NBOME
COMLEX-USA BULLETIN of INFORMATION 2018–2019

Description of Examinations

About COMLEX-USA

The COMLEX-USA examination series is designed to assess the osteopathic medical
knowledge, knowledge fluency, and clinical skills considered essential for osteopathic
generalist physicians to practice osteopathic medicine. The foundation of COMLEX-USA is
based on the osteopathic philosophy of whole-person health care, underlying structure-function
relationships and the interdependence of body systems, self-healing and
self-regulatory mechanisms, and the full scope of the osteopathic approach to patient care,
including osteopathic manipulative medicine.

The COMLEX-USA program is an examination sequence with three levels. This progressive
nature of the COMLEX-USA examinations ensures the consistency and continuity of the
measurement objectives of the osteopathic medical licensing examinations. A description of
the examination blueprints is below, and descriptions of each examination component of the
series, including what constitutes a passing score, follows.

COMLEX-USA examinations are administered only in the English language.

Each COMLEX-USA examination is administered in a standardized, time-measured
environment, as the ability to recall, interpret, process, and apply clinical knowledge and skills
without hesitation and in a fluid manner (“knowledge fluency”) is fundamental to a generalist
osteopathic physician’s competence to practice osteopathic medicine and therefore is one of
the fundamental competencies the COMLEX-USA examinations assess.

The blueprint contains two dimensions that outline the patient presentations (clinical
presentations) and the physician tasks (competency domains). While all examination Levels
have a two-dimensional blueprint structure, the depth and emphasis of each Level parallels
the educational experiences and the clinical responsibilities of the candidate.

COMLEX-USA Overview and Blueprint: Effective July 2018–May 2019

Purpose Format Length

LEVEL 1 · Effective through April 2019

LEVEL 1 assesses the competent application of foundational and basic biomedical
and osteopathic science knowledge relevant to clinical presentations as defined by
the COMLEX-USA blueprint, emphasizing the scientific concepts and principles
necessary for understanding the mechanisms of health, clinical problems and
disease processes.
  • A total of 400 test questions divided into two four-hour sessions
  • Computer-based: administered at Prometric Test Centers
One-day test session: Eight hours

LEVEL 2-CE · Effective through May 2019

LEVEL 2-CE assesses the competent application of knowledge of clinical concepts
and principles involved in all steps of clinical problem solving for osteopathic medical
practice as defined by the COMLEX-USA blueprint, emphasizing the biomedical
and osteopathic concepts and principles necessary for making appropriate clinical
diagnoses through patient history and physical examination findings.
  • A total of 400 test questions divided into two four-hour sessions
  • Computer-based: administered at Prometric Test Centers
One-day test session: Eight hours

LEVEL 2-PE · Effective through February 2019

LEVEL 2-PE provides an assessment of fundamental clinical skills. These skills are
evaluated in the context of clinical encounters and are required to be personally
performed as appropriate in a timely, efficient, safe, and effective manner. The
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).
  • Twelve standardized patient-based cases: 14-minute duration for each patient
    encounter plus 9 minutes to document findings in an e-SOAP note (Subjective
    Objective Assessment Plan format).
  • Administered at NBOME National Centers for Clinical Skills Testing in
    Philadelphia and Chicago.
One-day test session: Seven hours

LEVEL 3

See NEW COMLEX-USA Overview and Blueprint section below.

NEW COMLEX-USA Overview and Master Blueprint: Effective 2018–2019

IMPLEMENTATION OF NEW BLUEPRINT: Based on extensive research and expert
consensus, a new two-dimensional COMLEX-USA Master Blueprint has been developed and
will be implemented beginning with COMLEX-USA Level 3 in 2018. COMLEX-USA Levels 1
and 2 will implement the new blueprint in 2019.

The new master examination blueprint emphasizes the competencies required for generalist
physicians to deliver safe and effective osteopathic medical care.

The enhanced COMLEX-USA master examination blueprint, beginning with Level 3 in
September 2018, features a framework that maps content to competency domains and
clinical presentations.

COMPETENCY DOMAINS are related sets of foundational abilities representing the required
elements and outcomes that define the knowledge, skills, experience, attitudes, values,
behaviors, and established professional standards. They constitute a general descriptive
framework for the practice of osteopathic medicine. Required elements articulate the
essential foundational specifications, including specific, definable knowledge, skills,
experiences, attitudes, values, and/or behaviors that make up the standards for the
competency domain. Each required element is further delineated by measured outcomes.

CLINICAL PRESENTATIONS represent the manner in which a particular patient, group of
patients, or community present(s) to osteopathic physicians. These are high-frequency, high-impact
categories based on evidence from osteopathic medical practice and are further
categorized as topics. Clinical presentations may include, but are not limited to, presentations
of patients across all relevant age categories, from special populations, and in varied clinical
settings in which patients present for osteopathic medical care.

LEVEL 1 ·
Assessment of Foundational Biomedical Sciences and Osteopathic Principles and Practice ·
Effective May 2019

DESCRIPTION
A one-day computer-based assessment that integrates the foundational biomedical
sciences and osteopathic principles with clinical knowledge and other physician
competencies relevant to addressing clinical presentations and promoting health in
supervised clinical practice settings.

Foundational Biomedical Sciences

  • Anatomy
  • Behavioral Science
  • Biochemistry
  • Genetics
  • Immunology
  • Microbiology
  • Osteopathic Principles and Practice
  • Pathology
  • Pharmacology
  • Physiology
  • Health Promotion and Disease Prevention

FORMAT

  • Two computer-based test sessions taken on one day.
  • Administered in a secure, time-measured environment.
  • Contains approximately 400 questions related to diverse clinical and patient
    presentations and 7 defined competency domains for osteopathic medical
    practice.
  • Test questions are single-best answer, multiple-choice format. Also includes
    test questions involving audio-visual components designed to assess an
    expanded physician competency subset.
  • Examples of test question types in Level 1 are found in the
    practice exam.

PASSING

COMLEX-USA Level 1 indicates that the candidate has demonstrated competence
in the foundational biomedical sciences and osteopathic principles and related
physician competency domains for osteopathic medical care of patients as
required to enter supervised patient care settings and to continue lifelong learning.

LEVEL 2-CE ·
Assessment of Osteopathic Patient Care and Related Competency Domains ·
Effective June 2019

DESCRIPTION
A one-day computer-based assessment that integrates application of knowledge in
clinical and foundational biomedical sciences and osteopathic principles with other
physician competencies related to the clinical care of patients and promoting
health in supervised clinical settings. These competency domains include
application of osteopathic medical knowledge, osteopathic patient care and
osteopathic principles and practice, communication, systems-based practice,
practice-based learning and improvement, professionalism and ethics.

Clinical Sciences Disciplines

  • Emergency Medicine
  • Family Medicine
  • Health Promotion And Disease Prevention
  • Internal Medicine
  • Neurology
  • Obstetrics/Gynecology
  • Osteopathic Principles and Practice
  • Pediatrics
  • Psychiatry
  • Surgery

FORMAT

  • Two computer-based test sessions taken on one day.
  • Administered in a secure, time-measured environment.
  • Contains approximately 400 questions related to diverse clinical and patient
    presentations and 7 competency domains for osteopathic medical practice.
  • Test questions are single-best answer, multiple-choice format. Also includes
    test questions involving audio-visual components designed to assess an
    expanded physician competency subset.
  • Examples of test question types in Level 2-CE are found in the
    practice exam.

PASSING

Level 2-CE indicates that the candidate has demonstrated competence in the
clinical sciences and osteopathic principles and related physician competency
domains for osteopathic medical care of patients as required to enter into
supervised graduate medical education settings and to continue lifelong learning.

LEVEL 2-PE ·
Assessment of Fundamental Clinical Skills
for Osteopathic Medical Practice ·
Effective March 2019

DESCRIPTION
An assessment of fundamental clinical skills evaluated through 12 encounters with
standardized patients. Candidates assess problem-centered and health-promotion-centered
patient presentations. Each candidate must personally perform the clinical
skills with standardized patients as appropriate in a timely, efficient, safe, and
effective manner.

The examination augments the Level 2-Cognitive Evaluation (Level 2-CE) through
an assessment of six fundamental clinical skills for osteopathic medical practice
within two scored examination domains: the Humanistic Domain and the
Biomedical/Biomechanical Domain.

Fundamental Clinical Skills Assessed Humanistic Domain

  • Physician-patient Communication
  • Interpersonal skills
  • Professionalism

Biomedical/Biomechanical Domain

  • Medical history-taking and physical examination skills
  • Osteopathic principles and osteopathic manipulative treatment (OMT)
  • Documentation skills (including synthesis of clinical findings, integrated
    differential diagnosis, and formulation of a diagnostic and treatment plan)

FORMAT

  • See current format descriptions—12 standardized patient based-cases.
  • 14-minute duration for each patient encounter plus 9 minutes to document
    findings in an e-SOAP note (Subjective Objective Assessment Plan format).
  • Administered at NBOME National Centers for Clinical Skills Testing in
    Philadelphia and Chicago.

PASSING

Level 2-PE indicates that the candidate has demonstrated competence in the
fundamental clinical skills and related physician competency domains for
osteopathic medical care of patients as required to enter into supervised graduate
medical education settings and to continue lifelong learning.

LEVEL 3 ·
Assessment of Competencies
for Osteopathic Medical Practice ·
Effective September 2018

DESCRIPTION
A two-day computer-based examination assessing competence in the foundational
competency domains required for generalist physicians to deliver safe and effective
osteopathic medical care and promote health in unsupervised clinical settings.

Competency domains assessed include application of osteopathic medical
knowledge, osteopathic patient care and osteopathic principles and practice,
communication, professionalism and ethics. Competency assessment occurs in the
context of clinical and patient presentations and systems-based practice as
required for entry into the unsupervised practice of osteopathic medicine as an
independently practicing osteopathic generalist physician and for readiness for
lifelong learning and practice-based learning and improvement.

FORMAT

  • Four computer-based test sessions of 3.5 hours each taken over two days
    (two sessions per day).
  • Administered on consecutive days (or within a 14-day window) in a secure,
    time-measured environment.
  • Contains approximately 420 questions in the multiple-choice question format
    (MCQ) and test questions related to approximately 28 clinical decision-making
    (CDM) cases. These are related to diverse and representative clinical
    presentations and 7 competency domains for osteopathic medical practice.
  • Test questions are predominantly in the single-best answer and multiple-choice
    formats.
  • CDM question formats include extended multiple-choice (selection of more
    than one answer from an extensive list that may contain more than one correct
    answer) and constructed response (short-answer) test questions.
  • Also includes audio-visual components designed to assess an expanded
    physician competency subset.
  • Examples of test question types in Level 3 are found on the
    Level 3 page.

PASSING

Level 3 indicates that the candidate has demonstrated competence in the
foundational competency domains required for generalist physicians to deliver safe
and effective osteopathic medical care of patients as required for entry into the
unsupervised practice of osteopathic medicine and to continue lifelong learning
and practice-based learning and improvement.

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