Description of Examinations

About COMLEX-USA

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 based on 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 program is an examination sequence with three levels. This progressive nature of the COMLEX-USA examinations ensures the consistency and continuity of the measurement objectives of the osteopathic medical licensing examinations. A description of the examination blueprints is below, and descriptions of each examination component of the series, including what constitutes a passing score, follows. COMLEX-USA examinations are administered only in the English language. Each COMLEX-USA examination is administered in a standardized, time-measured environment, as the ability to recall, interpret, process, and apply clinical knowledge and skills without hesitation and in a fluid manner (“knowledge fluency”) is fundamental to a generalist osteopathic physician’s competence to practice osteopathic medicine and therefore is one of the fundamental competencies the COMLEX-USA examinations assess. The blueprint contains two dimensions that outline the patient presentations (clinical presentations) and the physician tasks (competency domains). While all examination Levels have a two-dimensional blueprint structure, the depth and emphasis of each Level parallels the educational experiences and the clinical responsibilities of the candidate.

COMLEX-USA Overview and Blueprint: Effective July 2018–May 2019

Purpose	Format	Length
LEVEL 1 · Effective through April 2019
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.	A total of 400 test questions divided into two four-hour sessions Computer-based: administered at Prometric Test Centers	One-day test session: Eight hours
LEVEL 2-CE · Effective through May 2019
LEVEL 2-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.	A total of 400 test questions divided into two four-hour sessions Computer-based: administered at Prometric Test Centers	One-day test session: Eight hours
LEVEL 2-PE · Effective through February 2019
LEVEL 2-PE provides an assessment of fundamental clinical skills. These skills are evaluated in the context of clinical encounters and are required to be personally performed as appropriate in a timely, efficient, safe, and effective manner. The clinical skills tested include: physician-patient communication, interpersonal skills and professionalism, medical history-taking and physical examination skills, osteopathic principles and osteopathic manipulative treatment, and documentation skills (including synthesis of clinical findings, integrated differential diagnosis, and formulation of a diagnostic and treatment plan).	Twelve standardized patient-based cases: 14-minute duration for each patient encounter plus 9 minutes to document findings in an e-SOAP note (Subjective Objective Assessment Plan format). Administered at NBOME National Centers for Clinical Skills Testing in Philadelphia and Chicago.	One-day test session: Seven hours
LEVEL 3
See NEW COMLEX-USA Overview and Blueprint section below.

NEW COMLEX-USA Overview and Master Blueprint: Effective 2018–2019

IMPLEMENTATION OF NEW BLUEPRINT: Based on extensive research and expert consensus, a new two-dimensional COMLEX-USA Master Blueprint has been developed and will be implemented beginning with COMLEX-USA Level 3 in 2018. COMLEX-USA Levels 1 and 2 will implement the new blueprint in 2019. The new master examination blueprint emphasizes the competencies required for generalist physicians to deliver safe and effective osteopathic medical care. The enhanced COMLEX-USA master examination blueprint, beginning with Level 3 in September 2018, features a framework that maps content to competency domains and clinical presentations. COMPETENCY DOMAINS are related sets of foundational abilities representing the required elements and outcomes that define the knowledge, skills, experience, attitudes, values, behaviors, and established professional standards. They constitute a general descriptive framework for the practice of osteopathic medicine. Required elements articulate the essential foundational specifications, including specific, definable knowledge, skills, experiences, attitudes, values, and/or behaviors that make up the standards for the competency domain. Each required element is further delineated by measured outcomes. CLINICAL PRESENTATIONS represent the manner in which a particular patient, group of patients, or community present(s) to osteopathic physicians. These are high-frequency, high-impact categories based on evidence from osteopathic medical practice and are further categorized as topics. Clinical presentations may include, but are not limited to, presentations of patients across all relevant age categories, from special populations, and in varied clinical settings in which patients present for osteopathic medical care.

LEVEL 1 · Assessment of Foundational Biomedical Sciences and Osteopathic Principles and Practice · Effective May 2019

DESCRIPTION A one-day computer-based assessment that integrates the foundational biomedical sciences and osteopathic principles with clinical knowledge and other physician competencies relevant to addressing clinical presentations and promoting health in supervised clinical practice settings. Foundational Biomedical Sciences

• Anatomy
• Behavioral Science
• Biochemistry
• Genetics
• Immunology
• Microbiology
• Osteopathic Principles and Practice
• Pathology
• Pharmacology
• Physiology
• Health Promotion and Disease Prevention

FORMAT

• Two computer-based test sessions taken on one day.
• Administered in a secure, time-measured environment.
• Contains approximately 400 questions related to diverse clinical and patient presentations and 7 defined competency domains for osteopathic medical practice.
• Test questions are single-best answer, multiple-choice format. Also includes test questions involving audio-visual components designed to assess an expanded physician competency subset.
• Examples of test question types in Level 1 are found in the practice exam.

PASSING COMLEX-USA Level 1 indicates that the candidate has demonstrated competence in the foundational biomedical sciences and osteopathic principles and related physician competency domains for osteopathic medical care of patients as required to enter supervised patient care settings and to continue lifelong learning.

LEVEL 2-CE · Assessment of Osteopathic Patient Care and Related Competency Domains · Effective June 2019

DESCRIPTION A one-day computer-based assessment that integrates application of knowledge in clinical and foundational biomedical sciences and osteopathic principles with other physician competencies related to the clinical care of patients and promoting health in supervised clinical settings. These competency domains include application of osteopathic medical knowledge, osteopathic patient care and osteopathic principles and practice, communication, systems-based practice, practice-based learning and improvement, professionalism and ethics. Clinical Sciences Disciplines

• Emergency Medicine
• Family Medicine
• Health Promotion And Disease Prevention
• Internal Medicine
• Neurology
• Obstetrics/Gynecology
• Osteopathic Principles and Practice
• Pediatrics
• Psychiatry
• Surgery

FORMAT

• Two computer-based test sessions taken on one day.
• Administered in a secure, time-measured environment.
• Contains approximately 400 questions related to diverse clinical and patient presentations and 7 competency domains for osteopathic medical practice.
• Test questions are single-best answer, multiple-choice format. Also includes test questions involving audio-visual components designed to assess an expanded physician competency subset.
• Examples of test question types in Level 2-CE are found in the practice exam.

PASSING Level 2-CE indicates that the candidate has demonstrated competence in the clinical sciences and osteopathic principles and related physician competency domains for osteopathic medical care of patients as required to enter into supervised graduate medical education settings and to continue lifelong learning.

LEVEL 2-PE · Assessment of Fundamental Clinical Skills for Osteopathic Medical Practice · Effective March 2019

DESCRIPTION An assessment of fundamental clinical skills evaluated through 12 encounters with standardized patients. Candidates assess problem-centered and health-promotion-centered patient presentations. Each candidate must personally perform the clinical skills with standardized patients as appropriate in a timely, efficient, safe, and effective manner. The examination augments the Level 2-Cognitive Evaluation (Level 2-CE) through an assessment of six fundamental clinical skills for osteopathic medical practice within two scored examination domains: the Humanistic Domain and the Biomedical/Biomechanical Domain. Fundamental Clinical Skills Assessed Humanistic Domain

• Physician-patient Communication
• Interpersonal skills
• Professionalism

Biomedical/Biomechanical Domain

• Medical history-taking and physical examination skills
• Osteopathic principles and osteopathic manipulative treatment (OMT)
• Documentation skills (including synthesis of clinical findings, integrated differential diagnosis, and formulation of a diagnostic and treatment plan)

FORMAT

• See current format descriptions—12 standardized patient based-cases.
• 14-minute duration for each patient encounter plus 9 minutes to document findings in an e-SOAP note (Subjective Objective Assessment Plan format).
• Administered at NBOME National Centers for Clinical Skills Testing in Philadelphia and Chicago.

PASSING Level 2-PE indicates that the candidate has demonstrated competence in the fundamental clinical skills and related physician competency domains for osteopathic medical care of patients as required to enter into supervised graduate medical education settings and to continue lifelong learning.

LEVEL 3 · Assessment of Competencies for Osteopathic Medical Practice · Effective September 2018

DESCRIPTION A two-day computer-based examination assessing 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. Competency domains assessed include application of osteopathic medical knowledge, osteopathic patient care and osteopathic principles and practice, communication, professionalism and ethics. Competency assessment occurs in the context of clinical and patient presentations and systems-based practice as required for entry into the unsupervised practice of osteopathic medicine as an independently practicing osteopathic generalist physician and for readiness for lifelong learning and practice-based learning and improvement. FORMAT

• Four computer-based test sessions of 3.5 hours each taken over two days (two sessions per day).
• Administered on consecutive days (or within a 14-day window) in a secure, time-measured environment.
• Contains approximately 420 questions in the multiple-choice question format (MCQ) and test questions related to approximately 28 clinical decision-making (CDM) cases. These are related to diverse and representative clinical presentations and 7 competency domains for osteopathic medical practice.
• Test questions are predominantly in the single-best answer and multiple-choice formats.
• CDM question formats include extended multiple-choice (selection of more than one answer from an extensive list that may contain more than one correct answer) and constructed response (short-answer) test questions.
• Also includes audio-visual components designed to assess an expanded physician competency subset.
• Examples of test question types in Level 3 are found on the Level 3 page.

PASSING Level 3 indicates that the candidate has demonstrated competence in the foundational competency domains required for generalist physicians to deliver safe and effective osteopathic medical care of patients as required for entry into the unsupervised practice of osteopathic medicine and to continue lifelong learning and practice-based learning and improvement.