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Comprehensive Osteopathic Medical Licensing Examination

Level 1, Level 2, and Level 3
Computer-based Cognitive Examinations

The COMLEX-USA examination series is designed to assess the osteopathic medical knowledge and clinical skills considered essential for osteopathic generalist physicians to practice osteopathic medicine. The foundation of COMLEX-USA is based on the osteopathic philosophy of whole person health care, underlying structure-function relationships and the interdependence of body systems, self-healing and self-regulatory mechanisms, and the osteopathic approach to patient care, including osteopathic manipulative medicine. COMLEX-USA is constructed in the context of clinical problem-solving that involves "Patient Presentations" and "Physician Tasks."

The COMLEX-USA program is an examination sequence with three Levels. While all examination Levels have the same two-dimensional blueprint structure, the depth and emphasis of each Level parallels the educational experiences and the clinical responsibilities of the candidate. This progressive nature of the COMLEX-USA examinations ensures the consistency and continuity of the measurement objectives of the osteopathic medical licensing examinations. A description of the examination blueprints is below, and descriptions of each examination component of the series, including what constitutes a passing score, follows.

COMLEX-USA examinations are administered only in the English language. Each of the COMLEX-USA examinations is administered in a standardized, time-measured environment, as the ability to interpret, process and apply clinical knowledge and skills with knowledge fluency and in a fluid manner is fundamental to a generalist osteopathic physician's competence to practice osteopathic medicine. The Blueprint contains two dimensions: "Dimension 1" that outlines the patient presentation, and "Dimension 2" that outlines the physician task (See Table 1):

The Patient Presentation ("Dimension 1") of the COMLEX-USA examination blueprint identifies high-frequency and/or high-impact health and disease issues that osteopathic generalist physicians encounter in clinical practice.

The Physician Task ("Dimension 2") specifies the major physician tasks and competency sets that osteopathic physicians generally employ to solve clinical problems and assist in providing patient care. Major categories of the two dimensions can be found in Table 1.

The COMLEX-USA Examination Blueprint

Dimension 1: Patient Presentation Level 1, Level 2 CE, Level 3
Population Health Concepts and Patients with Presentations Related to Health Promotion, Chronic Disease Management, and Human Development 8 - 16%
Patients With Presentations Related to Digestion and Metabolism 4 - 10%
Patients With Presentations Related to Cognition, Behavior, Sensory & Central Nervous Systems, Substance Abuse, and Visceral and Sensory Pain 28 - 38%
Patients With Presentations Related to the Musculoskeletal System, including Somatic Pain 6 - 12%
Patients With Presentations Related to the Genitourinary System and Human Sexuality 3 - 8%
Patients With Presentations Related to Circulation and the Respiratory System 8 - 16%
Patients With Presentations Related to Thermoregulation 2 - 6%
Patients With Presentations Related to Trauma, Masses, Edema, Discharge, and the Skin, Hair and Nails 8 - 16%
Patients With Presentations Related to Pregnancy, the Peripartum, and the Neonatal Period 3 - 8%

Dimension 2: Physician Tasks Level 1 Level 2 CE Level 3
Health Promotion & Disease Prevention 1 - 5% 15 - 20% 15 - 20%
History & Physical Examination 5 - 15% 30 - 40% 10 - 20%
Diagnostic Technologies 1 - 5% 10 - 20% 15 - 25%
Management 2 - 7% 10 - 20% 25 - 40%
Scientific Understanding of Health & Disease Mechanisms 70 - 85% 5 - 15% 5 - 10%
Health Care Delivery Issues 1 - 3% 5 - 10% 5 - 10%

Osteopathic principles and practices, by design, are integrated throughout all areas of the examination, as this best reflects the manner in which osteopathic principles and practices permeate osteopathic medicine.

IMPLEMENTATION OF NEW BLUEPRINT:

Based on extensive research and expert consensus, a new two-dimensional blueprint for COMLEX-USA examinations is being developed and will be implemented beginning with COMLEX-USA Level 3 in 2018. COMLEX-USA Levels 1 and 2 will implement the new blueprint in 2019. For more information, please refer to the Blue Ribbon Panel on Enhancing COMLEX-USA Report here.

Level 1

COMLEX-USA Level 1 is a problem-based and symptom-based assessment, administered in a time-measured environment, which integrates the foundational and basic biomedical sciences of anatomy, behavioral science, biochemistry, microbiology, osteopathic principles, pathology, pharmacology, physiology and other areas of medical knowledge as they are relevant to solving clinical problems and promoting and maintaining health in providing osteopathic medical care to patients. The examination consists of two, four-hour computer-based test sessions during one day, containing a total of 400 test questions (items) related to diverse clinical presentations. Test questions are predominantly in the single best answer, multiple choice or extended matching item formats, with some novel test items involving audio-visual components designed to assess an expanded physician competency subset. Examples of test item types expected to be encountered in Level 1 can be found under Practice Examinations, and this practice examination begins with a tutorial.

Passing of COMLEX-USA Level 1 indicates that the candidate has demonstrated competence in the foundational biomedical sciences and osteopathic principles as required to solve clinical problems in the supervised clinical practice setting and to prepare for lifelong learning.

Level 2-CE

COMLEX-USA Level 2-Cognitive Evaluation (CE) is a problem-based and symptoms-based assessment, administered in a time-measured environment, which integrates the clinical disciplines of emergency medicine, family medicine, internal medicine, obstetrics/gynecology, osteopathic principles and neuromusculoskeletal medicine, pediatrics, psychiatry, surgery, and other areas relevant to solving clinical problems and promoting and maintaining health in providing osteopathic medical care to patients. A similar problem-symptom-based approach is used in Level 2-CE as in Level 1. The examination consists of two, four-hour computer-based test sessions during one day, containing a total of 400 test questions (items) related to diverse clinical and patient presentations. Test questions are predominantly in the single best answer, multiple choice or extended matching item formats, with some novel test items involving audio-visual components designed to assess an expanded physician competency subset. Examples of test item types expected to be encountered in Level 2-CE can be found under Practice Examinations, and this practice examination begins with a tutorial.

Passing COMLEX-USA Level 2-CE indicates that the candidate has demonstrated competence in the clinical and biomedical sciences and osteopathic principles as required to solve clinical problems and manage patient presentations in the supervised clinical practice setting and for entry into graduate medical education, as well as to prepare for lifelong learning.

Level 3

COMLEX-USA Level 3 is a problem-based and symptom-based assessment, administered in a time-measured environment, which integrates the clinical disciplines of emergency medicine, family medicine, internal medicine, obstetrics/gynecology, osteopathic principles and neuromusculoskeletal medicine, pediatrics, psychiatry, surgery, and other areas relevant to solving clinical problems and promoting and maintaining health in providing osteopathic medical care to patients. The examination consists of two, four-hour computer-based test sessions during one day, containing a total of 400 test questions (items) related to diverse clinical and patient presentations. Test questions are predominantly in the single best answer, multiple choice or extended matching item formats, with some novel test items involving audio-visual components designed to assess an expanded physician competency subset. These novel test items may include clinical decision-making and/or constructed-response types of test items. Examples of test item types expected to be encountered in Level 3 can be found under Practice Examinations, beginning with a tutorial, as well as specific practice cases for clinical decision making.

Beginning on September 1, 2015, the COMLEX-USA Level 3 Examination includes a section containing Clinical Decision-Making (CDM) cases. The NBOME's CDM cases assess the ability to make appropriate patient management decisions as an independently practicing osteopathic generalist physician. Candidates are encouraged to take the CDM practice exam by clicking here as well as the COMLEX-USA Level 3 Practice Exams linked below.

Passing COMLEX-USA Level 3 indicates that the candidate has demonstrated competence in the clinical and biomedical sciences and osteopathic principles as required to solve clinical problems and manage patient presentations in the unsupervised osteopathic medical clinical practice setting and to prepare for lifelong learning.

IMPLEMENTATION OF COMLEX-USA Level 3, Day 2:

Beginning in 2018, the COMLEX-USA Level 3 will include a two-day, computer-based examination consisting of single best answer multiple choice test items, short answer constructed response test items and multiple correct multiple choice test items formats. These may include images, videos or audio exhibits and other novel test approaches designed to assess an expanded physician competency subset. For more information, please refer to the Blue Ribbon Panel for Enhancing COMLEX-USA 2014 Report.

EXAMINATION SCORES

COMLEX-USA Level 1, Level 2-CE, and Level 3 Examination Scoring

The number of items answered correctly (the raw score) is converted to a 3-digit standard score and a 2-digit standard score for the purposes of making pass-fail decisions and for reporting the results. The conversion for standard scores involves information about the performance of examinees that have taken these examinations previously.

The 3-digit standard scores of COMLEX-USA Level 1, Level 2-CE, and Level 3 have a mean of 500. A 3-digit standard score of 400 or a 2-digit standard score of 75 on COMLEX-USA Level 1 or COMLEX-USA Level 2-CE is required to pass the examination. A 3-digit standard score of 350 or a 2-digit standard score of 75 on COMLEX-USA Level 3 is required to pass the examination.

Some items, which may be included in the examination solely for research purposes, are not included in the candidate's score.

The percentage of examinees that pass or fail the examination is not predetermined. The passing score for all COMLEX-USA examinations is based solely on a candidate's performance on the total examination, not on performance on individual content areas. The COMLEX-USA score reports include graphical performance profiles summarizing strengths and weaknesses for areas designated on the blueprint.

Score Reports

All COMLEX-USA Level 1 and COMLEX-USA Level 2-CE score reports will be provided to both the candidate and the dean of the candidate's school. COMLEX-USA Level 3 score reports will be provided to both the candidate and the dean of the candidate's school, and may be released by the NBOME to the Director of Medical Education (DME) at the candidate's internship hospital.

Score reports will be available approximately 4-6 weeks from the date of the examination. Candidates and Deans will be notified by email that their scores are available and can be accessed through the NBOME Client Registration System (CRS). DMEs who wish to receive COMLEX-USA Level 3 scores for their interns should contact the NBOME Client Services Department to make appropriate arrangements. No scores will be reported by telephone, e-mail or fax.

In September 2012, the NBOME began to make COMLEX-USA cognitive examination score reports available online through the CRS. (Prior to that time, score reports were mailed.) Score reports provided in this manner remain available for printing from the CRS at the candidates' convenience. For those needing a duplicate score report for an examination completed before implementation of electronic score reporting, please send a written request to NBOME Client Services at the NBOME Corporate Offices & Conference Center: 8765 W. Higgins Rd Suite 200 · Chicago, IL 60631-4174. Candidates should allow 10 business days for delivery. Please note a copy of the score report is not the same as an official transcript. If a certified transcript is needed (e.g., to be sent to a third party), please refer to the guidance in the COMLEX-USA Bulletin of Information under Section VIII. Certified Transcripts. Appropriate fees as determined by the NBOME will apply.

Score Confirmation/Verification

Prior to releasing examination results and posting the Score Reports, the NBOME conducts a thorough process of quality assurance to ensure that all candidate scores are accurate. However, the NBOME will confirm a COMLEX-USA Level 1, Level 2-CE, Level 2-PE or Level 3 examination score if a candidate so chooses. To request a score confirmation, a candidate must submit a request from the "View Scores" tab of his/her NBOME online account within 120 days of the examination date. Please be advised that there is a $50 fee per score confirmation request.

For COMLEX-USA Level 1, Level 2-CE and Level 3, score confirmation involves confirmation of responses recorded by computer. Because score conformation is limited solely to the review of the responses recorded by the computer, it is unlikely to change the candidate score. The NBOME will ensure that all sections were complete and that your responses were graded against the proper form. The NBOME does not release information about the scoring of individual examination questions.

Further information regarding COMLEX-USA cognitive examination score reports can be found within the FAQs. Candidates are to carefully review the information provided prior to contacting the NBOME.

Practice Examinations

The COMLEX-USA Practice Exams provided below are primarily designed to assist the candidate in navigating through the examination, and are provided to facilitate the actual testing experience. They are NOT designed to give the candidate a score or provide information about how a candidate might actually perform on the examination. When an answer choice is selected, it will not be recorded for scoring and the selection will not be saved once another item is viewed. If you wish to track your answer choices, you must record them on paper. A special function is provided that allows you to view the correct answer for each item by clicking on the "Show Answer" button located below the answer choices. The "Show Answer" button will NOT appear on the actual examination.

Please refer the COMLEX-USA Bulletin of Information as the official source for accurate information regarding NBOME policy, regulations, and procedures.

COMLEX-USA Practice Examinations

Practice Exam: Level 1

Practice Exam: Level 2

Practice Exam: Level 3

Clinical Decision Making Cases