NBOME
COMLEX-USA BULLETIN of INFORMATION

COMLEX-USA Eligibility

Requirements

A candidate must meet the requirements outlined below. Examinations must be taken in sequence and each level passed before the candidate is eligible to take the next level. COMLEX-USA Level 2-CE and Level 2-PE may be taken in any order, but both parts of COMLEX-USA Level 2 must be passed to qualify for COMLEX-USA Level 3.
 

Prerequisites

COMLEX-USA Level 1

  • Completion of the first year of study at an accredited COM1
  • Attestation by the COM that the candidate is in good academic and professional standing2

COMLEX-USA Level 2-CE

  • Passing of COMLEX-USA Level 1
  • Completion of the second year of study at an accredited COM1
  • Attestation by the COM that the candidate is in good academic and professional standing2

COMLEX-USA Level 2-PE

  • Passing of COMLEX-USA Level 1
  • Completion of the second year of study at an accredited COM1
  • Attestation by the COM that the candidate is in good academic and professional standing2

COMLEX-USA Level 3

  • Passing of both COMLEX-USA Level 2-CE and Level 2-PE
  • Graduation from an accredited COM1
  • Has earned a DO degree
  • Attestation by a program director3,4 that the candidate is in good academic and professional standing2

1 An accredited COM is a college of osteopathic medicine (COM) accredited by the American Osteopathic Association (AOA) Commission on Osteopathic College Accreditation (COCA).

2 “Good academic and professional standing” denotes that the candidate meets the academic and professional requirements of the college of osteopathic medicine or residency program and is eligible to continue as a student or resident in the program.

3 Individual who meets the requirements and qualifications as deemed by the AOA or ACGME as the director of a residency program and designated with authority and accountability for the operation of a residency/fellowship program.

4 Candidates not in a residency program, refer to Temporary Alternate Attestation pathway below.

VERIFICATION: All levels require the COM dean’s office to confirm eligibility requirements are met.

NOTE: Attestation by a residency program director that a candidate is in good academic and professional standing in an AOA- or ACGME-accredited residency program will be required for Level 3 eligibility. This attestation does not expire unless rescinded by the program director and is good for up to the six-attempt limit and four attempts in any 12-month period. An attestation can be provided by a program director up to six months after a candidate leaves or graduates from a program.

NBOME recommends but does not require that a candidate has completed six months in a residency program prior to taking the Level 3 examination.

Beginning with the 2019-2020 test cycles, eligibility for the COMLEX-USA Level 1, Level 2-CE or Level 2-PE will require an attestation from an AOA COCA-accredited COM dean that an osteopathic medical student is in “good academic and professional standing.

Temporary Alternate Attestation Pathway
For those candidates who have never participated in any residency program and therefore unable to attain a residency program director attestation, NBOME has created a temporary alternate pathway. The NBOME will accept a request from a dean of a college of osteopathic medicine for a temporary alternate pathway for COMLEX-USA Level 3 attestation. The dean will attest to the candidate’s good academic and professional standing based on the conditions outlined in the petition guidelines. Read the petition guidelines and download the petition form.

Grandfathered Attestation
For candidates who graduated in 2017 or earlier the NBOME has created a “grandfathered” attestation for Level 3 eligibility. Candidates must have been previously eligible to take the COMLEX-USA Level 3 examination, request to waive the residency program director attestation and did or did not participate in in a residency program. This grandfathered eligibility attestation includes all requirements for other attestations such as multiple attempts up to our six attempt limit and a limit of four attempts in any twelve month period.

Additional Information

All candidates must:

  • Establish or maintain an online account with NBOME (see also Registration and Scheduling).
  • Agree to the Terms and Conditions described above.
  • Provide proof of identity at the time of the examination (see also Examination Administration).
  • Understand and agree that no candidate may take any Level examination for practice or to improve his or her score for any purpose other than to pass a previously failed examination or an examination where the score has been voided.

Sequence of Examinations

COMLEX-USA is a three-level examination sequence that must be taken in order as follows. All eligibility requirements are outlined above.

Examination Sequence

In order to take A candidate
COMLEX-USA LEVEL 1 Must meet all eligibility requirements to begin the examination sequence
COMLEX-USA LEVEL 2
Level 2-CE or Level 2-PE
Must meet all eligibility requirements and have taken and passed COMLEX-USA Level 1
COMLEX-USA LEVEL 3 Must meet all eligibility requirements and have taken and passed
COMLEX-USA Level 1, Level 2-CE and Level 2-PE

OUT-OF-SEQUENCE ADMINISTRATION OF COMLEX-USA LEVEL 2-PE

At the sole discretion of NBOME’s Vice President for Clinical Skills Testing, an Out-of-Sequence Administration of COMLEX-USA Level 2-PE Exception for a candidate who has graduated from an AOA COCA-accredited osteopathic medical school and successfully completed COMLEX-USA Level 3 (or its equivalent) may be administered provided all of the following criteria are met:

  • A state licensing board or jurisdiction, either domestic or international, that issues licenses to practice medicine (“Medical Licensing Agency”), provides a written request to the NBOME to administer the COMLEX-USA Level 2-PE examination out of sequence to the candidate;
  • The candidate and Medical Licensing Agency accept as final the NBOME’s standard pass/fail decision for the COMLEX-USA Level 2-PE examination, which is intended to assess the clinical skills and osteopathic principles required to solve clinical problems for entry into graduate medical education;
  • And the candidate agrees to indemnify and hold harmless the NBOME, including reasonable attorneys’ fees and costs, arising out of or relating to administration of the COMLEX-USA Level 2-PE examination.

If the NBOME approves the Medical Licensing Agency’s request to administer the COMLEX-USA Level 2-PE examination to a candidate out of sequence, the candidate must register and schedule to take the examination and pay the appropriate registration fee(s) as required by the NBOME. The candidate may not register for or schedule an out-of-sequence COMLEX-USA Level 2-PE examination until the candidate is notified by the NBOME that the Medical Licensing Agency’s request has been approved by the NBOME. The NBOME will provide the score and other related information directly to the Medical Licensing Agency and, if requested by the Medical Licensing Agency, to the candidate.

Retaking An Examination

If a Candidate’s Score Levels 1, 2-CE AND 3 Level 2-PE
IS PASSING Candidate is not permitted to retake examination to improve his or her score
IS FAILING Candidate may retake examination a maximum of four times in any 12-month period Candidate may retake examination a maximum of three times in any 12-month period
IS NOT REPORTED Candidate may retake
examination a maximum of four
times in any 12-month period
Candidate may retake
examination a maximum of three
times in any 12-month period

LIMITED NUMBER OF ATTEMPTS

Candidates taking COMLEX-USA examinations are limited to a total of six (6) attempts for each examination.

EXCEPTION TO SIX-ATTEMPT LIMIT

The only consideration for an exception to this policy for one additional attempt beyond the six-attempt limit is at the explicit request of a Medical Licensing Agency.

For NBOME to waive the limitation of a maximum of six attempts for any COMLEX-USA examination, candidates are required to:

  • Obtain a written petition for waiver from a Medical Licensing Agency;
  • And for Level 1, Level 2-CE and Level 2-PE, must submit written documentation from the COM confirming the candidate’s good academic and professional standing.

CHANGE IN ELIGIBILITY STATUS

If a candidate becomes ineligible before administration of an examination

  • The candidate may not take examination.
  • The candidate is required to promptly notify NBOME in writing via email of ineligibility to clientservices@nbome.org
  • If NBOME is notified that the candidate is ineligible for any reason and the examination was administered, the examination will not be scored. If the examination was administered and the examination was scored and released, the score will be voided. The NBOME transcript will reflect the test administration with no score, and the candidate’s record may be annotated as “Other.”
  • If irregular conduct occurred, a candidate’s record and NBOME transcript may be annotated with this information. See also “Irregular Conduct.”

To request a refund if the candidate becomes ineligible after the administration, the candidate must

  • Provide a written explanation satisfactory to NBOME, within 30 days of the date notified ineligible to take the examination.
  • At NBOME’s discretion, all or a portion of exam fees paid may be refunded.
  • Fees outlined in “Candidate Rescheduled, Canceled, or Missed Scheduled Examinations” apply.
  • If not in compliance with the terms herein, all fees paid by or for the candidate will be forfeited.
  • Please contact NBOME Client Services (clientservices@nbome.org) should you have questions about reimbursement for testing fees, rescheduling fees or related travel expenses.
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