COMSAE · Phase 3

The COMSAE Phase 3 examination uses content, scoring, and reporting similar to the corresponding COMLEX-USA Level 3 examination.

NOTE: COMSAE Phase 3 does not include Clinical Decision-Making (CDM) cases. Please refer to the CDM Practice Exam for sample structure and content.

Evaluation Components

Please note that the COMSAE Phase 3 examination does not include any COVID-19 questions at this time due to the rapidly changing nature of the information.

The content of COMSAE Phase 3 is defined by the same seven categories as the COMLEX-USA content outline for Dimension 1 – Competency Domains and the same ten categories for Dimension 2 – Clinical Presentations.

Dimension 1 of the COMLEX-USA blueprint consists of seven Competency Domains—related sets of foundational abilities representing the required elements and outcomes that define osteopathic knowledge, skills, experience, attitudes, values, behaviors, and established professional standards.

Dimension 1: Competency Domains Minimum % Level 3
1 Osteopathic Principles, Practice, and Manipulative Treatment 10%
2 Osteopathic Patient Care and Procedural Skills 40%
3 Application of Knowledge for Osteopathic Medical Practice 17%
3.1 Foundational Biomedical Sciences Knowledge Base 10%
4 Practice-Based Learning and Improvement in Osteopathic Medical Practice 8%
5 Interpersonal and Communication Skills in the Practice of Osteopathic Medicine 3%
6 Professionalism in the Practice of Osteopathic Medicine 6%
7 Systems-Based Practice in Osteopathic Medicine 6%

Dimension 2 consists of 10 Clinical Presentations, which represent the manner in which a particular patient, group of patients, or a community presents for osteopathic medical care.

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

Not only are items in the COMSAE Phase 3 examinations classified by competency domain and clinical presentation, but they are also classified according to discipline, as shown below:

Medical Discipline
Emergency Medicine
Family Medicine
Internal Medicine
Obstetrics & Gynecology
Osteopathic Principles and Practice
Scoring & Reporting

After completing an exam, candidates will receive a Score Report and Performance Profile which provides a numerical standard score for the total test and a graphic presentation for performance on three groups of content areas.

Score Report

The COMSAE report consists of a three-digit numerical score for the total test and a graphic representation of performance by content area. COMSAE does not involve a numerical minimum passing score. Instead, based on standard scores, it provides the following three suggested performance levels:

Standard ScorePerformance Level
Lower than 350Lower Performance
350 – 649Average Performance
Higher than 649Higher Performance

When using the performance profile to assess strengths and weaknesses, examinees should be aware that information provided in content areas consisting of relatively few questions may be less reliable than information provided in content areas with a larger number of questions. Therefore, it is possible that some subtest score patterns are not precisely aligned with a candidate’s numerical score for the total test. COMSAE should not be used to predict performance on the COMLEX-USA cognitive examinations.

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