Enhancing COMLEX-USA

What is the Enhanced COMLEX-USA?

The COMLEX-USA, the licensure examination for osteopathic medical students, has transitioned to a contemporary, two-decision point, competency-based COMLEX-USA blueprint and evidence-based design informed by extensive research on actual osteopathic physician practice, expert consensus, and stakeholder surveys.

The new COMLEX-USA assesses representative measurable outcomes of the seven competency domains and focused on high-frequency clinical presentations or high-impact health issues and clinical presentations that affect patients across the lifespan.


The new COMLEX-USA Master Blueprint began with Level 3 in September 2018. New Blueprint specifications for  Level 1, Level 2-CE and Level 2-PE, were implemented with their new test cycles beginning in 2019.

Two Distinct Dimensions

The assessment focuses on two dimensions that continue to integrate:

It features a framework that maps content to competency domains and clinical presentations.

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

Competency Domains: Dimension 1 Minimum
1 Osteopathic Principles, Practice, and Manipulative Treatment 10%
2 Osteopathic Patient Care and Procedural Skills 25%
3 Application of Knowledge for Osteopathic Medical Practice 30%
4 Practice-Based Learning and Improvement in the Practice of Osteopathic Medicine 5%
5 Interpersonal and Communication Skills in the Practice of Osteopathic Medicine 10%
6 Professionalism in the Practice of Osteopathic Medicine 5%
7 Systems-Based Practice in Osteopathic Medicine 5%

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

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