The NBOME recently introduced COMLEX-USA Blueprint 2.0, an updated examination framework designed to ensure the COMLEX-USA series continues to reflect the knowledge, skills, and professional competencies required for safe and effective osteopathic medical practice.
Aligned with the Fundamental Osteopathic Medical Competency Domains 2026 (FOMCD 2026), Blueprint 2.0 maintains the existing two-dimensional structure of competency domains and clinical presentations while updating content to reflect current practice and emerging priorities in osteopathic medical education and practice.
The revised Blueprint continues to organize exam content around seven competency domains and 10 clinical presentation categories, reinforcing the osteopathic profession’s commitment to comprehensive, whole-person-centered care.
Updates strengthen the integration of digital health care, nutrition, compassion, systems-based care, and health promotion across the clinical presentations. In addition, Blueprint 2.0 integrates the two new pathways to assess osteopathic clinical skills competencies: the Core Competency Capstone for DOs (C3DO) and the Comprehensive Competency Verification (CCV).
Current Blueprint vs. Blueprint 2.0
| Current Blueprint Revised February 2025 | Blueprint 2.0 Aligned with FOMCD 2026 | |
| Framework | Seven competency domains, ten clinical presentations, osteopathic philosophy/whole-person care, and the two-dimension framework. | Retains the same core framework while updating language, organization, and emphasis for FOMCD 2026. |
| Competency domains & measured outcomes | Seven domains with measured outcomes organized around core osteopathic practice, patient care, knowledge application, practice-based learning and improvement, communication, professionalism, and systems-based practice. | Seven domains and with revised measured outcomes to specify required elements related to compassion, nutrition, digital intelligence, augmented intelligence, physical examination skills, practice-based learning, and expanded systems-based practice. |
| Clinical presentations | Ten presentation categories organize high-frequency and high-impact concerns across patient care contexts. | Ten categories with high-frequency and high-impact presentations are retained with updated terminology and health promotion/preventive care integrated across all presentations. |
| Test specifications | Includes current examination-level and series minimum percentages. | Incorporates C3DO and CCV and includes minor percentage updates, including increased series minimums for OPP/OMT and Professionalism & Compassion. |
| Updated literature and source base | Draws on foundational competencies, assessment, patient safety, professionalism, and clinical practice resources supporting the current COMLEX-USA framework and informed by comprehensive practice analysis | Reflects updated literature and source review, including FOMCD 2026 and practice analysis in clinical skills, nutrition, digital health, health systems science, telehealth, patient safety, compassion, spirituality in health care decision-making, and osteopathic medical practice. |
Together, these updates support NBOME’s ongoing commitment to advancing high-quality osteopathic licensure assessment that reflects evolving standards in osteopathic medical education, patient care, and health systems.
Implementation Timeline
Examination content may reflect FOMCD 2026 as part of the transition to Blueprint 2.0. The Blueprint 2.0 test specifications for competency domains and clinical presentations will be implemented according to the timeline below.
- Level 1: May 2028
- Level 2-CE: June 2028
- Level 3: January 2029
Examinations administered before these dates will follow the current COMLEX-USA Blueprint (Rev. February 2025) specifications.