COMLEX-USA Examination Format
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COMLEX-USA includes three examination levels assessing fundamental osteopathic medical competencies at different stages of training.
COMLEX USA Level 1 & Level 2-CE
COMLEX-USA Level 1 is a one-day, computer-based assessment that integrates foundational biomedical sciences with other areas of osteopathic medical knowledge relevant to clinical problem-solving and the promotion of health maintenance.
COMLEX-USA Level 2-CE is also a one-day, computer-based assessment. It integrates the application of clinical and foundational biomedical sciences knowledge with other osteopathic physician competencies related to the clinical care of patients and the promotion of health in supervised patient care settings.
Format
- One-day, computer-based test administered in a secure, time-measured environment
- Two timed test sessions of four hours each (eight hours total)
- 352 single-best-answer, multiple-choice questions (note: changing to 320 questions in May 2026 for Level 1 and June 2026 for Level 2-CE)
- Questions based on the competency domains and clinical presentations outlined in the COMLEX-USA Blueprint
- Audiovisual elements (e.g., images, videos, or audio clips) in some questions
- Breaks permitted as outlined in the COMLEX-USA Bulletin of Information
Schedule
(For those testing before April 24, 2026)
| Session | Time | |
|---|---|---|
| MORNING | 4 hours | Total testing time for sections 1-4 |
| Section 1: 44 Questions | ||
| Section 2: 44 Questions | ||
| Scheduled Break | ||
| Section 3: 44 Questions | ||
| Section 4: 44 Questions | ||
| Scheduled Break | ||
| AFTERNOON | 4 hours | Total testing time for sections 5-8 |
| Section 5: 44 Questions | ||
| Section 6: 44 Questions | ||
| Scheduled Break | ||
| Section 7: 44 Questions | ||
| Section 8: 44 Questions |
Schedule
(For those testing after May 7, 2026)
| Session | Time | |
|---|---|---|
| SESSION A | 4 hours | Total testing time for sections 1-4 |
| Section 1: 40 Questions | ||
| Scheduled Break | ||
| Section 2: 40 Questions | ||
| Scheduled Break | ||
| Section 3: 40 Questions | ||
| Scheduled Break | ||
| Section 4: 40 Questions | ||
| Scheduled Break | ||
| SESSION B | 4 hours | Total testing time for sections 5-8 |
| Section 5: 40 Questions | ||
| Scheduled Break | ||
| Section 6: 40 Questions | ||
| Scheduled Break | ||
| Section 7: 40 Questions | ||
| Scheduled Break | ||
| Section 8: 40 Questions |
COMLEX-USA Level 3
COMLEX-USA Level 3 is a two-day, computer-based examination assessing competence in the fundamental competency domains required for generalist osteopathic physicians to deliver safe and effective osteopathic medical care and promote health in unsupervised clinical settings.
The Level 3 examination includes two types of assessment:
- Multiple-choice questions
- Clinical decision-making (CDM) cases
CDM Cases
CDM cases assess the ability to make appropriate patient management decisions as an independently practicing osteopathic physician. The cases assess not only factual knowledge but also the ability to apply knowledge and skills in caring for patients.
Each CDM case presents a clinical scenario followed by a series of two to four questions that focus on key decisions commonly encountered in osteopathic patient care.
CDM cases may assess:
- Data acquisition (e.g., obtaining history or physical exam findings, ordering tests)
- Data interpretation (e.g., generating a diagnosis)
- Treatment and management (e.g., prescribing medication, counseling, planning follow-up care)
Format
- Two-day, computer-based assessment administered within a 14-day window
- Four test sessions of 3.5 hours each, with two sessions per day
- 420 single-best-answer, multiple-choice questions
- 26 CDM cases, each including two to four questions
- CDM responses in extended multiple choice (more than one correct answer may be required) or short answer formats
- Audiovisual elements (e.g., images, videos, or audio clips) with some questions and CDM cases
- Breaks permitted as outlined in the COMLEX-USA Bulletin of Information
Note: The COMLEX-USA Level 3 examination will change to a 1-day examination starting in January 2027.
Schedule
Day 1
| Session | Time | |
|---|---|---|
| MORNING | 3.5 hours | Total testing time for sections 1 and 2 |
| Section 1: 70 MCQ items | ||
| Scheduled Break | ||
| Section 2: 70 MCQ items | ||
| Scheduled Break | ||
| AFTERNOON | 3.5 hours | Total testing time for sections 3 and 4 |
| Section 3: 70 MCQ items | ||
| Scheduled Break | ||
| Section 4: 70 MCQ items |
Day 2
| Session | Time | |
|---|---|---|
| MORNING | 3.5 hours | Total testing time for sections 5 and 6 |
| Section 5: 13 CDM items | ||
| Scheduled Break | ||
| Section 6: 13 CDM items | ||
| Scheduled Break | ||
| AFTERNOON | 3.5 hours | Total testing time for sections 7 and 8 |
| Section 7: 70 MCQ items | ||
| Scheduled Break | ||
| Section 8: 70 MCQ items |
Available Examination Features
Audio-visual Exhibits
Some questions may include audiovisual exhibits that can be accessed using an “Exhibit” button. These may include images, videos, and/or audio content. Multiple exhibits may be associated with a single question.
Headphones will be provided at the testing center. Please test your audio function during the tutorial. If the headphones are not working properly, notify a Test Administrator (TA) immediately.
Examination Review Screen
Each exam section (except for COMLEX-USA Level 3 CDM cases) includes a review screen that displays the status of your responses, including questions that are unanswered or flagged for review.
You may comment on questions and review those notes during the section review. Time spent reviewing questions or adding comments counts toward your total testing time.
Additional Tools
The following tools are available during the examination:
- Standard calculator
- Text highlighting
- Text strikeout
You may adjust the font size and color of the text and screen background during the tutorial or at any time during the examination. These features are demonstrated in the sample questions for each COMLEX-USA Level.
COMLEX-USA Practice Resources
View sample questions and resources to use in advance of taking COMLEX-USA Level 1, Level 2-CE, and Level 3 examinations.
Highlight Functionality
Learn how to use the highlight functionality during a COMLEX-USA examination.
