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What is COMLEX-USA?
COMLEX-USA stands for the
Comprehensive Osteopathic Medical Licensing Examination of the
United States. COMLEX-USA is a medical licensing examination
series for osteopathic physicians.
COMLEX-USA is a quality
high-stakes 3 Level examination in which each Level contains 400
test items in CBT format, and the Level 2 PE or clinical skills
examination contains 12 clinical encounters, all using
standardized patients. The COMLEX-USA is a comprehensive
licensing examination utilizing a problems and presentation vs.
physician task approach and it is the only licensing examination
that covers osteopathic principles, practices, and the
application of osteopathic manipulative treatment.
COMLEX-USA is accepted by all
fifty states in the U.S. for licensure purposes.
Internationally, many countries accept COMLEX-USA scores as a
component of their licensing requirements. For graduate
education in the United States, all osteopathic residency
programs accept COMLEX scores. Most ACGME accredited residency
programs accept COMLEX scores for osteopathic applicants.
What does COMLEX-USA measure?
COMLEX assesses the osteopathic
medical knowledge and clinical skills considered essential for
osteopathic generalist physicians to practice medicine without
supervision. To more directly and effectively achieve its
measurement objectives, COMLEX is constructed in the context of
medical problem-solving that involves clinical presentations and
physician tasks. The Bulletin of Information on
www.nbome.org details the COMLEX design and coverage.
COMLEX has three Levels. Level
1 is typically given to second year medical students. It
emphasizes the scientific concepts and principles necessary for
understanding the mechanisms of health, medical problems and
disease processes.
Level 2 has two separate
examinations: Level 2-Cognitive Evaluation (CE) and Level
2-Performance Evaluation (PE). Level 2-CE is typically given to
fourth year medical students. It emphasizes the medical
concepts and principles necessary for making appropriate medical
diagnoses through patient history and physical examination
findings.
The Level 2-Performance
Evaluation (PE) is also given to fourth year medical students.
It provides an assessment of fundamental clinical skills. These
clinical skills are doctor-patient communication, interpersonal
skills and professionalism, medical history-taking and physical
examination skills, osteopathic principles and osteopathic
manipulative treatment, and written communication skills
(including synthesis of clinical findings, integrated
differential diagnosis and formulation of a diagnostic and
treatment plan).
Level 3 is for osteopathic
postgraduate candidates. It emphasizes the medical concepts and
principles required to make appropriate patient management
decisions.
Levels 1, Level 2-CE, Level 3
are all delivered by computer at over 320 Prometric professional
test centers in the US and in Canada. Level 2 PE is
administered at the NBOME’s National Center for Clinical Skills
Testing in Conshohocken, Pennsylvania.
What scores does COMLEX
currently report?
Currently, COMLEX-USA Level 1,
Level 2 (CE), and Level 3 report 3-digit scores, 2-digit scores,
and pass/fail designation. Level 2 PE only reports a pass/fail
designation .
How does COMLEX report
scores?
COMLEX-USA Level 1, Level 2 CE,
and Level 3 scores are typically released within 4-6 weeks after
the examination is administered. The Level 2 PE, due to its
unique scoring issues, typically releases scores between 10-12
weeks from the time the test is given..
After the NBOME releases COMLEX
scores of a particular examination, the scores are immediately
posted to candidates’ secure web accounts. The NBOME also sends
printed candidate score reports to the most current addresses
provided by the candidates.
At the time scores are posted to
candidate web accounts, the same scores are also posted to
osteopathic medical schools’ secure web accounts. Osteopathic
medical schools also receive photocopies of the candidates’
printed score reports.
COMLEX issues two types of
transcripts: NBOME official transcripts and ERAS transcripts.
Candidates can request NBOME official transcripts be sent to any
agency they specify at any time after they have taken at least
one Level of COMLEX. Candidates can also apply for transcripts
through ERAS. COMLEX transcripts for ERAS are only sent to the
residency programs candidates specified through ERAS
applications.
The transcripts report a
complete history of the results from all attempts made by the
candidate to take COMLEX. .
What are 3-digit COMLEX
scores?
3-digit scores are standard
scores. The mean standard scores of all three Levels of COMLEX,
regardless of when the exams were given, are 500. The minimal
passing standard scores for Level 1 and Level 2-CE are 400, for
Level 3 is 350, regardless of when the exams were taken.
Standard deviations, however, are Level specific and time
specific. Please go to Score Interpretations at
www.nbome.org for the standard deviations of COMLEX by Level
and year in the unit of standard score.
3-digit scores are NOT
raw scores or the number of items answered correctly.
Similarly, they are NOT the percentage of items
candidates answered correctly.
What are 2-digit COMLEX
scores?
2-digit scores are standard
scores too. For all three Levels, the 2-digit scores are
constructed such that the minimum passing score is 75 and mean
is 82 regardless of when the exams were given. Standard
deviations, however, are Level specific and time specific.
2-digit scores are NOT
percentile ranks. Similarly, they are not the percentage of
items candidates answered correctly.
2-digit scores and 3-digit
scores convey the same performance information on COMLEX. By
definition, 2-digit scores can be directly converted from
3-digit scores. For example, if 3-digit score is 400 or the
minimum passing score, its corresponding 2-digit score will be
75, the minimum passing score in 2-digit scale. Similarly, if
3-digit score is 500, the mean score, the corresponding 2-digit
score will be 82, the mean score of 2-digit scale.
Why does COMLEX still report
2-digit scores if they do not provide more information than
3-digit scores?
3-digit scores provide all
necessary performance information for COMLEX. Psychometrically,
there is no need for 2-digit scores. However, in order to
accommodate some state legislatures require 2-digit scores. In
addition, many residency programs have been used to 2-digit
scores. It is for these reasons that the NBOME has decided to
report 2-digit COMLEX scores.
Why COMLEX does not report
percentile ranks?
OMLEX-USA is a medical licensing
examination sequence. Its mission is to protect the public by
screening candidates according to its definition of minimum
competence for practicing osteopathic medicine. Ranking medical
students is not the purpose of COMLEX. It is not COMLEX’s
intention to encourage the public to use its scores to rank its
candidates.
A percentile score is an
examinee’s performance rank among a defined peer group who take
the same examination. For COMLEX-USA examinees, this peer group
is commonly considered as the examinees who start osteopathic
medical school in the same year. To accurately compute a
percentile score, scores of the whole cohort, or at least most
of the cohort, need to be available. COMLEX is
computer-delivered. Each Level is given 40 or more times per
year. Candidates decide their own test date from a regularly
web-posted testing schedule. As a result, not all candidates
take the same examination at the same time. Therefore, when
some candidates have finished their exams and received their
scores, a large portion of their peers have not yet taken the
same examination. In this situation, COMLEX cannot calculate
percentile scores for those who finished the examinations
earlier without knowing the scores of their peers who have yet
to take the examination.
How can COMLEX help those
programs that really need to know percentiles?
As discussed above, without
sufficient data, it is not responsible for NBOME to report
percentiles at the time the COMLEX scores are first released.
However, the NBOME can provide a percentile and 3-digit score
conversion after a full-year testing cycle is completed.
Percentile scores in that context provide a candidate’s rank
among all the first time takers who take the same examination in
a defined year-long testing cycle. The testing cycle based
3-digit scores and percentile conversions can be found on the
NBOME website at www.nbome.org.
Can residency programs
estimate the percentiles from COMLEX 3-digit scores by
themselves?
For the purpose of initial
screening of applicants, residency programs may use COMLEX
3-digit scores to estimate percentiles before the percentile
scores for a particular testing cycle are released.
In normal situations, a score’s
distance from mean in terms of standard deviation implies a
percentile rank. A COMLEX 3-digit score’s distance from the
mean in terms of standard deviation can be computed in the
following way:
(3 digit score – Mean)/Standard
Deviation = distance from mean)
For example, Level 1 mean is 500
and standard deviation is 79, a score of 480 is -.25 deviations
from the mean ((480-500)/79= -.25) or .25 standard deviation
below the mean.
The table below converts a few
3-digit scores to percentiles. From this table, it can be seen
that the percentile for 480 for Level 1 is between 30 and 50.
It would be a reasonable estimate that the percentile of 480 for
Level 1 is approximately 40.
|
COMLEX 3-Digit Score |
Distance from
Mean
(in standard deviation) |
Percentile |
|
Level 1 (SD=79) |
Level 2 (SD=83) |
Level 3 (SD=123) |
|
381 |
375 |
315 |
-1.5 |
6 |
|
421 |
417 |
377 |
-1 |
15 |
|
460 |
458 |
438 |
-0.5 |
30 |
|
500 |
500 |
500 |
0 |
50 |
|
540 |
541 |
561 |
0.5 |
69 |
|
579 |
583 |
623 |
1 |
84 |
|
618 |
624 |
684 |
1.5 |
93 |
|
658 |
666 |
746 |
2 |
97 |
The method described above
provides a rough estimate of the percentiles as it assumes that
the mean of a particular testing cycle is exactly 500 and
standard deviation is exactly that of the 3-digit score scale.
However, the differences between the estimates and actual
percentiles, though not accurate, are typically anticipated to
be small enough to be tolerable for residency programs to use
for screening purposes.
Many ACGME residency programs
accept both DO and MD applicants. Can COMLEX scores be
converted into USMLE scores so that those programs can have a
common criterion in judging all applicants?
Although others have attempted
to create a conversion of COMLEX-USA and the USMLE, it must be
recognized that COMLEX and USMLE are two different licensing
examination systems. DO applicants and MD applicants are two
different test-taking populations by virtue of their training
and experience.
Therefore, without medical,
psychometric, and philosophical breakthroughs in addressing the
fundamental differences between the two testing systems, two
examinee populations, and the two professions, it would not be
responsible for the NBOME to attempt to provide such a direct
conversion for COMLEX-USA.
If COMLEX and USMLE scores
cannot be converted, how should ACGME programs use COMLEX scores
to evaluate osteopathic applicants?
Licensing examinations, such as
the COMLEX-USA, were not specifically designed to serve as a
screening tool for residency programs. However, many program
directors have elected to use the scores as a selection
criterion for residents. One may consider the use of COMLEX-USA
scores to determine the relative performance of the candidate to
his or her peers. Using the 3 digit or 2 digit standard score,
and the estimated percentile rank, either estimated or actual,
should provide some useful information about the potential of a
candidate applying for GME training. This information can also
be compared with letters of reference, and letters from the
candidate’s dean and clinical supervisors to form a general
sense of the capabilities of the applicant.
What has been the typical
pass/fail rate for the COMLEX-USA for the past few years?
The COMLEX-USA has experienced
relative psychometric stability over the past several years.
The typical pass rate for first-time takers of COMLEX-USA Levels
1, 2 CE and 3 has ranged from 88.5% to 92.0%. The first-time
pass rate for students taking the COMLEX-USA Level 2 PE
(clinical skills) is 94-96%. Performance tables are available
on the NBOME website,
www.nbome.org.
More detailed information
regarding the pass/fail rates on the COMLEX-USA may be obtained
from the NBOME website and past editions of the Examiner (a
publication of the NBOME).
As a program director can I
get more information about the NBOME or the COMLEX-USA?
Program directors are encouraged
to visit the NBOME website at
www.nbome.org to view information about the COMLEX-USA and
the NBOME. Here, content coverage, sample examinations, the
Bulletin of Information, and many other items of interest can be
reviewed easily. The NBOME also invites ACGME program directors
who have any questions regarding COMLEX-USA to contact us
through the email by sending inquiries to residency program
directors@nbome.org, by mail or by phone 877-714-0622 or
866-NBOME-97 for issues regarding the Level 2 PE
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© 2001 National
Board of Osteopathic Medical Examiners
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8765 West Higgins Road, Suite 200, Chicago, IL
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