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Comprehensive Osteopathic Medical Licensing Examination

Level 2 Performance Evaluation


For case selection, Level 2-PE applies the Dimension I categories from the COMLEX-USA blueprint. The content (case selection) of Level 2-PE is crossed with the following axes:

Patient Presentation Axis

Standardized patients present in simulated ambulatory medical settings with problems and symptoms that are either acute, chronic, or provide opportunities for health promotion and disease prevention. In addition, the patients encountered are balanced to meet the examination specifications for patient gender and age as a reflection of national osteopathic physician practice patterns based on national survey data as well as expert judgment. The demographic and cultural profiles of patients are instrumental considerations in the case development process.

Osteopathic Medical Practice Axis

In any examination form, the following clinical skills are evaluated in the majority of the standardized patient encounters

Biomedical/Biomechanical Domain

Humanistic Domain

Successful passage of the two distinctive domains is required to pass COMLEX-USA Level 2-PE.

Clinical Content Axis

Based on Dimension I of the COMLEX-USA blueprint, expert judgment, and national survey data of osteopathic physician practice patterns, candidates will encounter standardized patients presenting with the symptoms, problems, or complaints that are common to primary care osteopathic medical practice. These include:

The COMLEX-USA Level 2-Performance Evaluation (PE) is a one-day examination of clinical skills where each candidate encounters 12 standardized patients over the course of a seven-hour examination day. The examination is administered at the NBOME National Center for Clinical Skills Testing locations in Philadelphia and Chicago.

Examination design, test specifications, test format and other details are available in the Orientation Guide for COMLEX-USA Level 2-PE on the NBOME’s website. A DVD Instructional Program on COMLEX-USA Level 2-PE has been provided to the Office of the Dean at each of the colleges of osteopathic medicine, and is also available for viewing on NBOME’s website.

The COMLEX-USA Level 2-PE (Performance Evaluation) augments the written COMLEX-USA Level 2-CE of osteopathic medical knowledge by providing an assessment of fundamental clinical skills. These 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).

These patient-centered skills are evaluated in the context of clinical encounters with standardized patients each for a maximum 14-minute duration, and are required to be personally performed as appropriate in a timely, efficient, safe, and effective manner within the 14-minute time period, a limited time period that may be critical to a patient’s health. After each encounter, the candidate is required to document the encounter using a SOAP note format. Candidates have an additional nine minutes for this task, and are required to use computer keyboard entry to complete the eSOAP note.

The COMLEX-USA Level 2-PE examination assesses the ability of the candidate to interact with patients who vary in age, gender, ethnicity and cultural backgrounds, and includes clinical presentations of a variety of patients that could be acute, chronic or opportunities for health promotion and disease prevention. This diversity of standardized patients is essential to the construct of the examination. Therefore, the 14-minute patient encounter time period and the standardized patient mix encountered during the examination cannot be altered, as this would fundamentally alter the assessment of the clinical skills being assessed by the COMLEX-USA Level 2-PE examination.

The ability to communicate in the English language is required in each clinical encounter.


COMLEX-USA Level 2-PE/Clinical Skills Examination Scoring

Detailed information regarding examination scoring for COMLEX-USA Level 2-PE is available in the Orientation Guide that is on the website. Scoring is criterion-based and reported as Pass or Fail only. Successfully passing the two distinctive domains is required to pass COMLEX-USA Level 2-PE. These include the Humanistic Domain, which is a measure of physician-patient communication, interpersonal skills, and professionalism, as well as the Biomedical/Biomechanical Domain, which includes history-taking, physical examination, osteopathic principles and osteopathic manipulative treatment, written communication (synthesis of clinical findings in a SOAP Note format), integrated differential diagnosis, and clinical problem-solving. Candidates who are unsuccessful in meeting the passing standards for either domain are provided further feedback on their score reports as to relative areas of strengths and weaknesses.

Score Reports

COMLEX-USA Level 2-PE score reports will be available to the candidate and the dean of the candidate’s school approximately 8-10 weeks from the date of the examination, but may be subject to additional delays that are contingent upon candidate scheduling and other variables. Candidates and Deans will receive an email notifying them that score reports are available through the NBOME’s secure Client Registration System. Score reports can be accessed through the CRS using a unique candidate identifier and passcode. Deans (and their administrative representatives) may access this information for their students, as well as confirm test session dates using a secure school page of the system. Deans also receive aggregate score information for their students on an annual basis.

In July 2012, the NBOME began to make COMLEX-USA Level 2-PE score reports available online through the CRS. (Prior to that time, score reports were mailed.) Score reports provided in this manner remain available for printing from the CRS at the candidates’ convenience. For those needing a duplicate score report for an examination completed before implementation of electronic score reporting, please send a written request to NBOME Client Services at the NBOME Corporate Offices & Conference Center: 8765 W. Higgins Rd Suite 200, Chicago, IL 60631-4174. Candidates should allow 10 business days for delivery. Please note a copy of the score report is not the same as an official transcript. If a certified transcript is needed (e.g., to be sent to a third party), please refer to the guidance in the COMLEX-USA Bulletin of Information under Section VIII. Certified Transcripts. Appropriate fees as determined by the NBOME will apply.

Score Confirmation/Verification

Prior to releasing score reports, the NBOME conducts a thorough process of quality assurance to ensure that all candidate scores are accurate. However, a candidate who wishes for his or her scores to be rechecked may submit a written request for score confirmation/verification with the accompanying $50 fee.

For the COMLEX-USA Level 2-PE examination, score confirmation involves confirmation of the numerical aspects that make up the scores and pass-fail decisions, but does not include further review or re-scoring of the recorded performances or the eSOAP notes. Requests for score confirmation for COMLEX-USA Level 2-PE must be submitted directly to the NBOME through the website within 120 days of the examination date and must include the fee for score confirmation.