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General  Scoring COMLEX-USA Level 3 Post-Exam Standard Setting
About the Examination Series
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 and practices, and the application of osteopathic manipulative treatment. The series includes three computer-based examinations:
  • COMLEX-USA Level 1—assesses the competent application of foundational and basic biomedical and osteopathic science knowledge relevant to clinical presentations as defined by the COMLEX-USA blueprint, emphasizing the scientific concepts and principles necessary for understanding the mechanisms of health, clinical problems and disease processes.
  • COMLEX-USA Level 2-Cognitive Evaluation (CE)—assesses the competent application of knowledge of clinical concepts and principles involved in all steps of clinical problem-solving for osteopathic medical practice as defined by the COMLEX-USA blueprint, emphasizing the biomedical and osteopathic concepts and principles necessary for making appropriate clinical diagnoses through patient history and physical examination findings.
  • COMLEX-USA Level 3—assesses 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.
What do the COMLEX-USA computer-based examinations measure?
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 osteopathic medicine. The foundation of COMLEX-USA is the osteopathic philosophy of whole-person health care, underlying structure-function relationships and the interdependence of body systems, self-healing and self-regulatory mechanisms, and the full scope of the osteopathic approach to patient care, including osteopathic manipulative medicine. The COMLEX-USA Master Blueprint details the COMLEX-USA design and content coverage.
Do the computer-based examinations require substantial computer skills?
No. Research suggests that performance on computer-based tests is not related to the level of computer literacy. Substantial computer experience is not required to take the computer-based examinations. Examinees need to know only how to click the mouse to select answers or other labeled options.
What is the format of the computer-based COMLEX-USA examinations?
The COMLEX-USA Levels 1, 2-CE, and 3 examinations are computerized non-adaptive tests. The questions selected for each COMLEX-USA examination are predetermined. The number of questions and the 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. Please refer to each Level for specific detail on format: The COMLEX-USA Bulletin of Information will also have more detail.
Is there a separate list of lab values/reference ranges provided on the COMLEX-USA examinations?
No. If lab values are reported in a test question, then the normal reference ranges are also given either in a table or in parentheses. Please see our COMLEX-USA Question of the Month for examples.
Registration & Scheduling
How do I set up and use my Portal account?
View a video walkthrough here.
How do I get approval to take the COMLEX-USA examinations?
A candidate must meet the requirements outlined in the COMLEX-USA Bulletin of Information. Examinations must be taken in sequence and each level passed before the candidate is eligible to take the next level.

Your college may have additional requirements. Check with your school, and refer to the COMLEX-USA Bulletin of Information for more details.
How do I register for and schedule a computer-based COMLEX-USA exam?
To register for and schedule a computer-based exam:
  1. Log in to your NBOME Account.
  2. Once logged in, enter your Student Portal.
  3. Select “Exams.”
  4. Select “Purchase Exams.”
  5. Locate the “COMLEX-USA Exams Available for Purchase” section, and select your desired examination date range option.
  6. Once your preferred date range has been chosen, click the “Add to Cart” button. The system will prompt you to the shopping cart.
  7. On the Shopping Cart page you will be asked to “Agree to Terms.” After agreeing to the terms, “Proceed to Payment” to enter your credit card information and complete the purchase.
  8. After your payment is processed you can schedule an examination appointment by selecting “My Exams.”
  9. Choose your preferred examination location and date.
  10. You will receive an appointment ID and email confirmation after you “Confirm” the appointment.
The testing site does not recognize my NBOME ID number. What should I do?
In order for your NBOME ID number to be recognized, you must first register for the COMLEX-USA computerized examination via your NBOME Account. If you are still having problems, please contact Client Services at clientservices@nbome.org or 866-479-6828.
Are any fees associated with rescheduling or canceling examinations?
Yes. Please refer to the Registration & Scheduling section for each COMLEX-USA examination for fee information.
How do I reschedule or cancel an exam?
To reschedule an exam, log in to your NBOME Account, select “My Exams,” and then “Reschedule.” To cancel an exam, select “My Exams,” and then “Cancel.” In both instances, you will be redirected to our testing partner's website to reschedule a new test appointment. Before rescheduling or canceling an examination, please carefully review the policies and procedures for rescheduling and cancellation fee information. If you encounter unavoidable circumstances (e.g., health problems, travel delays), you can submit a Rescheduling Fee Waiver Form and send it with supporting documentation to clientservices@nbome.org.
How do I find my confirmation number?
The testing partner will generate a confirmation number once your testing appointment is confirmed. The number will appear on the confirmation page and will also be emailed to you immediately. Within 24 hours, this number will also appear as your “Appointment ID” next to your scheduled examination in your NBOME account under the “My Account” tab.
Is there a limit on how many times I can take a particular level of the COMLEX-USA computer-based examination?
Yes. Candidates are limited to a total of four attempts for each examination. Review the COMLEX-USA Bulletin of Information 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.
Personal Information
Is my personal information secure?
Yes. Your personal data is treated by the NBOME as confidential. Your information will not be disclosed to any individual or entity without written, signed consent by you or an order of a court of competent jurisdiction.
How do I change my name in the NBOME records?
If your name has changed, download and complete a Name Change Request Form.
How do I update my contact information?
You can update your mailing address, email address, and phone numbers in your NBOME Account under the "Student Information" section on the "My Account" tab.
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 schools and request that they forward your transfer information to NBOME Client Services.
How do I obtain my NBOME profile?
The NBOME obtains a student list from each college of osteopathic medicine at the start of each academic year. This list is used to automatically generate and email account access information to each candidate after validation. If you do not receive this email in August or September, check with your school or 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 email clientservices@nbome.org or call 866-479-6828 to set up an account. You will need to provide the name of the school or college you attended, the year of graduation, your date of birth, and any names you had in the past.
What browser is required to access the online system?
For candidates using a Mac, the NBOME recommends using Safari. For those using a PC, the NBOME recommends using Google Chrome. 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.
Test Accommodations
How do I request an accommodation?
If you are a “Person With Disability” under the Americans with Disabilities Act, and wish to receive test accommodations for an NBOME examination, review and download the following document. Complete and submit the Request for Test Accommodations form with the supporting documentation substantiating your eligibility for the accommodation to NBOME Test Accommodations:
  • By Email (preferred): testacc@nbome.org
  • Or By Mail: NBOME Test Accommodations; 101 West Elm Street, Suite 230; Conshohocken, PA 19428
A completed application with full supporting documentation is generally evaluated within 75 days of receipt by the NBOME. Consult the COMLEX-USA Bulletin of Information for more information.
Can I schedule a COMLEX-USA examination with a testing accommodation application pending?
Yes. You can schedule a standard (non-accommodated) examination while your application is pending. However, if you are approved for testing accommodations and have not yet taken your exam, you must reschedule the test depending on the nature of the approved accommodation(s). If you take a standard exam while your request for accommodation is still pending, the NBOME will deem your request withdrawn and you must re-apply. Consult the COMLEX-USA Bulletin of Information for more information.
Preparing for the Examination
Can I see what the computer-based examinations look like before I take at test?
Yes, you can find practice exams on the Practice and Preparation sections under each Level on the NBOME website. You are encouraged to review and take the practice exams before test day. At the beginning of practice and actual examinations, you will take a tutorial to familiarize yourself with the operation of the computer, the program options, and the procedures used during the examination.

Mac users should access practice questions using Safari, and PC users should use Google Chrome. Mobile devices are not recommended.
Does the NBOME offer any study materials for the COMLEX-USA examinations?
Yes. The NBOME offers practice examinations and other preparatory resource materials on our website. Visit the COMLEX-USA Practice & Preparation page for all available COMLEX-USA-related resources. In addition, the Comprehensive Osteopathic Medical Self-Assessment Examination (COMSAE) and WelCOM series, which were designed using the same competency-assessment framework as the COMLEX-USA series, enable you to conduct self-assessments before taking a COMLEX-USA exam. COMSAEs are not intended to predict performance on any of the corresponding levels of COMLEX-USA. The NBOME does not endorse any alternative study examinations or materials.
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 examination and intend to retake it, you should consult your school, college, or program for suggestions or study aids. The NBOME provides a score report and a graphical performance to help identify areas on which you may wish to focus in preparing for the retake.
Are there any breaks during the examination?
Yes. Please refer to each Level for specific detail on break times:
What is an acceptable government ID?
You are required to present a current government-issued photo ID with your first and last name. The name on your ID must match the name and signature on the registration form. Candidates whose ID does not match their registration will be considered a “No Show” and deemed responsible for paying rescheduling fees.

Acceptable forms of government ID include:
  • Passport
  • Driver's license, or state ID
  • A military ID with signature*
*A military ID that does not have a signature must be accompanied by a second form of ID that bears your signature.
What if my computer freezes during the examination?
You must bring the issue to the attention of a test administrator (TA) or proctor immediately so they can reboot the computer. Because the computer system stores all your answers instantly, you will not lose any answers already entered, nor will you lose any examination time. After rebooting, the computer screen will return to exactly where you were working before the malfunction, both in terms of your responses and the time remaining in the examination.

If the issue is not resolved to your satisfaction, you must contact Client Services at clientservices@nbome.org or 866-479-6828 within 10 calendar days of the examination date. You must provide credible, verifiable, written evidence of the adverse testing condition in order for the NBOME to investigate the incident. We will acknowledge your email in a timely manner and will investigate and contact you with a resolution.
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 NBOME Client Services within 10 calendar days of the examination date and provide credible, verifiable written evidence of the adverse testing condition in order for the NBOME to investigate the incident. We will acknowledge your email in a timely manner and will then investigate and contact you with a resolution. For more information, please reference the COMLEX-USA Bulletin of Information.
Are there any penalties for the 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 may 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 may be designated as 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 deemed as a "No Show" and will be responsible for the corresponding administration fee. For complete details, refer to the COMLEX-USA Bulletin of Information.
Scores and Transcripts
When and how will scores be reported?
Scores for COMLEX-USA Level 1 and Level 2-CE are released approximately 4-6 weeks from the date the exam is administered. (Note: the first score release of each test cycle may be subject to brief delays.) Score reports for COMLEX-USA Level 3 are released approximately 8 to 10 weeks from the completion of the examination (after the initial score release). Score release dates are available here: Candidates will be notified by email that their score reports are available online through their NBOME account, along with their examination history.

Once available, score reports are also shared with a candidate’s school or residency program via their online NBOME account. Authorized officials can access up-to-date information on students’/residents’ testing activities at any time.
What types of score reports will my school and I receive for my COMLEX-USA exam?
  • For COMLEX-USA Level 1, the student score report will provide a pass/fail designation instead of a three-digit standard score and a pass/fail designation. The NBOME also provides additional information in the Formative Performance Profile.
  • For Levels 2-CE and 3, the student score report will provide a three-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 Score Converter. You will also be provided with a graphical formative performance profile according to the COMLEX-USA blueprint.
  • Because COMLEX-USA examinations are administered continuously throughout the year, schools and colleges will receive a report after the testing cycle is completed. This report compares a school’s information with national performance.
Are some multiple choice questions (MCQs) weighted more than others on COMLEX-USA?
No. Every scorable test question contributes equally to the candidate's score.
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 competency domains and clinical presentations, not disciplines. The discipline performance profiles are provided at the request of the college of osteopathic medicine deans, the American Association of Colleges of Osteopathic Medicine, 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:
  • Are not additive for projecting the total score or pass/fail status
  • Do not contain metrics technically designed for sub-score reporting
  • Are sometimes based on a relatively small number of items as compared to the total test; therefore, reliability of sub-scores is lower than for the total test.
Apply caution in using performance profiles in order to avoid misinterpretation.
What are 3-digit COMLEX-USA scores?
The minimum passing 3-digit standard score for Level 2-CE is 400, and for Level 3 is 350, regardless of when the examination is taken. 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.

(Level 1 transitioned from numeric score reporting to “pass” or “fail” in 2022.)
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 those 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, must be available. The testing cycle-based three-digit scores and percentile conversions can be found with the COMLEX-USA Percentile Score Converter.
How do I request a score confirmation, and how long does it take to receive it?
You may request a score confirmation within 120 days of the examination. Log in to your NBOME account and select the "View Scores" tab. At the bottom of the page is the option to "Request Score Confirmation." The processing fee is $75.00 and covers the cost to confirm all responses recorded during your computer-based testing.

You should receive your Level 1 and/or Level 2-CE score confirmation from the NBOME within 10 business days, or 15 business days for Level 3.
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 way to easily compare osteopathic medical students applying to ACGME-accredited residency programs with other applicants.

However, we believe that licensure examinations should only be used in the context of a holistic review of all applicants. And where a program director is looking to understand an osteopathic medical student’s proficiency in competencies measured by licensure examinations (the common criterion), the best resource is COMLEX-USA. This examination series is aligned with osteopathic medical curricula and practice, and therefore is the best measure of a DO student’s osteopathic medical knowledge, knowledge fluency, clinical skills, and other competencies.

That said, some program directors may be unversed in the COMLEX-USA score scale. Many studies have shown that there is a positive relationship between scores on COMLEX-USA and USMLE, which may be more familiar. Some of these, and the largest of all of these can be found here. These allow for a better understanding of COMLEX-USA scores, and therefore the osteopathic applicant.

We also have percentile score converter so program directors and others can understand how that student performed relative to the cohort of all students taking that examination.

Finally, all of these resources are available on our website, in our Residency Program Director Toolbox.
How do I request an official transcript?
You can request an official transcript by submitting an electronic request with the appropriate fee via your NBOME Account.
  1. Log in to your NBOME Account.
  2. Once logged in, enter your Student Portal.
  3. Select “Transcript.”
  4. Complete the form.
Individuals who do not have access to their online account may submit a written request. Third parties that wish to request an official transcript must complete a transcript request and obtain written consent from the test-taker (physician or student) in order to receive the transcript. No request for a transcript will be taken by telephone.
What is the processing time for obtaining an official transcript?
Transcript requests will be processed in the order of the date received. The normal processing time is 1-2 business days from the date of receipt, and 3-5 shipping days using standard USPS mail. Transcripts can also be sent via FedEx's overnight delivery service for an additional fee.
Can I request my transcript while I am waiting for my scores?
The NBOME can only accept and process a transcript request for examination scores that 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 a score is available.
After I receive my new scores, will they automatically be sent to ERAS?
No. You must submit a new ERAS request to send your scores.
Clinical Decision-Making (CDM) Cases
What are CDM cases?
The CDM examination was first developed by the Medical Council of Canada in 1992 and has since been adopted by countries across the world. The NBOME’s CDM cases assess the ability of a candidate to make appropriate patient management decisions consistent with that of an independently practicing osteopathic generalist physician. The cases are not meant to simply assess factual knowledge but rather to assess the ability to apply knowledge at specific decision points in patient care, a special emphasis for the COMLEX-USA Level 3 examination.
How are CDM cases constructed?
The NBOME’s CDM cases focus on key, critical decisions and challenges related to patient care that are routinely faced by osteopathic generalist physicians. A typical CDM case consists of a clinical scenario followed by two to four questions. CDM cases feature two question types: constructed response (short answer) and extended multiple-choice (with the potential for multiple correct options). Test questions ask about data acquisition (e.g., obtaining history or physical exam findings, ordering tests), data interpretation (e.g., generating a diagnosis), and treatment (e.g., prescribing medication, counseling, or planning follow-up care). A CDM tutorial is available.
What content is being assessed in the CDM cases?
CDM cases follow the same content blueprint as COMLEX-USA.
How should I respond to short answer questions?
Responses should be concise and limited to specific diagnoses, examination steps, diagnostic studies, or treatments. It is unnecessary to answer short answer questions with full sentences. Do not include reasoning or justifications for your responses. The short answer text boxes will only allow you to type up to 100 characters per box.
Can I use abbreviations in my answers?
It is generally advisable to avoid or limit abbreviations due to the lack of standardization. Use of abbreviations when completing short answer questions runs the risk of misinterpretation in scoring and should be used with caution. It is therefore recommended that you spell out names and terms rather than abbreviate.
Will I be penalized for misspellings?
The examination does not include a spell-check feature; however, misspellings in answers are acceptable when the meaning and interpretation are still clear. There is technically no penalty for misspelling answers unless the meaning is ambiguous or incorrect.
Can I use protocols in my answers?
Use of protocols as answers will NOT be accepted as correct because they are not universal. The necessary steps or components of protocols must be listed individually in separate boxes. For example, the answer “ACLS protocol” would not be accepted as correct when “synchronized cardioversion” is the next step.
How should I write an order as an answer?
Write the order just as you would on a hospital or urgent care order record, in specific terms that a technician, nurse, or other health care professional could understand and carry out. However, medication dosages are not required in answers.
Can I answer a question with a laboratory test that is not included on the list of approved lab panels?
Yes, you can answer with any specific test. The approved laboratory test panels are the only panels that are acceptable as answers. If the panel you have in mind is not listed in the approved lab panels list, please enter the specific test(s) that you want to order. Separate tests should each be entered in separate text boxes.
Should I repeat an answer that I already provided on a previous question within a case?
Each question will be scored separately. Your previous answers will not be taken into account in the scoring of each individual question. If you feel that the option is the appropriate answer to the question, select it again.
How will I know which medical resources are available to me in each case?
For each case, assume all necessary resources are available to you as a generalist physician in the setting described, and answer accordingly.
Can a referral be an appropriate answer to a question?
If the correct plan of action requires a specialty referral and/or consultation, you must specify the appropriate procedure or management steps in addition to the type of specialist.
Why does COMLEX-USA Level 3 have a two-day format?
In September 2018, the COMLEX-USA Level 3 examination changed to a two-day format as part of an overall enhancement of the COMLEX-USA examination series. This was in response to substantive changes in the evolution of osteopathic medical practice and to ensure that COMLEX-USA remains current in meeting the needs of state licensing boards. To read more about the enhanced COMLEX-USA, you can access the COMLEX-USA Master Blueprint.
What is the attestation requirement?
Your residency program director will need to attest to the fact that you are in good academic and professional standing and are approved to take the Level 3 examination. It is recommended that you take the examination after a minimum of six months in residency.
How can I contest my score?
Any candidate who wishes to have their examination results reviewed one extra time may request a score confirmation, for a fee. Please refer to “How do I request a score confirmation?” for additional information.
Why doesn’t the NBOME provide remediation for candidates who fail an examination?
COMLEX-USA is a national standardized licensure examination for the practice of osteopathic medicine. It is an independent assessment of osteopathic medical knowledge, knowledge fluency, clinical skills, and other competencies essential for practice as an osteopathic generalist physician and, as such, does not provide recommendations for remediation. The NBOME is a national testing organization that does not follow any specific osteopathic medical school curriculum. All students are encouraged to reach out to their school for assistance in the remediation process.
Why does it take weeks to receive my scores?
This time is required to ensure accurate, reliable, and valid examination scoring and reporting. Scores are analyzed and checked for accuracy before the scores are released. There may be additional delays that are dependent on candidate testing and other variables that are not within the NBOME’s control.
After I fail an examination, how can I schedule a retake?
Candidates who have failed an examination may retake the examination, with a maximum of four attempts in any 12-month period. To register for an examination, log in to your NBOME Account and navigate to the “Purchase Exams” section. If you have specific questions, call us at 866-479-6828 for assistance with scheduling.
How soon after receiving a failing score can I reschedule my examination?
When rescheduling, be sure to allow adequate time to retake the examination based on your school or residency program requirements. Keep in mind the time required for remediation, rescheduling, and score report release (typically 4-6 weeks for Level 1 and Level 2-CE, and 8-10 weeks for Level 3).
Is there a limit on how many times I can take the COMLEX-USA examination?
Yes. Candidates taking COMLEX-USA examinations are limited to a total of four (4) attempts for each examination. Review the COMLEX-USA Bulletin of Information for details.
Standard Setting
What is standard setting?
Standard setting is a process commonly used by organizations involved with high-stakes testing. The NBOME's standard-setting process ensures that the standards of osteopathic medical licensure assessment reflect current medical education and medical practice.
How often are the standards changed?
The NBOME follows industry-standard best practices in establishing its standard-setting schedule for review of pass/fail standards—typically every 3-5 years.

Click each Level to see its respective previous and future standard setting dates:
How does the NBOME establish the pass/fail standard for COMLEX-USA examinations?
The NBOME applies criterion-referenced methods for establishing cut scores – the score at or above which a candidate is deemed to have passed.

Click each Level for more information:
Why are the standards periodically reviewed and changed?
The NBOME's mission is to protect the public by providing the means to assess competencies for osteopathic medicine and related health care professions. Consistent with our mission, the NBOME periodically reviews and resets pass/fail standards for COMLEX-USA to ensure that the standards of osteopathic medical licensure examinations reflect current medical education and medical practice.
How does the NBOME notify the colleges, students, and other stakeholders about changes to the COMLEX-USA standards?
The NBOME posts updates to its website and social media, sends emails to its stakeholders, and presents at numerous conferences and annual meetings, such as the American Association of Colleges of Osteopathic Medicine’s Educating Leaders conference; the Council of Osteopathic Student Government Presidents, the Assembly of Osteopathic Graduate Medical Educators, the American Osteopathic Association’s Leadership, Education, Advocacy & Development conference, and the American Association of Osteopathic Examiners.

The NBOME is continuously working to improve the effectiveness of our communications regarding standards and other areas that are important to stakeholders. You are welcome to contact us with your feedback.
Does the NBOME monitor the consequences of the new standards?
The NBOME studies test data and their consequences rigorously in a process of continuous quality improvement, ever guided by our mission and mandate to "protect the public."
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