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NBOME
COMLEX-USA BULLETIN of INFORMATION

COMLEX-USA Eligibility

Requirements

A candidate must meet the requirements outlined below. Examinations must be taken in sequence and each Level passed before the candidate is eligible to take the next Level.

Prerequisites

COMLEX-USA Level 1

  • Completion of the first year of study at an accredited COM1
  • Attestation by the COM that the candidate is in good academic and professional standing2

COMLEX-USA Level 2-CE

  • Passing of COMLEX-USA Level 1
  • Completion of the second year of study at an accredited COM1
  • Attestation by the COM that the candidate is in good academic and professional standing2

COMLEX-USA Level 2-PE

  • Effective March 2020, the exam was indefinitely suspended


COMLEX-USA Level 3

  • Pass COMLEX-USA Level 2-CE
  • Pass Level 2-PE or meeting attestation requirements as outlined below:
    Class of 2020, 2021: Attestation by COM Dean that you have graduated and have demonstrated the fundamental osteopathic clinical skills necessary for graduation
    Class of 2022: Enhanced Attestation by COM Dean that you have graduated and have demonstrated the fundamental osteopathic clinical skills necessary for graduation
  • Graduation from an accredited COM1
  • Earned a DO degree
  • Attestation by a program director3,4 in an ACGME-accredited residency program; that the candidate is in good academic and professional standing2

1 An accredited COM is a college of osteopathic medicine (COM) accredited by the American Osteopathic Association (AOA) Commission on Osteopathic College Accreditation (COCA).

2 “Good academic and professional standing” denotes that the candidate meets the academic and professional requirements of the college of osteopathic medicine or residency program and is eligible to continue as a student or resident in the program.

3 Individual who meets the requirements and qualifications as deemed by the ACGME as the director of a residency program and designated with authority and accountability for the operation of a residency/fellowship program.

4 Candidates not in a residency program, refer to Temporary Alternate Attestation pathway below.

VERIFICATION: All levels require the COM dean’s office to confirm eligibility requirements are met.

NOTE: Attestation by a residency program director that a candidate is in good academic and professional standing in an ACGME-accredited residency program is required for Level 3 eligibility for graduates after 2018. This attestation does not expire unless rescinded by the program director and is good for up to the six-attempt limit and four attempts in any 12- month period. An attestation can be provided by a program director up to six months after a candidate leaves or graduates from a program.

NBOME recommends but does not require that a candidate has completed six months in a residency program prior to taking the Level 3 examination. The exception to this is that candidates who have previously failed COMLEX-USA Level 2-PE examination and have not had an opportunity to retake the exam are required to complete six months of residency, and satisfy all other requirements as stated above.


Pathway Attestations for the Classes of 2020 and 2021
On March 11, 2021 the Special Commission on Osteopathic Medical Licensure Assessment announced three temporary eligibility pathways for the class of 2020 and 2021 for the COMLEX-USA Level 3. Below are the requirements for each of these pathways.

Pathway 1 (Traditional): for the Classes of 2020 and 2021 who have taken and passed COMLEX-USA Level 2-PE (as for prior DO graduates)

  • Pass both COMLEX-USA Level 2-CE and Level 2-PE
  • Graduation from an accredited college of osteopathic medicine (COM) with a DO degree as attested by the COM dean who will attest, “You are acknowledging that each student submitted is in good academic and professional standing, meets the requirements to graduate from your COM and that they have demonstrated the fundamental osteopathic clinical skills necessary for graduation.”
  • Attestation by the residency program director of an ACGME-accredited program that you are in good academic and professional standing
  • Six months of GME completion prior to taking COMLEX-USA Level 3 (Recommendation ONLY)


Pathway 2: for the Class of 2021, who have never taken COMLEX-USA Level 2-PE

  • Pass COMLEX-USA Level 2-CE
  • Graduation from an accredited college of osteopathic medicine (COM) with a DO degree as attested by the COM dean who will attest, “You are acknowledging that each student submitted is in good academic and professional standing, meets the requirements to graduate from your COM and that they have demonstrated the fundamental osteopathic clinical skills necessary for graduation.”
  • Attestation by the residency program director of an ACGME-accredited program that you are in good academic and professional standing
  • Six months of GME completion prior to taking COMLEX-USA Level 3 (Recommendation ONLY)

Pathway 3: for the classes of 2020 and 2021, who have unsuccessfully attempted (failed) COMLEX-USA Level 2-PE

  • Passing COMLEX-USA Level 2-CE
  • Graduation from an accredited college of osteopathic medicine (COM) with a DO degree as attested by the COM dean who will attest, “You are acknowledging that each student submitted is in good academic and professional standing, meets the requirements to graduate from your COM and that they have demonstrated the fundamental osteopathic clinical skills necessary for graduation.”
  • Attestation by the Residency Program Director of an ACGME-accredited program that you are in good academic and professional standing
  • Six months of GME completion prior to taking COMLEX-USA Level 3 (Required)

Pathway for Enhanced Attestation for the Class of 2022

In June 2021, the Special Commission on Osteopathic Medical Licensure Assessment announced the requirements for an enhanced attestation by the COM dean for a temporary eligibility pathway for the Class of 2022 for the COMLEX-USA Level 3. Below are the requirements for this pathway.
  • Passing COMLEX-USA Level 2-CE
  • Graduation from an accredited college of osteopathic medicine (COM) with a DO degree as attested by the COM dean who will provide an enhanced attestation that, “You are acknowledging that each student submitted is in good academic and professional standing, meets the requirements to graduate from your COM and that they have demonstrated the fundamental osteopathic clinical skills necessary for graduation.”
  • Attestation by the residency program director of an ACGME-accredited program that you are in good academic and professional standing
  • Six months of GME completion prior to taking COMLEX-USA Level 3 (Recommendation Only)


Temporary Alternate Pathway Attestation
For those candidates who are not in any residency program and therefore unable to attain a residency program director attestation, NBOME has created a temporary alternate pathway. The NBOME will accept a request from a dean of a college of osteopathic medicine for a temporary alternate pathway for COMLEX- USA Level 3 attestation for candidates who graduated in 2018 or later. This temporary alternate attestation will be reviewed during 2021 to determine if it will continue in 2022. The dean will attest to the candidate’s good academic and professional standing based on the conditions outlined in the petition guidelines. Read the petition guidelines and download the petition form.

Temporary Alternate Pathway Attestation (Dean’s Level 2-PE Verification)
For candidates who failed the COMLEX-USA Level 2-PE examination and did not have the opportunity to retake and pass, their deans will need to provide a Dean’s Verification attestation to confirm they have the fundamental osteopathic clinical skills necessary to graduate. With this verification attestation we would no longer require six months of GME training prior to taking the Level 3 examination. All other conditions noted above for the original Temporary Alternate Pathway Attestation will apply to this new attestation and the petition guidelines will include the additional criteria used by the dean to provide this Dean’s Level 2-PE Verification.

Grandfathered Attestation
For candidates who graduated in 2017 or earlier the NBOME has created a “grandfathered” attestation for Level 3 eligibility. Candidates must have been previously eligible to take the COMLEX-USA Level 3 examination, request to waive the Residency Program Director Attestation and did or did not participate in a residency program. This grandfathered eligibility attestation includes all requirements for other attestations such as multiple attempts up to our six attempt limit and a limit of four attempts in any twelve month period.

Additional Information

All candidates must:

  • Establish or maintain an online account with NBOME (see also Registration and Scheduling).
  • Agree to the Terms and Conditions described herein.
  • Provide proof of identity at the time of the examination (see also Examination Administration).
  • Understand and agree that no candidate may take any Level examination for practice or to improve their score for any purpose other than to pass a previously failed examination or an examination where the score has been voided.

Sequence of Examinations

COMLEX-USA is a three-level examination sequence that must be taken in order as follows. All eligibility requirements are outlined above.

Examination Sequence

In order to take A candidate
COMLEX-USA LEVEL 1 Must meet all eligibility requirements to begin the examination sequence
COMLEX-USA LEVEL 2-CE Must meet all eligibility requirements and have taken and passed COMLEX-USA Level 1
COMLEX-USA LEVEL 3 Must meet all eligibility requirements and have taken and passed
COMLEX-USA Level 1 and Level 2-CE

Retaking An Examination

If a Candidate’s Score Levels 1, 2-CE AND 3
IS PASSING Candidate is not permitted to retake examination to improve their score
IS FAILING Candidate may retake examination a maximum of four times in any 12-month period
IS NOT SCORED Candidate may retake examination a maximum of four times in any 12-month period

LIMITED NUMBER OF ATTEMPTS

Candidates taking COMLEX-USA examinations are limited to a total of six (6) attempts for each examination.

EXCEPTION TO SIX-ATTEMPT LIMIT

The only consideration for an exception to this policy for one additional attempt beyond the six-attempt limit is at the explicit request of a Medical Licensing Agency.

For NBOME to waive the limitation of a maximum of six attempts for any COMLEX-USA examination, candidates are required to:

  • Obtain a written petition for waiver from a Medical Licensing Agency;
  • Submit written documentation from the COM confirming the candidate remains in good academic and professional standing.
NOTICE of PLANNED CHANGE to POLICY:
Effective July 1, 2022, candidates taking COMLEX-USA examinations will be limited to a total of four (4) attempts for each examination (COMLEX-USA Level 1, Level 2-CE, and Level 3), including but not limited to all attempts prior to July 1, 2022. After June 30, 2022, no candidate will be allowed to take any examination more than four (4) times without obtaining approval from the NBOME.


CHANGE IN ELIGIBILITY STATUS

If a COM, residency program director or NBOME deems a candidate ineligible before administration of an examination

  • The candidate may not take the examination.
  • The candidate is required to promptly notify NBOME in writing via email of ineligibility to clientservices@nbome.org
  • If NBOME is notified that the candidate is ineligible for any reason and the examination was administered, the examination will not be scored. If the examination was administered and the examination was scored and released, the score will be voided.
  • If irregular conduct is found to have occurred, the NBOME transcript and other test administration records will be annotated with this information. See also “Irregular Conduct.”
  • COM must remove eligibility from the NBOME Portal.

To request a refund if the candidate becomes ineligible after the administration, the candidate must:

  • Provide a written explanation satisfactory to NBOME, within 30 days of the date notified ineligible to take the examination.
  • At NBOME’s discretion, all or a portion of exam fees paid may be refunded.
  • Fees outlined in “Candidate Rescheduled, Canceled, or Missed Scheduled Examinations” apply.
  • If not in compliance with the terms herein, all fees paid by or for the candidate will be forfeited.
  • Please contact NBOME Client Services (clientservices@nbome.org) should you have questions.
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