June 18, 2019

Over the years, we’ve seen and heard it all…from quiet hallway murmurings from candidates getting ready to take COMLEX-USA Level 2-PE, to questions and theories posed publicly on message boards and via social media. There are a lot of factors involved with exam administration – not to mention the preparation. Knowing the extraordinary pressure that exists for candidates to perform well, especially in a high-stress, high-stakes environment like this one, we wanted to take this opportunity to dispel some of the more popular (and entertaining) myths and rumors and help position you for success. What follows are some of our favorite questions from over the years – from the straight-forward, to the completely off-the-wall.

  1. NBOME fails 10% of students each year…just because.
    All levels of COMLEX-USA exams are based on standard passing scores determined by an independent group of national educators, practicing physicians, and state licensing board representatives. To pass the exam you must meet the passing standard. Passing rates aren’t based on a curve or a pre-determined number of failures.
  2. You have to pass x number of encounters to pass COMLEX-USA Level 2-PE.
    The score for the PE exam is compensatory across the day, which means that passing is determined based on your performance throughout the day — not just on each individual encounter. Fun fact: there is not a passing standard for each individual encounter.
  3. One Standardized Patient didn’t like me, so I failed the exam.
    Having one bad interaction with a Standardized Patient doesn’t automatically determine the end result. Conversely, Standardized Patients have SO much to do during the encounter – AND they do it 12 times daily. Truly, they don’t have enough time to determine if they like you or not. They are focused on portraying their case in a standardized fashion and the documentation and assessment duties of their job.
  4. I got all the right diagnoses on the PE exam so I couldn’t possibly fail
    Au contraire. The exam is a Performance Evaluation and assesses your ability to gather appropriate information, generate a SOAP note, and perform OMT (in addition to your communication skills). Cases are written with enough variability to allow students to generate a differential diagnoses list, so there is rarely only one correct diagnosis. If that’s all we wanted to assess, Level 2-PE would just be another multiple-choice exam.
  5. All I need to do to pass is perform a complete history and physical on each patient.
    If you’ve watched any of the videos on our website or read any of the content focused on Level 2-PE, you’ve seen that we ask you to evaluate and treat the patient as you see fit. Not all patients require a full history and physical to be assessed – what we really want to see is how you holistically evaluate and treat the patient given the time provided.
  6. The exam is easier to pass in Philadelphia. The exam is easier to pass in Chicago.
    Pass rates have consistently remained the same at both locations. In fact, we have students who have taken the exam at both sites and had the same outcome. We really do take this seriously, and consistency between sites is of paramount importance to us.
  7. You don’t need to perform OMT to pass Level 2-PE, it’s only in a few stations.
    OMT/OPP are incorporated throughout the exam, with OMT accounting for up to one third of the score for the Biomedical/Biomechanical exam. Missing a third of the exam score in this domain is a pretty big risk.
  8. If you just follow the correct prep book or prep course you’ll do fine on the Level 2-PE.
    The best preparation for Level 2-PE is your clinical rotations. Developing clinical reasoning, documentation, and OMT skills really only comes from seeing patients and doing it. Simulation is great – it gives you the opportunity to develop a level of comfort with these things before actually seeing a patient. But at the end of the day, working with multiple patients with different problems, agendas, and diagnoses is really what prepares you best to take the PE.
  9. The exam didn’t test what’s in my study materials.
    COMLEX-USA exams are based on a blueprint that is readily available on the NBOME website. Written questions are designed to address the topics outlined by the blueprint. COMLEX-USA examinations do not endorse nor write to any one standard program.
  10. COMSAE self-study examinations will predict my actual performance on COMLEX-USA.
    COMSAE is designed to provide a means to assess your current level of knowledge and skills. It can also help familiarize you with NBOME cognitive examination questions. Although COMSAE examinations have been shown to estimate COMLEX-USA performance that’s not their primary use (and not at all why they were created). COMSAE examinations are designed to provide insight into your strengths and weaknesses, and encourage further study and preparation.

While it’s great entertainment for us to hear about the many COMLEX-USA myths and misnomers that exist, what’s even more satisfying is ensuring you have the right tools, resources and information to put your best foot forward on exam day! We love being part of the DO journey, working collaboratively with candidates, COMs, residency programs and others in the osteopathic medical community to ensure safe, high-quality healthcare for patients.

We’d love to continue the conversation. If you have questions about any of the COMLEX-USA myths above, or would like to share one of your own, we hope you will reach out.


Gretta A. Gross, DO, MEd  |  Vice President for Clinical Skills Testing   |  NBOME

Joel L. Dickerman, DO  |  Vice President for Assessment Services  |  NBOME