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The COMLEX-USA examination series is designed to assess osteopathic medical knowledge, fundamental clinical skills, and other foundational competencies considered essential for the practice of osteopathic medicine. The primary and intended purpose of COMLEX-USA is for licensure of osteopathic physicians, and COMLEX-USA is accepted for medical licensure in all 50 states and US territories.

The master examination blueprint emphasizes the competencies required for generalist physicians to deliver safe and effective osteopathic medical care. The foundation of COMLEX-USA is the osteopathic approach to patient care. Its evidence-based design assures state licensing boards and the public that a DO has demonstrated minimal competence by passing a series of national standardized examinations designed for the practice of osteopathic medicine. Aligned with the education and training pathway of a DO, passing Levels 1 and 2-CE of COMLEX-USA is required for graduation with a DO degree and entry into residency training.

In the years since its implementation, the COMLEX-USA blueprint has been reviewed and revised regularly to reflect the practice of osteopathic medicine, consistent with the recommendations of the Standards for Educational and Psychological Testing 2014 established by the American Educational Research Association (AERA), the American Psychological Association (APA), and the National Council on Measurement in Education (NCME). The design of COMLEX-USA has transitioned from its initial conjunctive, discipline-based content organization in 1995 to today’s innovative blueprint.

The current COMLEX-USA master examination blueprint, implemented beginning with Level 3 in September 2018, features a framework that maps content to competency domains and clinical presentations. The master blueprint and test specifications for each exam were then introduced into Level 1, Level 2-PE, and Level 2-CE with the test cycles beginning in 2019.

Further information on the development of the COMLEX-USA master examination blueprint is described in “Evidence-Based Redesign of the COMLEX-USA Series” (John R. Gimpel, DO, MEd; Dorothy Horber, PhD; Jeanne M. Sandella, DO; Janice A. Knebl, DO; John E. Thornburg, DO, PhD), The Journal of the American Osteopathic Association, April 2017, Vol. 117, pp. 253–261. doi:10.7556/jaoa.2017.043.


Foundation for COMLEX-USA

Osteopathic principles and practice continue to form the foundation of COMLEX-USA within both of its dimensions.

Tenets of Osteopathic Medicine

arrow_forward The body is a unit; the person is a unit of body, mind, and spirit.
arrow_forward The body is capable of self-regulation, self-healing, and health maintenance.
arrow_forward Structure and function are reciprocally interrelated.
arrow_forward Rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function.


Two Distinct Dimensions

COMLEX-USA test content is organized by two dimensions:
Dimension 1, Competency Domains and Dimension 2, Clinical Presentations.


Master Blueprint Schematic


Licensure Assessment Aligned With Medical Education Pathway

Candidates will be required to demonstrate minimal competency across each of the seven competency domains. The outline for implementation of the two-decision-point, competency-based COMLEX-USA Master Examination Blueprint is depicted here:

COMLEX-USA Examination Program
Level 1 Level 2-CE Level 2-PE* Level 3
Assessment Purpose
Successful promotion along licensure pathway for entry into graduate medical education: “supervised practice” Successful promotion in graduate medical education for licensure: “unsupervised practice”
Decision Point
1 1 1 2
One-day computer-based examination consisting of 352 multiple-choice test questions One-day computer-based examination consisting of 352 predominantly multiple-choice test questions One-day 12-station standardized patient-based performance evaluation of fundamental clinical skills Two-day computer-based examination consisting of 420 multiple-choice test questions, clinical decision-making cases, and other novel test item formats (approx. 26 additional clinical cases)

* Please note that the Level 2-PE has been discontinued. For Level 3 eligibility pathways and details, please visit this page.


Test Specification Percentages for Each Examination


Dimension 1: Competency Domains Level 1 Level 2-CE Level 2-PE+
Level 3 Series Min.
1 Osteopathic Principles, Practice, and Manipulative Treatment 12% 10% 0% · 15% 10% 10%
2 Osteopathic Patient Care and Procedural Skills 6% 30% 0% · 25% 40% 25%
3 Application of Knowledge for Osteopathic Medical Practice 60% 26% 0% · 15% 15% 30%
3.1 Foundational Biomedical Sciences Knowledge Base 75% 25% 10%
4 Practice-Based Learning and Improvement in Osteopathic Medical Practice 4% 7% 0% · 5% 8% 5%
5 Interpersonal and Communication Skills in the Practice of Osteopathic Medicine 3% 5% 60% · 20% 5% 10%
6 Professionalism in the Practice of Osteopathic Medicine 3% 7% 30% · 5% 6% 5%
7 Systems-Based Practice in Osteopathic Medicine 2% 5% 0% · 5% 6% 5%

+ For the classes of 2020-2025, Level 2-PE is substituted with attestation by the COM Dean that a candidate has graduated and demonstrated the fundamental osteopathic clinical skills necessary for graduation.
* HUM: Humanistic Domain | BM/BM: Biomedical/Biomechanical Domain


Dimension 2: Clinical Presentations Level 1 Level 2-CE Level 2-PE Level 3 Series Min.
1 Community Health and Patient Presentations Related to Wellness 12% 12% 14% 12% 12%
2 Human Development, Reproduction, and Sexuality 5% 5% 5% 5%
3 Endocrine System and Metabolism 5% 5% 5% 5%
4 Nervous System and Mental Health 10% 10% 14% 10% 10%
5 Musculoskeletal System 13% 13% 14% 13% 13%
6 Genitourinary/Renal System and Breasts 5% 5% 5% 5%
7 Gastrointestinal System and Nutritional Health 10% 10% 14% 10% 10%
8 Circulatory and Hematologic Systems 10% 10% 14% 10% 10%
9 Respiratory System 10% 10% 14% 10% 10%
10 Integumentary System 5% 5% 5% 5%