Description of Examinations

About COMLEX-USA

The COMLEX-USA examination series is designed to assess the osteopathic medical knowledge, knowledge fluency, and clinical skills considered essential for osteopathic generalist physicians to practice. The foundation of COMLEX-USA is the osteopathic philosophy which consists of four tenets: whole-person health care, underlying structure-function relationships and the interdependence of body systems, self-healing and self-regulatory mechanisms of the body, and the full scope of the osteopathic approach to patient care, including osteopathic manipulative medicine.

The COMLEX-USA is an examination sequence with three levels. This progressive nature of the COMLEX-USA examinations ensures the consistency and continuity of the measurement objectives of the osteopathic medical licensing examinations. A brief description of the examination blueprint is provided below and includes explanations of each examination component, including what constitutes a passing score. The COMLEX-USA examinations are administered only in the English language.

Each COMLEX-USA examination is administered in a standardized, time-measured environment. The ability to recall, interpret, process, and apply clinical knowledge and skills without hesitation and in a fluid manner (“knowledge fluency”) is fundamental to an osteopathic generalist physician’s competence to practice osteopathic medicine and therefore is one of the fundamental competencies the COMLEX-USA examinations assess.

The blueprint contains two dimensions, outlining competency domains and clinical presentations. While all examination Levels have a two-dimensional blueprint structure, the depth and emphasis of each Level parallels the candidate’s educational experiences and clinical responsibilities.

Click here for more information on all COMLEX-USA examinations, including the full examination blueprint, registration, practice materials, and updates.

COMLEX-USA Overview and Blueprint

COMLEX-USA LEVEL 1
Assessment of Foundational Biomedical Sciences and Osteopathic Principles and Practice

DESCRIPTION

A one-day, computer-based assessment that integrates the foundational biomedical sciences and osteopathic principles with clinical knowledge and other physician competencies relevant to addressing clinical presentations and promoting health in supervised clinical practice settings.

FORMAT

• Two computer-based test sessions of four hours each taken on one day (8 hours’ exam time) administered in a secure, time-measured environment.
• 352 questions based on the competency domains and clinical presentations for osteopathic medical practice.
• Test questions are single-best answer, multiple-choice format and may include audio-visual elements.
• Examples of test question types in Level 1 are found on the website under Practice Exams.
• Breaks are only permitted as outlined under the section Examination Administration in this BOI.

Section	Questions
1	44	Time: 4 Hours Questions can be answered, reviewed, and changed one section at a time. Individual sections are not timed. Once you move to the next section the previous section is no longer accessible.
2	44
Scheduled break
3	44
4	44
Scheduled break
5	44	Time: 4 Hours Questions can be answered, reviewed, and changed one section at a time. Individual sections are not timed. Once you move to the next section the previous section is no longer accessible.
6	44
Scheduled break
7	44
8	44

All candidates receive sixty (60) minutes pooled break time that can be used in their discretion during the scheduled break periods listed above. Questions can be answered, reviewed, and changed one section at a time. Individual sections are not timed. Once you advance to a new section the previous sections are no longer accessible.

PASSING

Passing Level 1 indicates that the candidate has demonstrated competence in the foundational biomedical sciences and osteopathic principles and related physician competency domains for osteopathic medical care of patients as required to enter supervised patient care settings and to continue lifelong learning.

COMLEX-USA LEVEL 2-CE
Assessment of Fundamental Clinical Sciences for Osteopathic Medical Practice

DESCRIPTION
A one-day, computer-based assessment that integrates application of knowledge in clinical and foundational biomedical sciences and osteopathic principles with other physician competencies related to the clinical care of patients and promoting health in supervised clinical settings. These competency domains include application of osteopathic medical knowledge, osteopathic patient care, osteopathic principles and practice, communication skills, systems-based practice, practice-based learning and improvement, professionalism, and ethics.

Clinical Sciences Disciplines

• Emergency Medicine
• Family Medicine
• Internal Medicine
• Obstetrics/Gynecology
• Osteopathic Principles and Practice
• Pediatrics
• Psychiatry
• Surgery

FORMAT

• Two computer-based test sessions of four hours each, taken on one day (8 hours’ exam time), administered in a secure, time-measured environment.
• 352 questions based on the competency domains and clinical presentations for osteopathic medical practice.
• Test questions are single-best answer, multiple-choice format and may include audio-visual elements.
• Examples of test question types in Level 2-CE are found on the website under Practice Exams.
• Breaks are only permitted as outlined under the section Examination Administration in the BOI.

Section	Questions
1	44	Time: 4 Hours Questions can be answered, reviewed, and changed one section at a time. Individual sections are not timed. Once you move to the next section the previous section is no longer accessible.
2	44
Scheduled break
3	44
4	44
Scheduled break
5	44	Time: 4 Hours Questions can be answered, reviewed, and changed one section at a time. Individual sections are not timed. Once you move to the next section the previous section is no longer accessible.
6	44
Scheduled break
7	44
8	44

All candidates receive sixty (60) minutes pooled break time that can be used in their discretion during the scheduled break periods listed above. Questions can be answered, reviewed, and changed one section at a time. Individual sections are not timed. Once you advance to a new section the previous sections are no longer accessible.

PASSING

Passing Level 2-CE indicates that the candidate has demonstrated competence in the clinical sciences and osteopathic principles and related physician competency domains for osteopathic medical care of patients as required to enter into supervised graduate medical education settings and to continue lifelong learning.

Assessment of Fundamental Clinical Skills for Osteopathic Medical Practice

The COMLEX-USA Level 2-Performance Evaluation (Level 2-PE) clinical skills exam was indefinitely suspended in March 2020 and formally discontinued in June 2022. Fundamental osteopathic clinical skills competencies remain an important part of the COMLEX-USA series. Research is underway to investigate feasibility of a standardized osteopathic clinical skills assessment in a distributed model. There are temporary clinical skills attestation pathways for Level 3 eligibility in place for the Classes of 2020-2025, which are provided by the Dean of the college of osteopathic medicine and recorded in the candidate record for COMLEX-USA. Please see the Eligibility section of this BOI for more information.

COMLEX-USA LEVEL 3
Assessment of Competencies for Osteopathic Medical Practice

DESCRIPTION
A two-day computer-based examination assessing competence in the foundational competency domains required for generalist physicians to deliver safe and effective osteopathic medical care and promote health in unsupervised clinical settings. Competency domains assessed include application of osteopathic medical knowledge, osteopathic patient care, osteopathic principles and practice, communication skills, systems-based practice, practice-based learning and improvement, professionalism, and ethics. Competency assessment occurs in the context of clinical and patient presentations and systems-based practice as required for entry in the unsupervised practice of osteopathic medicine as an independently practicing osteopathic generalist physician and for readiness for lifelong learning and practice-based learning and improvement.

FORMAT

• Four computer-based test sessions of 3.5 hours each taken over two days (two sessions per day).
• Administered within a 14-day window in a secure, time-measured environment.
• 420 questions in a multiple-choice question format (MCQ) and test questions related to approximately 26 clinical decision-making (CDM) cases. These are related to diverse and representative clinical presentations and seven competency domains for osteopathic medical practice.
• Test questions are predominantly in the single-best answer and multiple-choice formats and may include audio-visual elements.
• CDM question formats include extended multiple-choice (selection of more than one answer from an extensive list that may contain more than one correct answer) and constructed response (short-answer) test questions.
• Examples of test question types in Level 3 are found on the website under Practice Exams.
• Breaks are permitted only as set forth under the section Examination Administration in the BOI.

DAY 1	Session	Time
	MORNING	3.5 Hours	Total testing time for sections 1 and 2
	Tutorial/instructions – standard	14 minutes
	Section 1: 70 MCQ items
	Break #1	Optional, deducted from pooled break time
	Section 2: 70 MCQ items
	Break #2	Optional, deducted from pooled break time
	AFTERNOON	3.5 Hours	Total testing time for sections 3 and 4
	Section 3: 70 MCQ items
	Break #3	Optional, deducted from pooled break time
	Section 4: 70 MCQ items

 

DAY 2	Session	Time
	MORNING	3.5 Hours	Total testing time for sections 5 and 6
	Tutorial/instructions – standard	14 minutes
	Section 5: 13 CDM cases
	Break #1	Optional, deducted from pooled break time
	Section 6: 13 CDM cases
	Break #2	Optional, deducted from pooled break time
	AFTERNOON	3.5 Hours	Total testing time for sections 7 and 8
	Section 7: 70 MCQ items
	Break #3	Optional, deducted from pooled break time
	Section 8: 70 MCQ items

All candidates receive sixty (60) minutes pooled break time that can be used in their discretion during the scheduled break periods listed above. Questions can be answered, reviewed, and changed one section at a time. Individual sections are not timed. Once you advance to a new section the previous sections are no longer accessible.

PASSING

Passing Level 3 indicates that the candidate has demonstrated competence in the foundational competency domains required for generalist physicians to deliver safe and effective osteopathic medical care of patients as required for entry into the unsupervised practice of osteopathic medicine and to continue lifelong learning and practice-based learning and improvement.