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Comprehensive Osteopathic Medical Licensing Examination

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

The COMLEX-USA series is designed to assess the osteopathic medical knowledge and clinical skills considered essential for osteopathic generalist physicians to practice medicine without supervision. COMLEX-USA is constructed in the context of medical problem-solving which involves clinical presentations and physician tasks. Candidates are expected to utilize the philosophy and principles of osteopathic medicine to solve medical problems. The Clinical Presentation ("Dimension 1") of the COMLEX-USA examination blueprint identifies high-frequency and/or high-impact health issues that osteopathic generalist physicians encounter in practice. The Physician Task ("Dimension 2") specifies the major steps osteopathic physicians generally undertake to solve medical problems. Major categories of the two dimensions can be found in Table 1.

The COMLEX-USA series is an examination sequence with three Levels. While all examination Levels have the same two-dimensional content structure, the depth and emphasis of each Level parallels the educational experiences 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 blueprints follows:

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.

Level 1

COMLEX-USA Level 1 is constructed according to the COMLEX-USA examination blueprint. Candidates are expected to demonstrate basic science knowledge relevant to medical problems as defined by the Level 1 blueprint. Level 1 emphasizes the scientific concepts and principles necessary for understanding the mechanisms of health, medical problems and disease processes.

Level 1, taken in one-day, is a problem- and symptom-based assessment integrating the basic medical sciences of anatomy, behavioral science, biochemistry, microbiology, osteopathic principles, pathology, pharmacology, physiology and other areas of medical knowledge as they are relevant to solving medical problems. The examination consists of two four-hour test sessions, each containing questions related to diverse clinical presentations and principles.

Level 2-CE

COMLEX-USA Level 2-CE is constructed according to the COMLEX-USA examination blueprint. Candidates are expected to demonstrate knowledge of clinical concepts and principles involved in all steps of medical problem-solving as defined by Dimension 2. Level 2-CE emphasizes the medical concepts and principles necessary for making appropriate medical diagnoses through patient history and physical examination findings.

Level 2-CE, taken in one-day, is a problem-based and symptom-based assessment integrating the clinical disciplines of emergency medicine, family medicine, internal medicine, obstetrics/gynecology, osteopathic principles, pediatrics, psychiatry, surgery, and other areas necessary to solve medical problems as defined by the Level 2-CE blueprint. A similar problem-symptom based approach is used in Level 2 and in Level 1. The examination consists of two four-hour test sessions, each containing questions related to diverse clinical presentations and principles.

Level 3

COMLEX-USA Level 3 is constructed according to the COMLEX-USA examination blueprint. Candidates are expected to demonstrate knowledge of clinical concepts and principles necessary for solving medical problems as independently practicing osteopathic generalist physicians. Level 3 emphasizes the medical concepts and principles required to make appropriate patient management decisions.

Level 3, taken in one-day, is a problem-based and symptom-based assessment integrating the clinical disciplines of emergency medicine, family medicine, internal medicine, obstetrics/gynecology, osteopathic principles, pediatrics, psychiatry, surgery, and other areas necessary to solve medical problems as defined by the Level 3 blueprint. Level 3, like Level 2-CE and Level 1, is problem-based and symptom-based in presentation. The examination consists of two four-hour test sessions, each containing questions related to diverse clinical presentations and principles.

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 on page 33 of the COMLEX-USA Bulletin of Information. Appropriate fees as determined by the NBOME will apply.

Score Confirmation/Verification

Prior to releasing score reports, the NBOME conducts a thorough process of quality assurance to ensure that all candidate scores are accurate. However, a candidate who wishes for his or her scores to be rechecked may submit a written request for score confirmation/verification with the accompanying $50 fee.

For COMLEX-USA Level 1, Level 2-CE, and Level 3 examinations, score verification involves confirmation of responses recorded by computer. Written requests for score verification for Level 1, Level 2-CE, or Level 3 should be submitted to the Chicago NBOME office within 30 days from the release of candidate's scores. The address is: NBOME Client Services, NBOME Corporate Offices & Conference Center, 8765 W. Higgins Rd Suite 200, Chicago, IL 60631-4174.

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