Examination Format

COMLEX-USA Computer-Based Examinations

The COMLEX-USA Level 3 examination consists of 420 multiple-choice questions (MCQs) with a single best answer and 26 Clinical Decision-Making (CDM) cases. The examination occurs over two days and is divided into two 3.5-hour sessions per day.

Candidates will receive a pool of 60 minutes of break time per day, which can be used over three scheduled breaks between sessions. Candidates may use as much or as little break time as they feel necessary during any given scheduled optional break. Use of these optional breaks does not reduce candidates’ available testing time. Please note that if the entire amount of pooled break time (60 minutes) is exhausted before the end of the examination day, any time spent on subsequent breaks will decrease available remaining examination time.

Any additional break time that may be provided to a candidate as an accommodation under the Americans with Disabilities Act is not covered within this section, as separate instructions for the utilization of those breaks are provided to those candidates on an individual basis.

The COMLEX-USA examinations are administered only in the English language in a standardized, time-measured environment to assess the candidate’s ability to interpret, process, and apply clinical knowledge and skills with fluency.

What Are CDM cases?

COMLEX-USA Level 3 includes two sections containing CDM cases. The cases assess the ability to make appropriate patient management decisions as an independently practicing osteopathic generalist physician. The cases are meant to assess not only factual knowledge but also the ability to apply knowledge and skills in caring for patients. This ability is especially important in the Level 3 examination because it is the pathway to licensure for osteopathic generalist physicians to practice in an unsupervised setting.

The CDM portion of the examination contains a series of clinical scenarios, each typically followed by two to four questions. The cases focus on key, critical decisions or challenges related to patient care that are routinely faced by osteopathic generalist physicians. CDM 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, planning follow-up care).

A CDM exam tutorial and a practice examination with sample cases can be found on the Practice & Preparation page.

 

COMLEX-USA Two-Day Level 3 Outline

DAY 1	Session	Time
	MORNING	3.5 Hours	Total testing time for sections 1 and 2
	Tutorial/instructions - standard	14 minutes
	Section 1: 70 MCQ items
	Break #1	Optional, deducted from pooled break time
	Section 2: 70 MCQ items
	Break #2	Optional, deducted from pooled break time
	AFTERNOON	3.5 Hours	Total testing time for sections 3 and 4
	Section 3: 70 MCQ items
	Break #3	Optional, deducted from pooled break time
	Section 4: 70 MCQ items

 

DAY 2	Session	Time
	MORNING	3.5 Hours	Total testing time for sections 5 and 6
	Tutorial/instructions - standard	14 minutes
	Section 5: 13 CDM cases
	Break #1	Optional, deducted from pooled break time
	Section 6: 13 CDM cases
	Break #2	Optional, deducted from pooled break time
	AFTERNOON	3.5 Hours	Total testing time for sections 7 and 8
	Section 7: 70 MCQ items
	Break #3	Optional, deducted from pooled break time
	Section 8: 70 MCQ items

Available Examination Features

Multiple Choice Question (MCQ) Section Review Screen
A review page is presented for each MCQ section. This provides candidates with information about the status of the MCQs in the current section, which includes questions completed, questions marked for further review, and questions left incomplete (i.e., no answer is given).

Advancing Through Examination Sections

Once a section is completed, the candidate cannot return to review or change any answers within that section.

Time Limitations

Although each session is 3.5 hours in length, the individual sections within a session are self-paced. A clock is provided to assist with time management. Warnings are given of the time remaining before the end of each 3.5-hour session.

Examination Visual References

Use of an “Exhibit” button may be required in order to see graphic materials related to a test question. These exhibits consist of images, videos, or audio avatars. In some cases, multiple exhibits may be used in order to answer a question.

Additional Tools

Functional features are available, including a standard calculator and laboratory values with reference ranges (where applicable) embedded directly into exam questions.