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Blueprint · COMLEX-USA Level 3

Required Knowledge & Content for COMLEX-USA Level 3 Examination

The COMLEX-USA examination series is designed to assess the osteopathic medical knowledge and fundamental clinical skills considered essential for osteopathic generalist physicians to practice osteopathic medicine. COMLEX-USA is constructed in the context of clinical problem-solving that involves “Competency Domains” and “Clinical Presentations.”

Two Distinct Dimensions

The assessment focuses on two dimensions that continue to integrate:

Dimension 1 of the COMLEX-USA blueprint consists of seven competency domains, which represent the related sets of foundational abilities representing the required elements and outcomes that define knowledge, skills, experience, attitudes, values, behaviors, and established professional standards.

Dimension 1: Competency Domains Minimum % Level 3
1 Osteopathic Principles, Practice, and Manipulative Treatment 10%
2 Osteopathic Patient Care and Procedural Skills 40%
3 Application of Knowledge for Osteopathic Medical Practice 17%*
3.1 Foundational Biomedical Sciences Knowledge Base 10%
4 Practice-Based Learning and Improvement in Osteopathic Medical Practice 8%
5 Interpersonal and Communication Skills in the Practice of Osteopathic Medicine 3%**
6 Professionalism in the Practice of Osteopathic Medicine 6%
7 Systems-Based Practice in Osteopathic Medicine 6%

* will change to 15% at start of 2024 testing cycle on January 17, 2024

** will change to 5% at start of 2024 testing cycle on January 17, 2024


Dimension 2 consists of 10 clinical presentations, which represent the manner in which a particular patient, group of patients, or community present for osteopathic medical care.

Dimension 2: Clinical Presentations Minimum
% Level 3
1 Community Health and Patient Presentations Related to Wellness 12%
2 Human Development, Reproduction, and Sexuality 5%
3 Endocrine System and Metabolism 5%
4 Nervous System and Mental Health 10%
5 Musculoskeletal System 13%
6 Genitourinary/Renal System and Breasts 5%
7 Gastrointestinal System and Nutritional Health 10%
8 Circulatory and Hematologic Systems 10%
9 Respiratory System 10%
10 Integumentary System 5%
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