After being accepted into medical school, a student must complete rigorous coursework. The first 2 years of medical school at dedicated to didactic courses such as anatomy, physiology, pharmacology, neuroanatomy and others. It is towards the end of the 2nd year of medical school that students start preparing for the 1st, and most say the most difficult, of three national board examinations. This first test being the USMLE step 1 for allopathic schools and COMLEX step 1 for osteopathic medical schools. This test MUST be passed.