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COMLEX-USA Eligibility


Below are the criteria and requirements used to determine candidates’ eligibility to take COMLEX-USA examinations. Documentation demonstrating a candidate meets the specific requirements must be provided, including but not limited to verification by colleges of osteopathic medicine and/or residency programs confirming the candidate has satisfied the requirements relating to their status and progress in such programs.


Accredited COM: means a college of osteopathic medicine (COM) accredited by the American Osteopathic Association (AOA) Commission on Osteopathic College Accreditation (COCA).

Good Academic and Professional Standing Attestation: COMLEX-USA eligibility requires attestation by a COM dean and/or residency program director that a candidate is in good academic and professional standing at their medical school and/or residency program. “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 in the program as a student or resident.

This attestation does not expire unless rescinded by the medical school dean or program director or if the candidate no longer satisfies all eligibility criteria, including but not limited to withdrawal or dismissal from medical school or residency program. An attestation can be provided by a program director up to six months after a candidate leaves or graduates from a program.

Clinical Skills Attestation: As a result of the formal discontinuation of the COMLEX-USA Level 2-Performance Evaluation exam in June 2022, the NBOME has adopted a clinical skills attestation requirement for COMLEX-USA Level 3 eligibility. This attestation requires the dean of an accredited COM to verify the candidate has graduated with a DO degree and has demonstrated the fundamental osteopathic clinical skills necessary for graduation.

Prerequisites for Eligibility

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


  1. Completion of the first year of study at an accredited COM
  2. Good academic and professional standing attestation by COM dean


  1. Passing of COMLEX-USA Level 1
  2. Completion of the second year of study at an accredited COM
  3. Good academic and professional standing attestation by COM dean


  1. Passed COMLEX-USA Levels 1 and 2-CE
  2. Graduation from an accredited COM
  3. Good academic and professional standing attestation by residency program director
  4. Clinical Skills Attestation or passing Level 2-PE

Special Circumstances

  1. Candidates who took and failed Level 2-PE and did not retake and pass:

    Same requirements as above but candidate must complete six (6) months in residency program before they can take Level 3

  2. Candidates who are not in a residency program:

    For those candidates who are not in any residency program and therefore are unable to attain a residency program director attestation, the NBOME has created a temporary alternate pathway (TAPA) for candidates who graduated in 2018 or later. NBOME will consider situations on a case by case basis and will accept an attestation from a dean of an accredited COM.

    This attestation will indicate the candidate’s good academic and professional standing and that they have demonstrated the requisite clinical skills outlined in the petition guidelines. Read the petition guidelines and download the petition form.

  3. Attestation for classes prior to 2018:

    For candidates who graduated in 2017 or earlier and have not previously taken Level 3, candidates may submit a request to waive the attestation requirement. Candidates must have been eligible to take Level 3 at the time of their graduation.

Additional Information

All candidates must:

Retaking an Examination


Candidates taking COMLEX-USA examinations are limited to a total of four (4) scored attempts for each examination level. Candidates who have passed an exam level are not permitted to retake the examination to improve their score. Candidates are not permitted to take an exam level more than four (4) times within a 12 month period.


The only consideration for an exception to this policy for a one time, one additional attempt beyond the four- scored attempts is permitted at the explicit request of a Medical Licensing Agency.

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


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

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


Bulletin of Information 2023-2024

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