Myths and Misconceptions: COMLEX-USA Level 1 Pass/Fail Score Reporting

As of May 10, 2022, candidates who take COMLEX-USA Level 1 will no longer receive a 3-digit numeric score and will receive a pass/fail designation with a formative performance profile. The Level 1 examination’s validity, reliability, and fairness are not impacted.

Misconception: Without a score, I won’t know how I performed in subject areas.

Candidates will be able to access a formative performance profile (updated June 27) in addition to their Level 1 pass/fail result. This profile will provide information on a candidate’s performance in the content areas of the COMLEX-USA blueprint (Competency Domains and Clinical Presentations) as compared with the national mean performance of candidates who have taken Level 1 for the first time. This information is provided for the purposes of continuous professional development and lifelong learning for the candidate. We have gathered feedback from student stakeholder groups and undergraduate medical educators who wanted to have this information for professional development; however, this information is not shared with residency program directors or on candidate transcripts.

Myth: COMLEX-USA Level 2-CE numeric scores will be more impactful to residency applications than Level 1 pass/fail designations.

Test scores should be just one component of an osteopathic medical student’s residency application. The NBOME supports holistic review of residency applicants as recommended by The Coalition for Physician Accountability Undergraduate Medical Education-Graduate Medical Education Review Committee. Things like MSPE (“dean’s letters”), letters of recommendation, commitment to specialty, professionalism and ethics, leadership qualities, other professional and research experiences, and performance on audition rotations all are highly regarded by program directors and are important for well-rounded application and holistic evaluation.

Misconception: The difficulty of COMLEX-USA Level 1 will change because of the transition to pass/fail score reporting.

The score required to pass the Level 1 examination will not change with pass/fail score reporting. There have been no changes to the examination blueprint, timing, or score needed to pass.

The passing standard for Level 1 is set through a process called Standard Setting. The Level 1 passing standard has not been changed this year, and is scheduled for review in 2024.

Myth: I don’t need to prepare as much for COMLEX-USA Level 1 because score reporting has transitioned to pass/fail.

COMLEX-USA Level 1 continues to be a high-stakes licensure examination that assesses competency in the foundational biomedical sciences and osteopathic principles necessary for osteopathic medical care of patients. We encourage candidates to ensure preparedness prior to taking the examination by following their COM’s curriculum and guidance, fully engaging in the COM’s curricular program leading to the DO degree. Use of the practice exams provided on the NBOME website, along with WelCOM and COMSAE, may also be useful.

Myth: COMLEX-USA Level 1 score reporting transitioned to pass/fail because USMLE Step 1 score reporting did.

We contemplated this transition for many years and actively participated in review and debate across the house of medicine on holistic review and student and resident wellness and opportunities to improve the system.  We conducted research and a literature review to inform this change and also considered input from various stakeholders–including organizations representing the medical licensure community, undergraduate and medical education organizations, accreditation authorities, and students and residents.

Transitioning Level 1 score reporting to pass/fail was thought by most to be an effective way to reduce student stress, especially during residency application. A study published in Medical Education Online found that performance pressure on examinations was one of the greatest stressors reported by participants. Interestingly, stress levels often peaked during the second year of medical school, which is the year in which Level 1 is typically taken. The study concludes that changing to a pass/fail grading system has demonstrated improvements in student wellbeing, as also shown by other studies.

For any other questions related to pass/fail, please see our list of FAQs, or email clientservices@nbome.org.