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The Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA or the Boards) is a series of three osteopathic medical licensing examinations administered by the National Board of Osteopathic Medical Examiners (NBOME) similar to the United States Medical Licensing Examination (USMLE). COMLEX-USA is the most common pathway by which osteopathic physicians (D.O.s) apply for medical licensure, and is accepted in all 50 states. The 3-digit standard scores of COMLEX-USA Level 1, Level 2- Cognitive Evaluation (CE), and Level 3 have a range of 200-871 and a mean of 500. 400 is the minimum passing score for COMLEX-USA Levels 1 and 2; 350 for COMLEX-USA Level 3.[1]

COMLEX-USA Level 1[edit]

COMLEX-USA Level 1 is typically taken after completion of the second year of medical school. The exam consists of 400 questions administered in one day and consists of two, four-hour exam sessions separated by a 40-minute break. Each of the four-hour sessions allows a ten-minute break which is subtracted from the time allotted for the respective four-hour session. Candidates are expected to know the basic mechanisms of health and disease process. The mean score for the COMLEX-USA Level 1 is approximately 520 (for first time test-takers), with a standard deviation of about 85 (although this may vary slightly from year to year), and is an important factor in determining a medical student's competitiveness when applying to residency programs.[2] Student performance on COMLEX-USA Level 1 strongly correlates with MCAT biology section scores and undergraduate science GPA,[3] as well as medical school grades.

Specifically, level one covers basic medical sciences, including:

COMLEX-USA Level 2[edit]

COMLEX-USA Level 2, taken during the third or fourth year of medical school, consists of two parts: Level 2-Cognitive Evaluation (CE) and Level 2-Performance Evaluation (PE). Level 2-CE requires candidates to demonstrate knowledge of clinical concepts and medical decision-making. The mean score for the COMLEX-USA Level 2 CE is approximately 540 (for first time test-takers), with a standard deviation of about 100 (although this may vary slightly from year to year). The examination is problem-based and symptoms-based, integrating the clinical disciplines of:

Level 2-PE was introduced in 2005. It is a one-day, seven-hour clinical skills examination and utilizes standardized patients (actors trained to present clinical symptoms) to test clinical skills. The exam is graded either pass or fail unlike the other COMLEX exams. Currently, the only available testing site is in Conshohocken, PA, a suburb of Philadelphia. In the fall of 2016, a testing site became available in Chicago, IL.[4] Candidates must complete 12 standardized patient encounters, each 14 minutes in duration. Scoring for the COMLEX-USA Level 2 PE is on a pass/fail basis only. Candidates must demonstrate proficiency in:

COMLEX-USA Level 3[edit]

The final examination, COMLEX-USA Level 3, is typically taken after starting a residency program and covers the clinical disciplines of medicine, including:

USMLE comparison[edit]

Many osteopathic medical students apply to ACGME-accredited residencies, and some residency directors are uncertain of how to best interpret applicants' COMLEX scores. Conversions between the COMLEX and the USMLE are somewhat challenging since the content and style of the two exams differ. First-time USMLE pass rates for D.O. and M.D. students in 2012 are as follows: Step 1: 92% and 96%, Step 2 CK: 97% and 98%, and Step 2 CS: 87% and 97% respectively; (these figures may be misleading as only 46 D.O. students were evaluated compared to 16,662 M.D. students for Step 2 CS) Step 3: 100% and 96% (these figures may be misleading as 16 D.O. students were evaluated compared to 18,172 M.D. students for Step 3).[5]


  1. ^ "COMLEX Computer Based Testing (CBT)". NBOME. 2010. Retrieved 18 July 2012. 
  2. ^ Carolyn Schierhorn (December 21, 2011). "Match Report Sheds Light on Credentials Needed to Secure Residencies". The DO. Retrieved June 5, 2012. 
  3. ^ Donna Dixon (2012). "Prediction of Osteopathic Medical School Performance on the Basis of MCAT Score, GPA, Sex, Undergraduate Major, and Undergraduate Institution" (PDF). The Journal of the American Osteopathic Association. AOA. 112 (4): 175–181. Retrieved June 25, 2012. 
  4. ^
  5. ^ "2012 Performance Data". United States Medical Licensing Examination. 2014. Retrieved 16 February 2014. 

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