The COMLEX-USA examination series is designed to assess osteopathic medical knowledge, fundamental
clinical skills, and other foundational competencies considered essential for the practice of osteopathic
medicine. The primary and intended purpose of COMLEX-USA is for licensure of osteopathic physicians, and
COMLEX-USA is accepted for medical licensure in all US states and jurisdictions.

The master examination blueprint emphasizes the competences required for generalist physicians to deliver
safe and effective osteopathic medical care. The framework of COMLEX-USA is based on the foundation of
the osteopathic approach to patient care. Its evidence-based design assures state licensing boards and the
public that a DO has demonstrated minimal competence by passing a series of national standardized
examinations designed for the practice of osteopathic medicine. Aligned with the education and training
pathway of a DO, passing Levels 1 and 2 of COMLEX-USA is also an accreditation standard for graduation
with a DO degree and required for entry into residency training.

In the years since its implementation, the COMLEX-USA blueprint has been reviewed and revised regularly to
reflect the practice of osteopathic medicine, consistent with the recommendations of the Standards for
Educational and Psychological Testing 2014 established by the American Educational Research Association
(AERA), the American Psychological Association (APA), and the National Council on Measurement in
Education (NCME). The design of COMLEX-USA has transitioned from its initial conjunctive, discipline-based
content organization in 1995 to today’s innovative blueprint that aligns content with patient presentations and physician tasks. The addition of a clinical skills/performance evaluation component, COMLEX-USA Level 2-
PE, augmented the COMLEX-USA series in 2004.

The new COMLEX-USA master examination blueprint, targeted for implementation beginning with Level 3 in
September 2018, features a framework that maps content to competency domains and clinical
presentations. This new master blueprint and test specifications for each exam will then be introduced into
Level 1, Level 2-PE, and Level 2-CE with the new test cycles beginning in 2019.

Further information on the development of the new COMLEX-USA master examination blueprint is described in “Evidence-Based
Redesign of the COMLEX-USA Series” (John R. Gimpel, DO, MEd; Dorothy Horber, PhD; Jeanne M.
Sandella, DO; Janice A. Knebl, DO; John E. Thornburg, DO, PhD), The Journal of the American Osteopathic
Association, April 2017, Vol. 117, pp. 253–261. doi:10.7556/jaoa.2017.043.


Foundation for COMLEX-USA

The foundation of COMLEX-USA and both dimensions continues to be osteopathic principles and practice.

Tenets of Osteopathic Medicine

arrow_forward The body is a unit; the person is a unit of body, mind, and spirit.
arrow_forward The body is capable of self-regulation, self-healing, and health maintenance.
arrow_forward Structure and function are reciprocally interrelated.
arrow_forward Rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the
interrelationship of structure and function.


Two Distinct Dimensions

COMLEX-USA test content is organized by two dimensions,
Dimension 1, Competency Domains and
Dimension 2, Clinical Presentations.

Dimension 1 · Competency Domains

Dimension 1 of the new COMLEX-USA master examination blueprint consists of the 7 COMPETENCY
DOMAINS, the related sets of foundational abilities representing the required elements and outcomes that
define osteopathic knowledge, skills, experience, attitudes, values, behaviors, and established professional
standards. Each competency domain is described in detail with required elements and measured outcomes.
For each examination in the series, test specifications outline the content coverage as it relates to these 7
competency domains.

Dimension 2 · Clinical Presentations

Dimension 2 of the new blueprint consists of the 10 CLINICAL PRESENTATIONS, which represent the
manner in which a particular patient, group of patients, or a community present(s) for osteopathic medical
care. These high-frequency, high-impact categories are based on evidence from osteopathic medical
practice. Patient presentations span all relevant age categories, special populations, and varied clinical
settings. Each clinical presentation is described in detail, further categorized into topics with accompanying guides, and provides examples illustrative of the presentation. For each examination in the series, test specifications outline the content coverage as it relates to the 10 clinical presentations.


Master Blueprint Schematic


Licensure Assessment Aligned With Medical Education Pathway

Candidates will be required to demonstrate minimal competency across each of the seven domains of competency. The outline for implementation of the new,
two-decisionpoint, competency-based COMLEX-USA Master Examination Blueprint is depicted here:

COMLEX-USA Examination Program
Level 1 Level 2-CE Level 2-PE Level 3
Assessment Purpose
Successful promotion along licensure pathway for entry into graduate medical education: “supervised practice” Successful promotion in graduate medical education for licensure: “unsupervised practice”
Decision Point
1 1 1 2
One-day computer-based examination. 400 predominantly multiple-choice test questions. One-day computer-based examination. 400 predominantly multiple-choice test questions. One-day 12 station standardized patient-based performance evaluation of fundamental clinical skills. Two-day computer-based examination. 420 MCQs, clinical decision-making cases, and other novel test item formats (approx. 28 additional clinical cases).
Implementation Timeline
May 2019 June 2019 March 2019 September 2018


Test Specification Percentages For Each Examination


Dimension 1: Competency Domains Level 1 Level 2-CE Level 2-PE
Level 3 Series Min.
1 Osteopathic Principles, Practice, and Manipulative Treatment 11% 10% 0% · 15% 10% 10%
2 Osteopathic Patient Care and Procedural Skills 6% 30% 0% · 25% 40% 25%
3 Application of Knowledge for Osteopathic Medical Practice 60% 26% 0% · 15% 17% 30%
3.1 Foundational Biomedical Sciences Knowledge Base 75% 25% 10%
4 Practice-Based Learning and Improvement in Osteopathic Medical Practice 5% 7% 0% · 5% 8% 5%
5 Interpersonal and Communication Skills in the Practice of Osteopathic Medicine 3% 5% 60% · 20% 3% 10%
6 Professionalism in the Practice of Osteopathic Medicine 3% 7% 30% · 5% 6% 5%
7 Systems-Based Practice in Osteopathic Medicine 2% 5% 0% · 5% 6% 5%

* HUM: Humanistic Domain | BM/BM: Biomedical/Biomechanical Domain


Dimension 2: Clinical Presentations Level 1 Level 2-CE Level 2-PE Level 3 Series Min.
1 Community Health and Patient Presentations related to Wellness 12% 12% 14% 12% 12%
2 Human Development, Reproduction, and Sexuality 5% 5% 5% 5%
3 Endocrine System and Metabolism 5% 5% 5% 5%
4 Nervous System and Mental Health 10% 10% 14% 10% 10%
5 Musculoskeletal System 13% 13% 14% 13% 13%
6 Genitourinary/Renal System and Breasts 5% 5% 5% 5%
7 Gastrointestinal System and Nutritional Health 10% 10% 14% 10% 10%
8 Circulatory and Hematologic Systems 10% 10% 14% 10% 10%
9 Respiratory System 10% 10% 14% 10% 10%
10 Integumentary System 5% 5% 5% 5%