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Computer-Based Testing FAQ

The National Board of Osteopathic Medical Examiners, Inc. (NBOME) is the creator and sole administrator of the COMLEX-USA series of examinations, the recognized pathway to licensure for osteopathic physicians in the United States and a number of international jurisdictions. The COMLEX-USA examination series includes computer-based cognitive examinations and a clinical skills examination. This FAQ addresses questions specific to the computer-based testing (CBT) format of the Level 1, 2-CE, and 3 COMLEX-USA cognitive examinations.

About the examination series

1. What is COMLEX-USA?
2. What do the COMLEX-USA computer-based cognitive examinations measure?

Examination format

3. Do the computer-based COMLEX-USA examinations require substantial computer skills?
4. What is the format of the computer-based COMLEX-USA examinations?
5. Can I see what the COMLEX-USA computer-based examinations look like before I take an examination?

Candidate profile information/accessing the online system

6. Is my personal information secure?
7. How do I change my name in the NBOME records?
8. How do I update my contact information?
9. How do I update my medical school information?
10. How do I obtain my NBOME profile?
11. What browser is required to access the online system?

Examination registration and scheduling

12. How do I get approval to take the COMLEX-USA examinations?
13. How do I locate a Prometric test location before scheduling an examination?
14. How do I register for and schedule a computer-based COMLEX-USA examination?
15. When I try to schedule my examination on the Prometric site, my NBOME ID number is not recognized. What should I do?
16. Are any fees associated with rescheduling or canceling examinations?
17. How do I reschedule my examination or change the testing location?
18. How do I find my confirmation number?
19. Is there a limit on how many times I can take a particular level of the COMLEX-USA computer-based examination?

Test accommodations

20. How do I apply for testing accommodations before taking a COMLEX-USA examination?
21. Can I schedule a COMLEX-USA examination while my application is pending?

Preparing for the examination

22. Does the NBOME offer any study materials for the COMLEX-USA examinations?
23. Can the NBOME offer any suggestions and/or materials to aid me in studying my problem areas for a retake?

On the day of the examination

24. What identification do I need to present at the Prometric test center?
25. Are there any breaks during the examination?
26. What happens if the computer freezes in the middle of testing?
27. What should I do if I experience issues/problems during administration of my examination?
28. Are there any penalties for late registration or cancellation of an examination or tardiness on the day of the exam?

Score reporting

29. When and how will scores be reported?
30. What types of score reports will my school and I receive from my COMLEX-USA cognitive examinations?
31. Are some multiple choice questions (MCQs) weighted more than others on COMLEX-USA?
32. A fellow student scored extremely low in one discipline area of the COMLEX-USA examination, but still passed the examination. What are the discipline scores, and how do they relate to the total COMLEX-USA score?
33. How do the discipline performance profiles provided for COMLEX-USA Level 1 individual score reports and the reports to the COM Deans relate to the disciplines noted under the Physician Task of Scientific Understanding of Health and Disease Mechanisms?
34. What are 3-digit COMLEX-USA scores?
35. Why doesn't the NBOME report COMLEX-USA percentile ranks?
36. How do I request a score confirmation, and how long does it take to receive it?
37. Many Accreditation Council on Graduate Medical Education (ACGME) residency programs accept both osteopathic (DO) and allopathic (MD) applicants. Can COMLEX-USA scores be converted into United States Medical Licensing Examination (USMLE) scores so that those programs can have a common criterion to judge all applicants?
38. If COMLEX-USA and USMLE scores cannot be converted, how should ACGME programs use COMLEX-USA scores to evaluate osteopathic applicants?

Transcripts

39. How do I request an official transcript?
40. What is the process time for obtaining an official transcript?
41. Can I request my transcript while I am waiting for the scores?
42. What should I do if my ERAS request is listed as "NOT MATCHED"?
43. How do I update my ERAS request after I receive my new scores?

More questions

If you have any questions, please feel free to contact NBOME Client Services by emailing clientservices@nbome.org or calling 866-479-6828.

About the examination series

1. What is COMLEX-USA?

COMLEX-USA - the Comprehensive Osteopathic Medical Licensing Examination of the United States-is a high-quality, high-stakes, three-level medical licensing examination series for osteopathic physicians.

The COMLEX-USA series emphasizes medical problem-solving knowledge and cognitive skills. It is the only licensing examination that covers osteopathic principles, practices, and the application of osteopathic manipulative treatment.

The series includes three computer-based examinations, delivered at more than 350 Prometric professional test centers in the US and Canada:

COMLEX-USA is accepted by all 50 states for the licensure of osteopathic physicians. Internationally, many countries accept COMLEX-USA scores as a component of their licensing requirements. For graduate medical education in the United States, all osteopathic residency programs accept COMLEX-USA scores. Most Accreditation Council for Graduate Medical Education (ACGME)-accredited residency programs accept COMLEX-USA scores for osteopathic physician applicants.

2. What do the COMLEX-USA computer-based cognitive examinations measure?

The COMLEX-USA cognitive examinations assess the osteopathic medical knowledge considered essential for osteopathic generalist physicians to practice medicine without supervision. To more directly and effectively achieve its measurement objectives, COMLEX-USA is constructed in the context of medical problem-solving that involves Clinical Presentations and Physician Tasks. The COMLEX-USA Examination Blueprint details the COMLEX-USA design and content coverage.

Examination format

3. Do the computer-based COMLEX-USA examinations require substantial computer skills?

No. Substantial computer experience is not required to take the computer-based COMLEX-USA examinations. Examinees need to know only how to click the mouse to select answers or other labeled options. Literature suggests that performance on computer-based tests is not related to the level of computer literacy.

4. What is the format of the computer-based COMLEX-USA examinations?

The COMLEX-USA examinations are computerized non-adaptive tests. The questions selected for each COMLEX-USA examination are predetermined. The number of questions and time limit for the examinations are also predetermined and under normal administration conditions are the same regardless of when and where the examinations are administered.

The total number of questions for a computer-based COMLEX-USA examination (COMLEX-USA Level 1, Level 2-CE, and Level 3) does not exceed 400, and the total testing time is eight hours. The examination is divided into two sessions consisting of four sections. You will have four hours to complete each session; within a session, the individual sections are not timed.

COMLEX-USA Levels 1 and 2-CE computer-based examination day sessions:

Session 1 - Four hours total
Section 1
50 questions Questions can be answered, reviewed, and changed
one section at a time.
Section 2
50 questions
Section 3
50 questions
Section 4
50 questions
Session 2 - Four hours total
Section 1
50 questions Questions can be answered, reviewed, and changed
one section at a time.
Section 2
50 questions
Section 3
50 questions
Section 4
50 questions

For COMLEX-USA Level 1 and Level 2-CE, all questions are multiple-choice. Most are one-best-answer questions, while a small number are matching-type questions. Most of the one-best-answer questions are single, stand-alone items; the remainder use two or more one-best-answer items following a case history. The COMLEX-USA Level 3 examination, includes multiple-choice questions and a Clinical Decision-Making (CDM) portion with short-answer and extended-multiple-choice (one or more correct answers) questions.

5. Can I see what the COMLEX-USA computer-based examinations look like before I take an examination?

The COMLEX-USA Practice Examinations are available on the NBOME website. You are encouraged to review them to familiarize yourself with taking the examination.

A tutorial session is also presented before you start the actual examination so you can familiarize yourself with the operation of the computer, the program options, and the procedures used during the examination.

New question formats using multi-media are being introduced gradually. You will be notified in advance as new question formats are introduced.

Candidate profile information/accessing the online system

6. Is my personal information secure?

Yes. Your personal data is treated by the NBOME as confidential. It will not be disclosed to any individual or entity without written, signed consent by you or an order of a court of competent jurisdiction.

7. How do I change my name in the NBOME records?

In order to take a COMLEX-USA examination, your name on the registration form and the valid government-issued photo ID presented to the testing center must be the same. If your name has changed, submit a Name Change Request Form and include a copy of the supporting document noting the name change (eg, marriage license, divorce decree, court document, naturalization document, etc.). Documentation can be scanned and emailed to clientservices@nbome.org or faxed to 773-714-0606.

Name changes must be made no later than five business days before the testing appointment. The NBOME recommends submitting the Name Change Request Form before registering for an examination if possible.

8. How do I update my contact information?

You can update your mailing address, email address, and phone numbers in the Client Registration System under the "Student Information" section on the "My Account" tab.

9. How do I update my medical school information?

If you transferred medical schools, you must contact the Dean's office at your old and new school and request that they forward the information to clientservices@nbome.org.

10. How do I obtain my NBOME profile?

Each year, the NBOME obtains a student list from each college of osteopathic medicine (COM). The NBOME system automatically generates and emails the access information to each candidate. This typically occurs by the beginning of November each year. If you do not receive the code by this time, check with your college to confirm your information has been submitted to the NBOME.

If you are a former osteopathic student and do not have an NBOME username and password, please contact Client Services by emailing clientservices@nbome.org or calling 866-479-6828 to set up an account. Please provide the osteopathic college you attended, the year of graduation, your date of birth, and any names you had in the past

11. What browser is required to access the online system?

For candidates in a MAC environment, the NBOME recommends using Safari. For those using a PC, the NBOME recommends using Internet Explorer. The system may not run properly when using other browsers. At this time, the NBOME does not recommend accessing the online system from a mobile device because of compatibility issues.

Examination registration and scheduling

12. How do I get approval to take the COMLEX-USA examinations?

Your college of osteopathic medicine will determine when you are approved to take each examination. You must also meet all of the NBOME eligibility requirements to take a COMLEX-USA examination. Check the COMLEX-USA Bulletin of Information 2016-2017 for details-and remember that your college may have additional requirements.

13. How do I locate a Prometric test location before scheduling an examination?

You can access test site information at the Prometric website through the "Locate a Test Center" option (second button).

14. How do I register for and schedule a computer-based COMLEX-USA examination?

To register for and schedule a computer-based exam,

After the payment is processed:

15. When I try to schedule my examination on the Prometric site, my NBOME ID number is not recognized. What should I do?

In order for Prometric to recognize your NBOME ID number, you must first register for the COMLEX-USA computerized examination as outlined above.

16. Are any fees associated with rescheduling or canceling examinations?

Yes. Please refer to COMLEX-USA Exam Fees for rescheduling and cancellation fee information.

17. How do I reschedule my examination or change the testing location?

18. How do I find my confirmation number?

Prometric will generate a 16-digit confirmation number once your appointment is confirmed. The number will appear at the top part of the confirmation page and will also be emailed to you immediately. Within 48 hours, this number will also appear as your "Prometric Appointment ID" next to your scheduled examination in your NBOME account under the "My Account" tab.

19. Is there a limit on how many times I can take a particular level of the COMLEX-USA computer-based examination?

Yes. Effective July 1, 2016, candidates are limited to total of six attempts for each examination, including but not limited to all attempts prior to July 1, 2016.

Candidates may take (including retakes) the COMLEX-USA Level 1, Level 2-CE, or Level 3 examination up to four times in any 12-month period. Review the COMLEX-USA Bulletin of Information 2016-2017 for details.

You should also be sure to check the policies of your college of osteopathic medicine for its retake guidelines, which may differ from the NBOME's. You will need the approval of your dean or residency program director to retake the examination; however, approval to retake a COMLEX-USA examination by a dean or residency program director will not override NBOME retake policy.

NOTE: Candidates may not retake any level of COMLEX-USA to improve their scores or for any purpose other than to pass a previously failed examination.

Test accommodations

20. How do I apply for testing accommodations before taking a COMLEX-USA examination?

If you are a "person with disability" under the Americans with Disabilities Act (ADA) and wish to receive test accommodations for an NBOME examination, you must

A completed application with full supporting documentation is generally evaluated within 45 days of its receipt by the NBOME.

21. Can I schedule a COMLEX-USA examination while my application is pending?

You can schedule a standard (non-accommodated) examination while your application is pending. However, if the application is approved by the NBOME and testing accommodations are granted, and you have not yet taken the examination, you will likely need to reschedule depending on the nature of the approved accommodation(s). If you schedule a standard (non-accommodated) examination and have taken the examination without accommodations before being notified by the NBOME of its decision on your request, the NBOME will report your score as if you had not requested an accommodation.

Preparing for the examination

22. Does the NBOME offer any study materials for the COMLEX-USA examinations?

While the NBOME does not provide any study materials for the COMLEX-USA examinations, the Comprehensive Osteopathic Medical Self-Assessment Examination (COMSAE) series enables you to conduct a self-assessment before taking a COMLEX-USA examination. The competency level of osteopathic medicine assessed by COMSAE was defined using the same framework as the COMLEX-USA examination. COMSAEs are not intended to predict performance on any of the corresponding levels. The NBOME does not endorse any alternative study examinations or materials.

You can also view the COMLEX-USA Practice Examinations on the NBOME website.

23. Can the NBOME offer any suggestions and/or materials to aid me in studying my problem areas for a retake?

If you did not pass a COMLEX-USA cognitive examination and intend to retake it, you should work alongside your college or program for suggestions or study aids. The NBOME provides the score report, and a graphical performance profile is included. This profile will help identify areas on which you may wish to focus in preparing for the retake.

On the day of the examination

Complete details for what happens on examination day can be found at Test Day Tips.

24. What identification do I need to present at the Prometric test center?

You are required to present one form of current (not expired) government-issued photo identification that bears your name (first and last name on the ID must match the name on your registration form) and your signature. Acceptable forms of government ID include:

Military ID that does not have a signature must be accompanied by a second form of ID that bears your signature.

Note: Candidates whose identifications do not match will be considered a "No Show" and will be responsible for paying the appropriate administration fee to reschedule.

25. Are there any breaks during the examination?

Yes. You are permitted to take three optional breaks during the examination:

If you choose to take the 10-minute optional breaks, the actual time spent on the break will be deducted from the time allocated to complete the examination. If you choose not to take the 10-minute optional breaks, you can continue taking the examination.

Any other breaks, without previous approval, will be brought to the NBOME's attention and will be subject to review.

26. What happens if the computer freezes in the middle of testing??

Occasionally, computers will malfunction, and the test center staff will need to reboot the computer for you. You will not lose any answers already entered, nor will you lose any examination time. The computer system stores all your answers instantly. After rebooting, the computer screen will return exactly to where you were working before the malfunction, both in terms of your responses and the time remaining in the examination.

27. What should I do if I experience issues/problems during administration of my examination?

You must bring the issue to the attention of a test center staff member or proctor immediately. If the issue is not resolved to your satisfaction, you must contact clientservices@nbome.org within 10 calendar days of the examination date.

You must provide credible and verifiable written evidence of the adverse testing condition in order for the NBOME to investigate the incident. The NBOME will contact you in a timely manner upon receipt of the noted information. The NBOME will then investigate and contact you with a resolution. For more information, please reference the COMLEX-USA Bulletin of Information 2016-2017.

28. Are there any penalties for late registration or cancellation of an examination or tardiness on the day of the exam?

If you arrive at the test center on the scheduled examination date within 30 minutes after the scheduled start time, you will be permitted to take the examination only if the test center is able to deliver the examination in its entirety. If you arrive at the test center more than 30 minutes past the scheduled start time, you run the risk of being designated a "No Show." You may be permitted to take the examination at the sole discretion of the proctor or testing vendor only if the test center is able to deliver it in its entirety. If you are not permitted to take the examination, you will be considered a "No Show" and will be responsible for the corresponding administration fee.

For complete details, candidates are advised to check the information regarding fees associated with rescheduling/cancellation in the COMLEX-USA Bulletin of Information 2016-2017.

Score reporting

29. When and how will scores be reported?

For the COMLEX-USA cognitive examinations, candidates can expect to receive test results within four to six weeks after taking the examination. You can check the dates when scores will be released at COMLEX-USA Score Release Information. Candidates will be notified by email that their score reports are accessible through the Client Registration System. Candidates will be able to access the test results immediately after they are available along with their examination history.

The NBOME will also post score reports to osteopathic schools immediately after the results are available, and schools can access and obtain up-to-date information about their student's test-taking activities and test results at any time.

30. What types of score reports will my school and I receive from my COMLEX-USA cognitive examinations?

The student score report will provide 3-digit standard score and a pass/fail designation. Percentile rank will not be reported because candidates will be taking the examination throughout the year. Following completion of the annual testing cycle, you can look up your percentile rank in relation to others in the same cohort using the COMLEX-USA Percentile Scores. You will also be provided with a graphical performance profile according to the COMLEX-USA content categories.

Because computer-based COMLEX-USA examinations are administered continuously throughout the year, osteopathic medical schools will receive summary reports at the end of the annual testing cycle. The school summary reports include school information compared with the national average performance.

31. Are some multiple choice questions (MCQs) weighted more than others on COMLEX-USA?

No. With the exception of pretest questions (or tryouts), which do not contribute to the scores candidates receive, every test question contributes equally to the candidate's score. The total reported score is a model-based scaled score that takes into account each question response and its psychometric properties.

32. A fellow student scored extremely low in one discipline area of a COMLEX-USA examination, but still passed the examination. What are the discipline scores, and how do they relate to the total COMLEX-USA score?

COMLEX-USA is an examination currently designed around patient presentations and physician tasks, not disciplines. The discipline performance profiles are provided at the request of the College of Osteopathic Medicine (COM) deans, American Association of Colleges of Osteopathic Medicine (AACOM), and candidates to potentially assist with lifelong learning, remediation, and program evaluation.

Performance profiles should not be used to interpret areas of importance or emphasis for any particular examination. Performance profiles

Apply caution in using performance profiles in order to avoid misinterpretation.

33. How do the discipline performance profiles provided for COMLEX-USA Level 1 individual score reports and reports to the COM Deans relate to the disciplines noted under the Physician Task of "Scientific Understanding of Health and Disease Mechanisms"?

The COMLEX-USA discipline performance profiles are provided at the request of the COM deans and candidates to potentially assist with lifelong learning, remediation, and program evaluation.

They should be interpreted with significant caution as the number of test questions classified to any particular discipline in a 400-question test is often lower than that required to achieve optimal reliability.

The primary classifications in COMLEX-USA relate to the two Dimensions of the examination: Dimension 1 - Patient Presentation and Dimension 2 - Physician Tasks (Physician Skills). The Dimension categories are further delineated in the COMLEX-USA Level 1, Level 2, and Level 3 Computer-based Cognitive Examinations.

As COMLEX-USA is an integrated, clinically oriented examination designed for the licensure pathway for osteopathic medical practice and developed around patients and their clinical presentations to DOs, multiple disciplines may be reflected in one clinical scenario or case that makes up one test item. As an example, a test question may be sub-classified in the discipline performance profiles as Anatomy, but may also include concepts from Physiology and Osteopathic Principles.

In COMLEX-USA Level 1, a minimum of 70-85% of the test content can be classified under the Physician Task of "Scientific Understanding of Health and Disease Mechanisms," which comprises the discipline performance profiles provided. Test question classification in the eight discipline areas for COMLEX-USA Level 1 is further defined with:

34. What are 3-digit COMLEX-USA scores?

The mean of the 3-digit standard score for all three computer-based cognitive examinations has historically been in the 500-550 range. For up-to-date normed data, the performance of first-time candidates in recent administrations on COMLEX-USA cognitive examinations is reported:

The minimum passing 3-digit standard score for Level 1 and Level 2-CE is 400, and Level 3 is 350, regardless of when the examination is taken. The minimum passing 3-digit standard score for COMLEX-USA Level 1, Level 2-CE, and Level 3 is equivalent to a minimum passing 2-digit standard score of 75.

COMLEX-USA 3-digit scores are NOT raw scores or the number of items answered correctly. Similarly, they are NOT the percentage of items answered correctly.

35. Why doesn't the NBOME report COMLEX-USA percentile ranks?

A percentile score is an examinee's performance rank among a defined peer group that takes the same examination. For COMLEX-USA examinees, this peer group is considered to be the examinees who take an examination in the same testing cycle. To accurately compute a percentile score, scores of the whole cohort, or at least most of the cohort, need to be available. The testing cycle-based 3-digit scores, 2-digit scores, and percentile conversions can be found at COMLEX-USA Percentile Scores.

36. How do I request a score confirmation, and how long does it take to receive it?

You can choose to submit a request to the NBOME for score confirmation within 120 days of the examination. Log in to the Client Registration System and select the "View Scores" tab. At the bottom of the page is the option to "Request Score Confirmation." The processing fee for score confirmations for all COMLEX-USA examinations is $50.00. This covers the cost to confirm all responses recorded during your computer-based testing.

37. Many Accreditation Council on Graduate Medical Education (ACGME) residency programs accept both osteopathic (DO) and allopathic (MD) applicants. Can COMLEX-USA scores be converted into United States Medical Licensing Examination (USMLE) scores so that those programs can have a common criterion to judge all applicants?

The NBOME understands the desire for a "conversion formula" for osteopathic medical students applying to ACGME-accredited residency programs. However, because of the fundamentally different characteristics of the examinations, it is not possible-or even desirable-to make a direct numerical comparison between the scores of the COMLEX-USA examination series and those of the United States Medical Licensing Examination (USMLE). COMLEX-USA 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.

The COMLEX-USA series assesses the skills and philosophy unique to the osteopathic medical profession. The curriculum of every osteopathic medical school incorporates distinctive osteopathic principles and prepares medical students and residents for medical practice as osteopathic physicians. COMLEX-USA incorporates these distinctive osteopathic principles, and it is constructed and validated based on practice patterns that are unique to DOs, including the use of osteopathic manipulative treatment. By contrast, the USMLE does not meet these criteria for assessing osteopathic medical students, and it does not test for osteopathic principles or osteopathic manipulative treatment.

The NBOME encourages residency program directors to consider the COMLEX-USA series as the valid and most appropriate assessment tool for osteopathic medical students.

38. If COMLEX-USA and USMLE scores cannot be converted, how should ACGME programs use COMLEX-USA scores to evaluate osteopathic applicants?

The NBOME encourages ACGME Residency Program Directors to gain a full understanding of the COMLEX-USA examination series-in particular, what it assesses, its format, and how standards are set. In addition, all residency program directors can take advantage of the percentile score converter.

Note: A full testing cycle cohort must be complete before a given score can be converted.

Information on all these areas can be found on the NBOME website:

Transcripts

39. How do I request an official transcript?

You can request an official transcript by submitting an electronic request with the appropriate fee via the Client Registration System. Individuals that do not have access to their online account may submit a written request form. Third parties that wish to request an official transcript will need to complete the transcript form and obtain a written consent from the osteopathic physician in order to receive the transcript. No request for a transcript will be taken by telephone.

40. What is the process time for obtaining an official transcript?

Transcript requests will be processed in the order of the date received. The normal processing time is one to two business days from the date of receipt, and three to five shipping days using standard USPS mail. Transcripts can also be sent via FedEx's overnight delivery service for an additional fee.

41. Can I request my transcript while I am waiting for the scores?

The NBOME can only accept and process a transcript request for examination scores which are available. If you request a transcript and a score is pending, it will not appear on your transcript. In order to process your transcript request, you must have at least one COMLEX-USA examination for which the score is available.

42. What should I do if my ERAS request is listed as "NOT MATCHED"?

In order for an Electronic Residency Application Service (ERAS) request to be transmitted successfully, all personal profile information in the ERAS account must match with your NBOME online account. The profile information includes your first and last name, date of birth, and NBOME ID. If the information in ERAS does not match your NBOME online account, you will see "NOT MATCHED," and the request will not be processed. In order to resolve the mismatch, you will need to contact NBOME Client Services and update the necessary information. You will then re-transmit the request via the ERAS application.

43. How do I update my ERAS request after I receive my new scores?

NBOME will send new scores upon receipt of a new ERAS request. You will use the ERAS application to request a re-transmit.