The COMLEX-USA Examination Sequence

Candidates for COMLEX-USA must meet the following requirements as well as the requirements of their college of osteopathic medicine. Examinations must be taken in sequence and each level passed before the candidate is eligible to take the next level.

  • Passing of both COMLEX-USA Level 2-PE & 2-CE
  • Graduated from an accredited college of osteopathic medicine (COM)
  • Has earned a DO degree
  • Attestation by a Program Director that the candidate is in good academic and professional standing


Eligibility Requirements

Eligibility will require an attestation from an Accreditation Council for Graduate Medical Education (ACGME)-accredited graduate medical education program director that the Level 3 resident/exam candidate is in “good academic and professional standing” meeting the professional requirements of the residency program and is eligible to continue as a resident in the program. In addition, as a recommendation but not a requirement, the NBOME recommends that Level 3 candidates have completed a minimum of six months of residency training prior to testing.

Temporary Alternate Pathway Attestation for COMLEX-USA Level 3

For those candidates who have never participated 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. The dean will attest to the candidate’s good academic and professional standing based on the conditions outlined below.

Guidelines and Petition for Temporary Alternate Pathway

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.

Guidelines and Petition for 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 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.

Reference Materials

Fundamental Osteopathic Medical Competency Domains


Client Registration System Tutorial


Candidate Assistance Program: Rescheduling Fee Waivers

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