The Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) is a series of three osteopathic medical licensing examinations administered by the National Board of Osteopathic Medical Examiners (NBOME) similar to the United States Medical Licensing Examination (USMLE). COMLEX-USA is the most common pathway by which osteopathic physicians (D.O.s) apply for medical licensure, and is accepted in all 50 states. The 3-digit standard scores of COMLEX-USA Level 1, Level 2- Cognitive Evaluation (CE), and Level 3 have a range of 9-999 and a mean of 500. Most candidates score between 250 and 800. 400 is the minimum passing score for COMLEX-USA Levels 1 and 2; 350 for COMLEX-USA Level 3.[1]


COMLEX-USA Level 1 is typically taken after completion of the second year of medical school. The exam consists of 400 questions administered in one day and consists of two, four-hour exam sessions separated by a 40-minute break. Each of the four-hour sessions allows a ten-minute break which is no longer subtracted from the time allotted for the respective four-hour sessions since the 2017 NBOME policy change. Candidates are expected to know the basic mechanisms of health and disease process. The mean score for the COMLEX-USA Level 1 is approximately 500-540 (for first time test-takers), with a standard deviation of about 85 (although this may vary slightly from year to year). [2]

Specifically, level one covers basic medical sciences, including:


COMLEX-USA Level 2, taken during the third or fourth year of medical school, consists of two parts: Level 2-Cognitive Evaluation (CE) and Level 2-Performance Evaluation (PE). Level 2-CE requires candidates to demonstrate knowledge of clinical concepts and medical decision-making. The mean score for the COMLEX-USA Level 2 CE is approximately 540 (for first time test-takers), with a standard deviation of about 100 (although this may vary slightly from year to year). The examination is problem-based and symptoms-based, integrating the clinical disciplines of:

Level 2-PE was introduced in 2005. It is a one-day, seven-hour clinical skills examination and utilizes standardized patients (actors trained to present clinical symptoms) to test clinical skills. The exam is graded either pass or fail unlike the other COMLEX exams. Testing sites are available in Conshohocken, PA, and in Chicago, IL.[3] Candidates must complete 12 standardized patient encounters, each 14 minutes in duration. Following each encounter, candidates have 9 minutes in order to type a SOAP note. Candidates are strongly encouraged to make full use of the allotted time for each encounter to ensure thoroughness in both components of an encounter. Scoring for the COMLEX-USA Level 2 PE is on a pass/fail basis only. Candidates must demonstrate proficiency in:

  • history taking and physical examination skills
  • integrated differential diagnosis and clinical problem solving
  • written communication and synthesis of clinical findings (SOAP note format)
  • osteopathic principles and/or osteopathic manipulative treatment


The final examination, COMLEX-USA Level 3, is typically taken after starting a residency program and covers the clinical disciplines of medicine, including:

Beginning in September 2018, this exam will be a two-day computer-based examination consisting of up to 550 multiple choice questions, and up to 30 additional clinical decision-making cases.[4] The mean score for COMLEX-USA Level 3 is approximately 550 (for first-time test takers), with a standard deviation of about 125.[5]

USMLE comparison

Many osteopathic medical students apply to ACGME-accredited residencies with COMLEX scores alone. Based on data from recent results of the COMLEX-USA examination, for level 1 and level 2, a score of 500-540 is considered the 50th percentile with scores falling slightly under and over this mark to be considered similarly. A score of 600 is historically considered to be around the 80th percentile. [6]


  1. "COMLEX Computer Based Testing (CBT)". NBOME. 2010. Archived from the original on 30 May 2012. Retrieved 18 July 2012.
  2. Carolyn Schierhorn (December 21, 2011). "Match Report Sheds Light on Credentials Needed to Secure Residencies". The DO. Archived from the original on 2012-06-07. Retrieved June 5, 2012.
  3. "Testing Sites for the COMLEX-USA Level 2 PE". Retrieved 2017-11-08.
  4. "COMLEX-USA · Level 3 — NBOME". Retrieved 2017-11-06.
  5. "Scoring Principles — NBOME". Retrieved 2017-11-06.
  6. "CBT Score Conversion (COMLEX-USA to USMLE)". Retrieved 2017-11-08.
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