea” zones (OB, OMM, peds, ethics).
     • Timing issues (are you reading too slowly? second‑guessing too much?).

Write your three worst areas on an actual piece of paper. They will steer Week 1–2.

---

Week 1: Systems + OMM Reboot (Days 1–7)

Goal this week: shake off rust and re‑prime your brain for clinical reasoning.

You are not chasing a score curve yet. You are rebuilding foundations and regaining speed.

4-Week COMLEX Level 3 Sprint Overview

Period	Event
Week 1 - Systems review	Qbank + OMM reboot
Week 2 - Primary care focus	Outpatient + inpatient basics
Week 3 - Simulation	Full practice days + CCS style
Week 4 - Sharpen & Taper	Targeted review + rest

Days 1–2: Internal Medicine Spine + OMM Orientation

At this point you should:

• Do 2 timed blocks per day (40–44 each) of mixed, but IM‑heavy questions.
• Spend as long reviewing as you spent answering.

Focus:

• Chest pain, dyspnea, GI bleed, AKI, sepsis, diabetic emergencies.
• Always ask:
  • What is the immediate stabilization?
  • What is the safest next step?
  • What can kill them in the next hour?

OMM task:

• 45–60 minutes per day:
  • Rebuild the spinal level map (T1–L2 sympathetics, cranial nerves, sacrum in pregnancy, Chapman points basics).
  • Relearn the patterns that show up in test questions, not in lab:
    • Psoas syndrome vs appendicitis.
    • Radiculopathy vs peripheral nerve lesions.
    • Somatic dysfunctions tied to common diseases (e.g., asthma – upper thoracics).

By end of Day 2, you should have:

• ~160 Qs done.
• A marked list of “pain points” in IM and OMM.

Days 3–4: OB/GYN + Pediatrics – No More Guessing

Level 3 punishes weak OB/peds. Residents are forced into these calls on night float.

At this point you should:

• Do 2 blocks per day (aim 80–88 Qs).
• Force at least one block each day to be OB/peds-heavy (filter if your qbank lets you).

Daily focus:

• OB/GYN

  • Prenatal labs schedules, Rh issues, hypertensive disorders, GDM management timelines.
  • Fetal heart tracing interpretation – what demands delivery now vs surveillance.
  • Postpartum hemorrhage algorithms.

• Pediatrics

  • Vaccine schedule (you must at least know red‑flag contraindications, catch‑up logic).
  • Common infections (AOM, pneumonia, bronchiolitis) and when to admit.
  • Neonatal basics – jaundice thresholds, sepsis workup, bilirubin phototherapy logic.

OMM:

• 30–45 minutes:
  • Pregnancy OMM: sacral dysfunctions, contraindications to HVLA, what is safe.
  • Rib dysfunctions and respiratory issues.

You should end Day 4 with roughly 320–350 questions completed.

Days 5–6: Surgery, Trauma, Emergency – Stabilize First, Then Think

At this point you should:

• Run 2 mixed blocks per day, but bias toward surgery/trauma/ED.
• Review with a “residency lens”: what would you do right now, not what lab to send.

Focus:

• Trauma surveys, indications for CT vs FAST vs straight to OR.
• Common postop complications: POD3 fever, atelectasis vs pneumonia vs DVT/PE.
• Bowel obstruction vs ileus, acute abdomen differentials.

OMM:

• 30 minutes a day:
  • Rib mechanics with trauma, respiratory failure, thoracic outlet ideas.
  • Quick review of counterstrain, muscle energy “testable favorites,” not 80 obscure tenderpoints.

Day 7: Light Day + Targeted Patch

You do not grind yourself into paste.

At this point you should:

• Do 1 timed block only (mixed).
• Spend the rest of the study time on:
  • Reviewing your worst two systems based on Week 1 stats.
  • Creating a 1–2 page “Level 3 OMM cheat sheet” (levels, patterns, contraindications).

Aim end of Week 1:

• Question count: ~400–450
• You can walk through:
  • Chest pain algorithms without checking a book.
  • Basic OB emergencies and hypertensive disorder management.
  • Top pediatric vaccines and red‑flag symptoms.

---

Week 2: Real‑World Primary Care and Inpatient Flow (Days 8–14)

Now you know where the holes are. This week you pivot to thinking like an intern: continuity, safety, and next steps over weeks to months.

Suggested Daily Question Volume Over 4 Weeks

Category	Value
Week 1	70
Week 2	90
Week 3	100
Week 4	60

Days 8–9: Outpatient Medicine + Preventive Care

At this point you should:

• Increase to 90–100 questions per day (2–3 blocks, depending on length).
• Emphasize ambulatory scenarios:
  • Diabetes follow‑up, HTN titration, lipid management for different ages and risk levels.
  • Cancer screenings: who gets colonoscopy at what age, lung CT criteria, pap/HPV rules.
  • Thyroid, osteoporosis, depression follow‑up.

As you review:

• Build mini‑algorithms. Example:
  • ASCVD risk thresholds and statin intensity.
  • BP targets in diabetics, CKD, pregnancy.

OMM:

• 30 minutes:
  • Common musculoskeletal complaints you will see in clinic:
    • Low back pain, neck pain, headaches and which techniques are appropriate.

Days 10–11: Inpatient Medicine + Orders Mindset

Level 3 likes “what to order” more than Level 2.

At this point you should:

• Do 2 timed blocks + 1 shorter “speed drill” block (20–25 Qs very fast).
• Focus on:
  • Admissions criteria (who goes home, who stays).
  • Initial order sets: fluids, labs, monitoring, DVT prophylaxis, diet orders.
  • Antibiotic choices upfront (and when to de‑escalate).

In review, make sure you can:

• Name at least one reasonable antibiotic for:
  • CAP inpatient vs outpatient.
  • UTI vs pyelo vs urosepsis.
  • Cellulitis vs necrotizing fasciitis.

OMM:

• Fold OMM into IM where possible:
  • For COPD, asthma, pneumonia – recall rib and thoracic techniques that improve ventilation.

Days 12–13: Ethics, Risk Management, Public Health

This is where many strong test‑takers hemorrhage points because they find it “annoying.”

At this point you should:

• Do 2 mixed blocks with a filter or tag toward:
  • Ethics, legal, end-of-life, informed consent, capacity.
  • Occupational health, epidemiology, screening yield questions.

Create a one‑page Ethics Rules You Do Not Break:

• Never breach confidentiality without one of the classic exceptions (harm to self/others, abuse, public health reportables).
• Always respect capacity unless properly assessed otherwise; know how to test capacity.
• Understand surrogate decision-making hierarchies and advanced directives.

Day 13 evening:

• Quick sweep of your OMM cheat sheet.
• Light skim of preventive care tables in your reference book.

Day 14: Half Sim, Half Review

At this point you should:

• Do a single 6‑hour “mini‑simulation”:
  • 3 back‑to‑back blocks with 10–15 minute breaks, timed.
  • Try to replicate test conditions: no phone, no constant snacking, sit at a desk.

The remaining time:

• Debrief:
  • Where did your concentration die?
  • Any consistent time crunch?
  • Which topics felt like random guessing?

End of Week 2 target:

• Total Qs completed: ~900–1,000
• You have a functioning sense of:
  • Clinic follow‑ups and screening intervals.
  • Admission vs discharge reasoning.
  • Ethics calls that match NBOME’s worldview, not just your opinion.

---

Week 3: Full Simulation + CCS/Case Logic (Days 15–21)

This is the make-or-break week. You will now train for the psychology and pacing of a 2‑day exam.

Day 15: Full-Length Practice Day 1

At this point you should:

• Do a full-length practice test if your qbank offers it, or:
  • 6–7 timed blocks back‑to‑back, standard break structure.

Rules:

• Sit the whole thing. No random texting, no long lunch.
• Use scratch paper as you would on the real exam (especially for complex multi‑step cases).

Afterward:

• Only skim review the same day. You will be mentally fried.
• Mark the questions that felt:
  • Conceptually unfamiliar.
  • Guessy due to poor strategy (not knowledge).

Day 16: Targeted Autopsy of Day 15

At this point you should:

• Spend most of the day on deep review of yesterday’s test:
  • For each miss: was it knowledge, misread question, or poor risk/safety instinct?
  • Build a “Patterns that Beat Me” list (e.g., over-ordering imaging, under-treating pain, missing red flags).

Supplement with:

• 1 short timed block (20–25 Qs) just to keep question muscles warm.
• 30 minutes of OMM focused on patterns that actually showed up in questions.

Days 17–18: Case / CCS-Style Thinking

COMLEX Level 3’s case component is different from USMLE CCS but the mindset is the same: order, monitor, re‑assess.

At this point you should:

• Spend 2–3 hours/day on:
  • Whatever COMLEX‑style cases or interactive scenarios your resource offers.
  • If you have UWorld CCS, use it for flow only:
    • Admit orders.
    • Hourly vs daily rechecks.
    • Discharge criteria.

Key habits to train:

• Always stabilize first: airway, breathing, circulation, IV, monitor, O2.
• Do not shotgun labs; order what directly changes management.
• Move the clock forward deliberately; do not stare at static cases.

The rest of each day:

• 1–2 regular blocks (mixed).
• Focus especially on your worst domains from the full-length.

Day 19: Full-Length Practice Day 2

Same concept as Day 15, but you should be a little sharper now.

At this point you should:

• Sit another 6–7 block simulation (or at least 5, if resource limited).
• Notice:
  • Are you more efficient?
  • Are you changing answers more or less? (Usually, more changes = more errors.)

Again, very light review in the evening.

Day 20: Final Big Patch Day

At this point you should:

• Deep review of Day 19 misses.
• Build or refine:
  • OB cheatsheet (hypertensive disorders, FHR, labor stages, postpartum emergencies).
  • Peds cheatsheet (vaccines, fever in various age groups, milestones).
  • Top 20 OMM patterns (spinal levels, autonomics, high-yield dysfunctions).

Do 1–2 light blocks to keep timing.

Day 21: Strategic Rest + Light Synthesis

End Week 3 with a controlled downshift.

At this point you should:

• Do 1 relaxed block (untimed) in the morning only.
• Spend the rest on:
  • Organizing notes into 3–4 one‑page summaries.
  • Walking through 2–3 case scenarios in your head:
    • Chest pain in ED to discharge plan.
    • 32‑week pregnant patient with decreased fetal movement.
    • Toddler with fever and no source.

Go to bed like it is a work night. Week 4 is about sharpening, not hammering.

---

Week 4: Sharpen, Taper, and Execute (Days 22–28)

You are not going to “cram” everything this week. You will:

• Solidify high-yield patterns.
• Protect your brain.
• Rehearse test‑day so it feels familiar, not intimidating.

Cognitive Load vs Practice Volume in Final Week

Category	Value
Day 22	80
Day 23	70
Day 24	60
Day 25	50
Day 26	40

Days 22–23: High-Yield Circuits Only

At this point you should:

• Drop to 60–70 questions per day, all targeted:
  • OB/peds.
  • Ethics and risk.
  • OMM.
  • Whatever your stats still show as weaker.

For each missed question, force yourself to articulate:

• “The safest choice is X because Y. The tempting but wrong choice is Z because…”
• You are training your internal attending, not just your memory.

Spend at least an hour across these two days revisiting:

• Your OMM cheat sheet.
• Your 3–4 system cheatsheets.

Day 24: Dress Rehearsal Lite

At this point you should:

• Do a half-day simulation:
  • 3 timed blocks in the morning.
  • Same wake time, breakfast, hydration plan that you will use for the real exam.

Afternoon:

• Review only big, repeated themes.
• Light walking, stretching; protect your neck and back (you are about to sit a lot).

Day 25: Content Polish + Logistics

This is your last real study day.

At this point you should:

• Do 1–2 short blocks in the morning (max 40–50 questions total).
• No more giant new topics. Only reinforce patterns you already know.

Logistics checklist:

• Confirm:

  • Test center location and drive time.
  • Required IDs.
  • Arrival time and expected length each day.

• Pack:

  • Snacks (simple carbs, nothing experimental).
  • Water bottle (if allowed).
  • Comfortable clothing layers.

Stop structured studying by late afternoon. Light skim of your cheatsheets only.

Day 26–27: Exam Days

Assuming a standard 2‑day COMLEX Level 3 schedule.

Morning of each day:

• Wake up at least 2 hours before exam.
• Small, stable breakfast with some protein.
• 10–15 minutes:
  • Skim OMM levels, OB emergencies, and your ethics “never break” rules.
  • Nothing new.

During the exam:

• First pass through each block:
  • Answer all straightforward questions.
  • Flag true dilemmas only.
• Do not let a single question eat >90 seconds on first pass unless it is trivial math.

During cases (if interactive):

• Stabilize. Always.
• Ask yourself after every action:
  • “Did this change anything?” If not, move time or reassess orders.

Evening between days:

• Do not open the qbank.
• Short walk, real food, hydration.
• Sleep over everything else.

Day 28: Decompression and Zero Review

Exam is done. You do not “postgame analyze” every missed question. That way lies madness.

At this point you should:

• Do nothing academic.
• Let your brain reset before you step into intern year.

---

If You Are Starting Behind (Low Level 1/2 Scores, Longer Rust)

You may be thinking: this is aggressive. You are right.

If you have:

• Multiple Level failures, or
• Have been out of school >1 year with no clinical activity,

then a pure 4‑week sprint is risky. You should:

• Extend to 6–8 weeks if at all possible.
• Double down on:
  • Core IM, OB, peds via a text like Step-Up to Medicine + a Level‑specific qbank.
  • Doing at least 1,500+ questions before exam day rather than 1,000.

Profile	Weeks Available	Total Q Target
Strong Level 1/2, recent	4	900–1,100
Average scores, minor gaps	4–5	1,200–1,400
Prior failures / long gap	6–8	1,500–2,000

---

Key Takeaways

1. Treat COMLEX Level 3 like a contained 4‑week project, not background noise. Anchor your days around timed blocks and deliberate review.
2. Build cheatsheets and patterns, not stacks of random facts. Safety, order sets, and OMM patterns win this exam.
3. Use Week 3–4 to rehearse the actual exam experience—fatigue, timing, and case flow—so test day feels familiar, not hostile.