The COMLEX-USA Examination Sequence

Candidates for COMLEX-USA must meet the following requirements as well as the requirements of their college of osteopathic medicine. Examinations must be taken in sequence and each level passed before the candidate is eligible to take the next level.

  • Passing of both COMLEX-USA Level 2-PE & 2-CE
  • Graduated from an accredited college of osteopathic medicine (COM)
  • Has earned a DO degree
  • Attestation by a Program Director that the candidate is in good academic and professional standing


New Eligibility Requirements

Beginning with the 2018-2019 test cycle for the two-day COMLEX-USA Level 3, eligibility will require an attestation from an American Osteopathic Association (AOA) or Accreditation Council for Graduate Medical Education (ACGME) accredited graduate medical education program director that the Level 3 resident/exam candidate is in “good academic and professional standing” meeting the professional requirements of the residency program and is eligible to continue as a resident in the program. In addition, as a recommendation but not a requirement, the NBOME recommends that Level 3 candidates have completed a minimum of six months of residency training prior to testing.

Temporary Alternate Attestation Pathway for COMLEX-USA Level 3

For those candidates who are not in a 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.

Petition Guidelines

Petition for Temporary Alternate Pathway

Reference Materials

Fundamental Osteopathic Medical Competency Domains

Upcoming Changes

COMLEX-USA Master Blueprint Effective 2018


Client Registration System Tutorial

Practice Exams

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