COMLEX-USA FAQs

The NBOME will transition administration of COMLEX to Pearson VUE beginning with Level 3 in January 2023. Click here to learn more.

General  Scoring Level 3 Standard Setting

General

About the Examination Series

What is COMLEX-USA?

COMLEX-USA - the Comprehensive Osteopathic Medical Licensing Examination of the United States-is a high-quality, high-stakes, three-level medical licensing examination series for osteopathic physicians. The COMLEX-USA series emphasizes medical problem-solving knowledge and cognitive skills. It is the only licensing examination that covers osteopathic principles, practices, and the application of osteopathic manipulative treatment. The series includes three computer-based examinations, delivered at more than 350 Prometric professional test centers in the US and Canada:

• COMLEX-USA 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.
• COMLEX-USA Level 2-Cognitive Evaluation (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.
• COMLEX-USA Level 3 - assesses 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.

What do the COMLEX-USA computer-based cognitive examinations measure?

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 Master Blueprint details the COMLEX-USA design and content coverage.

Do the computer-based examinations require substantial computer skills?

No. Research suggests that performance on computer-based tests is not related to the level of computer literacy. Substantial computer experience is not required to take the computer-based examinations. Examinees need to know only how to click the mouse to select answers or other labeled options.

What is the format of the computer-based COMLEX-USA examinations?

The COMLEX-USA Levels 1, 2-CE and 3 examinations are computerized non-adaptive tests. The questions selected for each COMLEX-USA examination are predetermined. The number of questions and time limit for the examinations are also predetermined and under normal administration conditions are the same regardless of when and where the examinations are administered. The total number of questions for COMLEX-USA Level 2-CE is 352, and the total testing time is eight hours for both the Level 1 and Level 2-CE.

Beginning May 4, 2021, the COMLEX-USA Level 1 examination, which currently contains 400 test items will be reduced to 352 test items.

The examination is divided into two sessions consisting of four sections. You will have four hours to complete each session; within a session, the individual sections are not timed. The Level 3 examination is a two-day examination.  Refer to the Level 3 FAQs or visit COMLEX-USA for more information.

Registration & Scheduling

How do I get approval to take the COMLEX-USA examinations?

A candidate must meet the requirements outlined in the table below. Examinations must be taken in sequence and each level passed before the candidate is eligible to take the next level. COMLEX-USA Level 2-CE and Level 2-PE may be taken in any order, but both sections of COMLEX-USA Level 2 must be passed to qualify for COMLEX-USA Level 3.  

COMLEX-USA LEVEL 1	Completion of the second year of study at an accredited COM Attestation by the COM that the candidate is in good academic and professional standing
COMLEX-USA LEVEL 2-CE	Passing of both COMLEX-USA Level 1 Completion of the second year of study at an accredited COM Attestation by the COM that the candidate is in good academic and professional standing
COMLEX-USA LEVEL 2-PE	Passing of both COMLEX-USA Level 1 Completion of the second year of study at an accredited COM Attestation by the COM that the candidate is in good academic and professional standing
COMLEX-USA LEVEL 3	Passing of both COMLEX-USA Level 2-CE and Level 2-PE Graduation from an accredited COM Has earned a DO Degree Attestation by a Program Director that the candidate is in good academic and professional standing

  Your college may have additional requirements. Check with your school, and refer to the COMLEX-USA Bulletin of Information for more details.

Where do I take computer based COMLEX-USA exam?

Computer based tests are administered at a Prometric test center. To locate a test center, go to the Prometric website and enter “NBOME” as the test sponsor. You can also reschedule, or confirm a test at this site. You will receive a 16-digit confirmation number online and by email.

How do I register for and schedule a computer-based COMLEX-USA exam?

To register for and schedule a computer-based exam:

1. Login to your NBOME Account
2. Once logged in, select the ’Register or Schedule Exam’ option from your My Account screen
3. Locate the ’Eligible Examination to Purchase’ section, and select your desired examination date range option
4. Once your preferred date range has been chosen, click the ’Add to Cart’ button. The system will prompt you to the shopping cart
5. On the Shopping Cart page you will be asked to ’Agree to Terms’ after you have indicated your agreement you may ’Proceed to Payment’ where you will be able to enter your credit card information and complete the purchase
6. After the payment has been processed you are able to schedule an examination appointment from the ’My Account’ page
7. Choose a preferred exam location, paying attention to seat availability
8. Once you ’Confirm’ the appointment, you will obtain a 16-digit confirmation number from Prometric

The Prometric site does not recognize my NBOME ID number. What should I do?

In order for Prometric to recognize your NBOME ID number, you must first register for the COMLEX-USA computerized examination via your NBOME Account. If you are still having problems, please contact Client Services by email or calling 866.479.6828.

Are any fees associated with rescheduling or canceling examinations?

Yes. Please refer to Registration & Scheduling section for each COMLEX-USA examination for rescheduling and cancellation fee information.

How do I reschedule an exam?

If you need to reschedule a test this can be accomplished by logging into your NBOME Account and selecting the “Reschedule” option. You will be redirected to Prometric website to reschedule a new test appointment. Before rescheduling an examination, which may carry significant cost penalties, please carefully review the policies and procedures for rescheduling and cancellation fee information. If you encounter unavoidable circumstances (e.g., health problems, travel delays), you should complete and submit the Rescheduling Fee Waiver Form with supporting documentation, to NBOME Client Services. Documentation can be sent using any of the following methods: Emailed To: NBOME Client Services Faxed To: 773.714.0606.

How do I find my confirmation number?

Prometric will generate a 16-digit confirmation number once your testing appointment is confirmed. The number will appear at the top part of the confirmation page and will also be emailed to you immediately. Within 48 hours, this number will also appear as your “Prometric Appointment ID” next to your scheduled examination in your NBOME account under the “My Account” tab.

Is there a limit on how many times I can take a particular level of the COMLEX-USA computer-based examination?

Yes. Effective July 1, 2016, candidates are limited to a total of six attempts for each examination, including but not limited to all attempts prior to July 1, 2016. Candidates may take (including retakes) the COMLEX-USA Level 1, Level 2-CE, or Level 3 examination up to four times in any 12-month period. Review the COMLEX-USA Bulletin of Information for details. You should also be sure to check the policies of your college of osteopathic medicine for its retake guidelines, which may differ from the NBOME's. You will need the approval of your dean or residency program director to retake the examination; however, approval to retake a COMLEX-USA examination by a dean or residency program director will not override NBOME retake policy. NOTE: Candidates may not retake any level of COMLEX-USA to improve their scores or for any purpose other than to pass a previously failed examination.

Personal Information

Is my personal information secure?

Yes. Your personal data is treated by NBOME as confidential. Your information will not be disclosed to any individual or entity without written, signed consent by you or an order of a court of competent jurisdiction.

How do I change my name in the NBOME records?

If your name has changed, download and complete a Name Change Request Form.

How do I update my contact information?

You can update your mailing address, email address, and phone numbers in your NBOME Account under the "Student Information" section on the "My Account" tab.

How do I update my medical school information?

If you transferred medical schools, you must contact the dean's office at your old and new school and request that they forward the information to NBOME Client Services.

How do I obtain my NBOME profile?

Each year, the NBOME obtains a student list from each college of osteopathic medicine. The NBOME system automatically generates and emails the access information to each candidateafter validation. This typically occurs during the fall of each year. If you do not receive the code by this time, check with your college to confirm your information has been submitted to the NBOME. If you are a former osteopathic student and do not have an NBOME username and password, please contact Client Services by emailing clientservices@nbome.org or calling 866-479-6828 to set up an account. Please provide the osteopathic college you attended, the year of graduation, your date of birth, and any names you had in the past.

What browser is required to access the online system?

For candidates in a MAC environment, the NBOME recommends using Safari. For those using a PC, the NBOME recommends using Internet Explorer. The system may not run properly when using other browsers. At this time, the NBOME does not recommend accessing the online system from a mobile device because of compatibility issues.

Test Accommodations

If you are a “Person With Disability” under the Americans with Disabilities Act, and wish to receive test accommodations for an NBOME examination, review and download the following request forms and instructions document. Complete and submit the Request for Test Accommodations form with the supporting documentation substantiating your eligibility for the accommodation to NBOME Test Accomodations:

• By Email testacc@nbome.org
• Or By Mail NBOME Test Accommodations 101 West Elm Street Suite 230 Conshohocken, PA 19428

A completed application with full supporting documentation is generally evaluated within 60 days of its receipt by NBOME. Consult the COMLEX-USA Bulletin of Information, Accommodations section for more information.

Can I schedule a COMLEX-USA examination with a testing accommodation application pending?

Yes. You can schedule a standard (non-accommodated) examination while your application is pending. However, if your application is approved by NBOME with testing accommodations granted, and you have not yet taken the examination, you will likely need to reschedule the test depending on the nature of the approved accommodation(s). If you schedule a standard (non-accommodated) examination while your application is pending and have taken the examination without accommodations before being notified by NBOME of its decision on your request, NBOME will deem your request for an accommodation withdrawn. Also consult the COMLEX-USA Bulletin of Information, Accommodations section.

Can I take COMLEX-USA Level 2-PE out of sequence?

This would be decided at the sole discretion of the NBOME Vice President for Clinical Skills Testing. Criteria to meet include:

• Graduated from a AOA COCA accredited osteopathic medical school
• Completed COMLEX-USA Level 3
• Written request from a state licensing board or jurisdiction (domestic or international)
• Candidate and Licensing board accepts the NBOME’s pass/fail decision as final
• Candidate agrees to indemnify and hold harmless the NBOME
• Cannot schedule an exam without the NBOME’s approval

The NBOME will provide the score and other related information directly to the Medical Licensing Agency and, if requested by the Medical Licensing Agency, to the candidate.

Preparing for the Examination

Can I see what the computer-based examinations look like before I take at test?

Yes, you can take practice exams on the NBOME website. Visit Practice & Preparation for each level examination. You are encouraged to review and take the practice exams before test day. Before the practice and actual examinations, a tutorial is presented before you start the test so you can familiarize yourself with the operation of the computer, the program options, and the procedures used during the examination. New multimedia question formats are being introduced gradually. You will be notified in advance as new question formats are introduced.

• For students working on a MAC computer, NBOME recommends using Safari to access the online practice tests
• For those using a PC, NBOME recommends using Internet Explorer

The system may not run properly when using other browsers. At this time, NBOME does not recommend accessing practice exams from a mobile device because of compatibility issues.

Does the NBOME offer any study materials for the COMLEX-USA examinations?

Yes. NBOME offers practice examinations and other preparatory resource materials on our website. Visit the COMLEX-USA Practice & Preparation page for all available COMLEX-USA related resources. In addition, the Comprehensive Osteopathic Medical Self-Assessment Examination (COMSAE) series, which was defined using the same competency-assessment framework as the COMLEX-USA series, enables you to conduct a self-assessment before taking a COMLEX-USA exam. COMSAEs are not intended to predict performance on any of the corresponding levels of COMLEX-USA. NBOME does not endorse any alternative study examinations or materials.

Can the NBOME offer any suggestions and/or materials to aid me in studying my problem areas for a retake?

If you did not pass a COMLEX-USA cognitive examination and intend to retake it, you should work alongside your college or program for suggestions or study aids. The NBOME provides the score report, and a graphical performance profile is included. This profile will help identify areas on which you may wish to focus in preparing for the retake.

Are there any breaks during the examination?

The test day for all levels consists of two sessions of four hours each, except Level 3 which consists of four sessions of three and a half hours over two days, Candidates can choose to take three optional breaks during a testing day:

• Two authorized 10-minute breaks
• One authorized 40-minute lunch break

It is important to allow enough time to return to your seat before the next section or session begins, or the time will be deducted from your exam time. See Test Day Tips for more details on how the day is structured and the associated requirements.

What identification do I need to present at the Prometric test center?

Acceptable forms of government ID include a passport, driver’s license, or state ID. A military ID that does not have a signature must be accompanied by a second form of ID that bears your signature.

What is an acceptable government ID?

You are required to present:

• A current government-issued photo identification, that bears your first and last name
• ID must match the name and signature on the registration form
• Students whose identification does not match their registration are considered a “No Show” and deemed responsible for paying rescheduling fees

Acceptable forms of government ID include:

• Passport
• Driver's license, or state ID
• A military ID with signature*

*A military ID that does not have a signature must be accompanied by a second form of ID that bears your signature.

What if my computer freezes during the examination?

You must bring the issue to the attention of a test center staff member or proctor immediately so they can reboot the computer for you. You will not lose any answers already entered, nor will you lose any examination time—the computer system stores all your answers instantly. After rebooting, the computer screen will return exactly to where you were working before the malfunction, both in terms of your responses and the time remaining in the examination. If the issue is not resolved to your satisfaction, you must contact NBOME Client Services within 10 calendar days of the examination date and provide credible, verifiable written evidence of the adverse testing condition in order for the NBOME to investigate the incident. We will acknowledge your email in a timely manner and will then investigate and contact you with a resolution.

What should I do if I experience issues/problems during administration of my examination?

You must bring the issue to the attention of a test center staff member or proctor immediately. If the issue is not resolved to your satisfaction, you must contact NBOME Client Services within 10 calendar days of the examination date and provide credible, verifiable written evidence of the adverse testing condition in order for the NBOME to investigate the incident. We will acknowledge your email in a timely manner and will then investigate and contact you with a resolution. For more information, please reference the COMLEX-USA Bulletin of Information.

Are there any penalties for late registration or cancellation of an examination or tardiness on the day of the exam?

If you arrive at the test center on the scheduled examination date within 30 minutes after the scheduled start time, you may be permitted to take the examination only if the test center is able to deliver the examination in its entirety. If you arrive at the test center more than 30 minutes past the scheduled start time, you may be designated as a "No Show." You may be permitted to take the examination at the sole discretion of the proctor or testing vendor only if the test center is able to deliver it in its entirety. If you are not permitted to take the examination, you will be deemed as a "No Show" and will be responsible for the corresponding administration fee. For complete details, candidates are advised to check the information regarding fees associated with rescheduling/cancellation in the COMLEX-USA Bulletin of Information.

Scores and Transcripts

Scoring

When and how will scores be reported?

For the COMLEX-USA Level 1 and 2-CE computer-based examinations, candidates can expect to receive test results approximately 4 to 6 weeks from the day of examination administration. (Note: the first score release of each test cycle may be subject to brief delays) Candidates can expect to receive score reports approximately 8 to 10 weeks from the completion of the Level 3 examination (after the initial score release). You can check the dates when scores will be released under Scoring and Reportingfor each COMLEX-USA examination on the website. Candidates will be notified by email that their score reports are accessible through your NBOME Account. Candidates will be able to access the test results immediately after they are available along with their examination history. The NBOME will also post score reports to osteopathic medical schools immediately after the results are available, and schools can access and obtain up-to-date information about their student's test-taking activities and test results at any time. For Level 3, residency program directors also received their resident score reports through CRS/Portal when the reports are released.

What types of score reports will my school and I receive from my COMLEX-USA cognitive examinations?

The student score report will provide 3-digit standard score and a pass/fail designation. Percentile rank will not be reported because candidates will be taking the examination throughout the year. Following completion of the annual testing cycle, you can look up your percentile rank in relation to others in the same cohort using the COMLEX-USA Percentile Score Converter. You will also be provided with a graphical performance profile according to the COMLEX-USA blueprint. Because computer-based COMLEX-USA examinations are administered continuously throughout the year, osteopathic medical schools will receive school annual reports after the testing cycle is completed. The annual school reports include school information compared with the national performance.

Are some multiple choice questions (MCQs) weighted more than others on COMLEX-USA?

No. Every scorable test question contributes equally to the candidate's score.

A fellow student scored extremely low in one discipline area of a COMLEX-USA examination, but still passed the examination. What are the discipline scores, and how do they relate to the total COMLEX-USA score?

COMLEX-USA is an examination currently designed around competency domains and clinical presentations, not disciplines. The discipline performance profiles are provided at the request of the college of osteopathic medicine deans, American Association of Colleges of Osteopathic Medicine, and candidates to potentially assist with lifelong learning, remediation, and program evaluation. Performance profiles should not be used to interpret areas of importance or emphasis for any particular examination. Performance profiles:

• Are not additive for projecting the total score or pass/fail status
• Do not contain metrics technically designed for sub-score reporting
• Based on a relatively small number of items as compared to the total test, therefore reliability of sub-scores is lower than for the total test.

Apply caution in using performance profiles in order to avoid misinterpretation.

How do the discipline performance profiles provided for COMLEX-USA Level 1 individual score reports and reports to the COM Deans relate to the disciplines noted under the Physician Task of "Scientific Understanding of Health and Disease Mechanisms"?

The COMLEX-USA discipline performance profiles are provided at the request of the COM deans and candidates to potentially assist with lifelong learning, remediation, and program evaluation. They should be interpreted with significant caution as the number of test questions classified to any particular discipline in a 400-question test is often lower than that required to achieve optimal reliability. The primary classifications in COMLEX-USA relate to the two Dimensions of the examination: Dimension 1 - Patient Presentation and Dimension 2 - Physician Tasks. The Dimension categories are further delineated in the COMLEX-USA Level 1, Level 2, and Level 3 computer-based Cognitive Examinations. As COMLEX-USA is an integrated, clinically oriented examination designed for the licensure pathway for osteopathic medical practice and developed around patients and their clinical presentations to DOs, multiple disciplines may be reflected in one clinical scenario or case that makes up one test item. As an example, a test question may be sub-classified in the discipline performance profiles as Anatomy, but may also include concepts from Physiology and Osteopathic Principles. In COMLEX-USA Level 1, a minimum of 70-85% of the test content can be classified under the Physician Task of "Scientific Understanding of Health and Disease Mechanisms," which comprises the discipline performance profiles provided. Test question classification in the eight discipline areas for COMLEX-USA Level 1 is further defined with:

• Biochemistry, including Biochemistry and Genetics
• Anatomy, including Anatomy and Molecular and Cell Biology
• Microbiology, including Microbiology and Immunology

What are 3-digit COMLEX-USA scores?

The minimum passing 3-digit standard score for Level 1 and Level 2-CE is 400, and Level 3 is 350, regardless of when the examination is taken.  COMLEX-USA 3-digit scores are NOT raw scores or the number of items answered correctly. Similarly, they are NOT the percentage of items answered correctly.

Why doesn't the NBOME report COMLEX-USA percentile ranks?

A percentile score is an examinee's performance rank among a defined peer group that takes the same examination. For COMLEX-USA examinees, this peer group is considered to be the examinees who take an examination in the same testing cycle. To accurately compute a percentile score, scores of the whole cohort, or at least most of the cohort, need to be available. The testing cycle-based 3-digit scores, 2-digit scores, and percentile conversions can be found with the COMLEX-USA Percentile Score Converter.

How do I request a score confirmation, and how long does it take to receive it?

You can choose to submit a request to the NBOME for score confirmation within 120 days of the examination. Log in to your NBOME Account and select the "View Scores" tab. At the bottom of the page is the option to "Request Score Confirmation." The processing fee for score confirmations for all COMLEX-USA examinations is $50.00. This covers the cost to confirm all responses recorded during your computer-based testing. It takes up to 10 business days for Level 1 and Level 2-CE and 15 business days for Level 3 to receive a letter from NBOME with the score verification result.

Many Accreditation Council on Graduate Medical Education (ACGME) residency programs accept both osteopathic (DO) and allopathic (MD) applicants. Can COMLEX-USA scores be converted into United States Medical Licensing Examination (USMLE) scores so that those programs can have a common criterion to judge all applicants?

The NBOME understands the desire for a "conversion formula" for osteopathic medical students applying to ACGME-accredited residency programs. The NBOME is currently developing a study plan for the development of a valid and reliable conversion formula.  Meanwhile, NBOME publishes a guide to residency program directors which includes the proper use of the percentile score converter and secondary uses of COMLEX-USA exam scores.

If COMLEX-USA and USMLE scores cannot be converted, how should ACGME programs use COMLEX-USA scores to evaluate osteopathic applicants?

The NBOME encourages ACGME Residency Program Directors (RPDs) to gain a full understanding of the COMLEX-USA examination series-in particular, what it assesses, its format, and how standards are set. The NBOME provides resources for this purpose, one of which is the COMLEX-USA for RPDs brochure.  In addition, all residency program directors can take advantage of the percentile score converter. Note: A full testing cycle cohort must be complete before a given score can be converted.

Transcripts

How do I request an official transcript?

You can request an official transcript by submitting an electronic request with the appropriate fee via your NBOME Account. Individuals that do not have access to their online account may submit a written request form. Third parties that wish to request an official transcript will need to complete the transcript form and obtain a written consent from the osteopathic physician in order to receive the transcript. No request for a transcript will be taken by telephone.

What is the process time for obtaining an official transcript?

Transcript requests will be processed in the order of the date received. The normal processing time is one to two business days from the date of receipt, and three to five shipping days using standard USPS mail. Transcripts can also be sent via FedEx's overnight delivery service for an additional fee.

Can I request my transcript while I am waiting for the scores?

The NBOME can only accept and process a transcript request for examination scores which are available. If you request a transcript and a score is pending, it will not appear on your transcript. In order to process your transcript request, you must have at least one COMLEX-USA examination for which the score is available.

What should I do if my ERAS request is listed as "NOT MATCHED"?

In order for an Electronic Residency Application Service (ERAS) request to be transmitted successfully, all personal profile information in the ERAS account must match with your NBOME online account. The profile information includes your first and last name, date of birth, and NBOME ID. If the information in ERAS does not match your NBOME online account, you will see "NOT MATCHED," and the request will not be processed. In order to resolve the mismatch, you will need to correct the information with ERAS. If you have any questions, please contact NBOME Client Services and update the necessary information. You will then re-transmit the request via the ERAS application.

How do I update my ERAS request after I receive my new scores?

NBOME will send new scores upon receipt of a new ERAS request. You will use the ERAS application to request a re-transmit.

COMLEX-USA Level 3

Clinical Decision-Making (CDM) Cases

Why have CDM cases been added to the Level 3 exam?

The NBOME's Blue Ribbon Panel on Enhancing COMLEX-USA, a prestigious group of academic subject matter experts, practicing physicians, and psychometric experts, recommended the development and implementation of novel test items to evaluate clinical decision-making performance beyond the scope of standard multiple choice questions. CDM cases offer an opportunity to test critical steps, enabling candidates to show their abilities over a wider range of clinical challenges.^1,2 Research indicates that these item types have greater capacity to discriminate candidate performance than more traditional multiple choice questions.^3,4

References
1. 1. Farmer EA, Hinchy J. Assessing general practice clinical-decision making skills: The key features approach. Aust Fam Physician. 2005; 34: 1059-61.
   2. Page G, Bordage G, Allen T. Developing key-feature problems and examinations to assess clinical-decision-making skills. Acad Med: 1995; 70: 194-201.
   3. Page G, Bordage G. The Medical Council of Canada's Key Feature Project: A more valid written exam of clinical decision-making skills. Acad Med. 1995; 70: 104-110.
   4. Trudel JL, Bordage G, Downing SM. Reliability and validity of key feature cases for the self-assessment of colon and rectal surgeons. Ann Surg. 2008; 248: 252-8.

What are the benefits of CDM cases?

The CDM examination was first developed by the Medical Council of Canada in 1992 and has been adopted by countries across the world, including Australia and Germany. CDM cases assess the ability to make appropriate patient management decisions as an independently practicing osteopathic generalist physician. The cases are not meant to simply assess factual knowledge but rather to assess the ability to apply knowledge at specific decision points in patient care, a special emphasis for the COMLEX-USA Level 3 examination.

How are CDM cases constructed?

CDM cases focus on key, critical decisions and challenges related to patient care that are routinely faced by osteopathic generalist physicians. A typical CDM case consists of a clinical scenario followed by two to four questions. CDM cases feature two question types: constructed response (short answer) and extended multiple choice (one or more correct) questions. Test questions ask about data acquisition (e.g., obtaining history or physical exam findings, ordering tests), data interpretation (e.g., generating a diagnosis), and treatment (e.g., prescribing medication, counseling, or planning follow-up care). Follow these links for a CDM tutorial and example CDM cases.

What content is being assessed in the CDM cases?

CDM cases follow the same content blueprint as COMLEX-USA.

How should I respond to short answer questions?

Responses should be concise and limited to specific diagnoses, examination steps, diagnostic studies, or treatments. It is unnecessary to answer short answer questions with full sentences. Do not include reasoning or justifications for your responses. The short answer text boxes will only allow you to type up to 100 characters per box.

Can I use abbreviations in my answers?

It is generally advisable to avoid or limit abbreviations due to the lack of standardization. Use of abbreviations when completing short answer questions runs the risk of misinterpretation in scoring and should be used with caution. It is therefore recommended that you spell out names and terms rather than abbreviate.

Will I be penalized for misspellings?

The examination does not include a spell-check feature; however, misspellings in answers are acceptable when the meaning and interpretation are still clear. There is technically no penalty for misspelling answers unless the meaning is ambiguous or incorrect.

Can I use protocols in my answers?

Use of protocols as answers will NOT be accepted as correct because they are not universal. The necessary steps or components of protocols must be listed individually in separate boxes. For example, the answer “ACLS protocol” would not be accepted as correct when “synchronized cardioversion” is the next step.

How should I write an order as an answer?

Write the order just as you would on a hospital or urgent care order record, in specific terms that a technician, nurse, or other health care professional could understand and carry out. However, medication dosages are not required in answers.

Can I answer a question with a laboratory test that is not included on the list of approved lab panels?

Yes, you can answer with any specific test. The approved laboratory test panels are the only panels that are acceptable as answers. If the panel you have in mind is not listed in the approved lab panels list, please enter the specific test(s) that you want to order. Separate tests should each be entered in separate text boxes.

Should I repeat an answer that I already provided on a previous question within a case?

Each question will be scored separately. Your previous answers will not be taken into account in the scoring of each individual question. If you feel that the option is the appropriate answer to the question, select it again.

How will I know which medical resources are available to me in each case?

For each case, assume all necessary resources are available to you as a generalist physician in the setting described, and answer accordingly.

Can a referral be an appropriate answer to a question?

If the correct plan of action requires a specialty referral and/or consultation, you must specify the appropriate procedure or management steps in addition to the type of specialist.

Why has the COMLEX-USA Level 3 examination changed to a two-day format?

In September 2018, the COMLEX-USA Level 3 examination changed to a two-day format as part of an overall enhancement of the COMLEX-USA examination series. This was in response to substantive changes in the evolution of osteopathic medical practice and to ensure COMLEX-USA remains current in meeting the needs of state licensing boards. To read more about the enhanced COMLEX-USA, you can access the COMLEX-USA Master Blueprint.

What is the attestation requirement?

Your residency program director will need to attest to the fact that you are in good academic and professional standing and are approved to take the Level 3 examination. It is recommended that you take the examination after a minimum of six months in residency.

Post-Examination

If I contest my score, why won’t the NBOME re-grade my exam?

Prior to releasing any COMLEX-USA Level 2-PE scores, multiple checks are done for score accuracy as well as reliability and ongoing quality assurance is performed to assure that the score accurately reflects your performance across the course of the day. The scoring process involves numerous individuals who have completed extensive training under a competence-based process.

Why doesn’t the NBOME re-mediate failures?

COMLEX-USA (Comprehensive Osteopathic Medical Licensing Examination of the United States) series is a national standardized licensure examination for the practice of osteopathic medicine. It is an independent assessment of osteopathic medical knowledge, knowledge fluency, clinical skills and other competencies essential for practice as an osteopathic generalist physician and, as such, does not provide recommendations for remediation. The NBOME is a national testing organization independent of specific osteopathic medical school curriculum and we encourage all students to reach out to their school for assistance in the remediation process.

When will I receive my examination scores?

Scores are generally available within 8-10 weeks of the examination date; please see the website for score release dates. This time is required to ensure accurate, reliable and valid examination scoring and reporting. Scores are analyzed and checked for accuracy before the scores are released. There may be additional delays that are dependent on candidate testing and other variables that are not within NBOME’s control.

How can I access my examination scores?

Candidates and deans will receive an e-mail notifying them that score reports are available through your NBOME Account. A notice will also be posted via social media (Facebook and Twitter). Score reports can be accessed via CRS using your username and password. Candidates should consult the COMLEX-USA Bulletin of Information and the COMLEX-USA Level 2- PE Orientation Guide for additional information.

Can I request a score confirmation?

A score confirmation checks the accuracy and computation of scores. The score confirmation does not include having videotape performances or SOAP Notes rescored by additional examiners. You can request a score confirmation for COMLEX-USA Level 2-PE via your NBOME Account. All requests must be received within 120 days of the completion of the examination. You will be notified of the score confirmation results electronically via your CRS secure user account within two weeks of the receipt of your request.

What is "Irregular Conduct," as annotated on the score report?

Any irregular behavior that would constitute unprofessional conduct, as outlined in the COMLEX-USA Bulletin of Information and the COMLEX-USA Level 2- PE Orientation Guide, in regards to the application or registration for, the taking of, or the conduct after taking any COMLEX-USA examination series subject to NBOME's policies, could result in invalidation of an examination or disqualification. This includes copying, fraud, or sharing of any examination content or material, use of prohibited reference materials during the examination, and verbally or physically harassing any NBOME staff at any time, including when contacting NBOME for information about failing scores. In addition, misrepresentation of findings documented on the medical record (SOAP Notes) in COMLEX-USA Level 2-PE by documenting medical history that was not elicited or physical examination maneuvers or techniques that were not performed is considered irregular conduct and will be thoroughly investigated and dealt with as specified in NBOME's Bulletin of Information.

Why did I fail the COMLEX-USA Level 2-PE examination? My medical school course grades and test scores, COMLEX-USA Level 1, Level 2-CE scores, and/or my clerkship ratings are very good.

Candidates should be aware that cognitive knowledge is measured principally by the COMLEX Level 1, Level 2-CE and Level 3 examinations, whereas clinical skills and performance are measured by COMLEX-USA Level 2-PE. The assessment formats of Level 2-CE and Level 2-PE examinations are different, and the examinations therefore are designed to measure different competencies. Numerous published studies show that there is only a very modest correlation between national clinical skills examinations (such as COMLEX-USA Level 2-PE) and other measures of academic performances (i.e., academic grades in medical school years 1 and 2, COMLEX-USA multiple choice cognitive examinations such as COMLEX-USA Level 1, Level 2-CE, USMLE scores, MCAT scores, and clerkship ratings). Consequently, the fact that a student may have performed satisfactorily or even quite well in an academic or other setting may not predict achievement in clinical skills. There is extensive literature that documents the low correlation between clerkship global rating forms and other academic measures (e.g., Multiple Choice Question- MCQ- examinations) as well as with national clinical skills examinations including COMLEX-USA Level 2-PE. For research related to the COMLEX-USA Level 2-PE, please see our Publications page.

How could I have failed the Humanistic Domain? I am a good person and generally get along well in my rotations.

This is not a judgment about your character. It means that over the course of 7 hours with 12 clinical encounters with standardized patients on your exam day, you performed below standards for doctor-patient communication, interpersonal skills, and professionalism established by experts in osteopathic medical education and practice. One suggestion is to practice with standardized patients and real patients under direct observation, and get feedback from your supervisors. Another suggestion is to examine the Humanistic Domain dimensions carefully, asking your supervisor to provide constructive feedback using these criteria after directly observing your interactions with patients.

Can I get more specific feedback as to what I need to do to improve?

The COMLEX-USA Level 2-PE was designed to make reliable pass/fail decisions for licensure. If you did not pass, more specific feedback is provided on the back page of the score report. Within the Biomedical/Biomechanical domain, further feedback is presented, by score component, for data-gathering (history-taking and physical examination), OMT, and the SOAP Notes. For the Humanistic Domain, feedback is presented as to the level of proficiency demonstrated in the examination in this domain as a whole. Doctor-patient communication, interpersonal skills and professionalism are complex and multidimensional, and are best defined in the assessment context as specific observable behaviors and conduct throughout the entire examination. For this reason, further information as to the performance on each of the dimensions of the domain, cannot be reliably reported. Investigations show that students who fail this domain should seek out remediation in all of these skill areas. In the COMLEX-USA Level 2-PE the Global Patient Assessment is a global holistic rating scale under the Humanistic Domain that assesses the interpersonal, communication skills and professionalism quality of osteopathic medical students. This scale evaluates candidate quality in two areas:

1. Patient Examination and Treatment Quality – The ability to gather and exchange information with the patient to ensure diagnostic accuracy and treatment quality. Dimensions in this area include:
   • Eliciting information - the ability to gather information in an understandable, straight-forward manner)
   • Listening skills – the ability to listen to and respond to the patient’s statements and questions
   • Giving information – the ability to inform, educate and counsel the patient
2. Patient Relationship Quality - The ability to demonstrate an interpersonal connection to the patient, pay attention to the psychological, situational and cultural contexts of the doctor-patient relationship and collaborate with patients in their care. Dimensions in this area include:
   1. Respectfulness – the ability to hold the patient in high regard or esteem
   2. Empathy – the ability to demonstrate understanding, concern and interest in the patient’s medical problem and life situation
   3. Professionalism – the ability to help the patient, instill confidence and maintain ethical standards.

Why can’t I get more information on what specifically I did wrong to fail the examination?

Unlike scoring approaches that are typically used in an educational setting to provide detailed feedback about performance on specific behavior or knowledge, the COMLEX-USA Level 2-PE utilizes a global scoring approach which is designed to provide a reliable summative score in the COMLEX-USA licensure series, but not to provide the detail to help with further training as would be common in the osteopathic medical education setting (e.g. formative OSCE). For example, for the Global Patient Assessment Tool, which is the scoring tool used to evaluate behaviors for the Humanistic Domain, Standardized Patients are trained to use a holistic rubric that assesses the overall performance of an examinee in specific aspects of doctor-patient communication, interpersonal skills and professionalism. Each of the 12 Standardized Patients is trained to recognize well researched, well documented behaviors which are associated with positive physician-patient relationships, and improved patient satisfaction, compliance and outcomes. For the post-encounter SOAP note, each case note is scored by a Physician Examiner trained to that case. For each case in which OMT is scored, a trained individual Physician Examiner has viewed and scored that particular case. So for both domains, there are many trained raters contributing to one reliable final score. Furthermore, because there are multiple behaviors/observations that are assigned to a global rating score, it is not possible to disaggregate specific skills that contributed to an examinee’s overall performance rating (e.g., information gathering, questioning style, eye contact). Further, it is the examinee’s performance across several stations that becomes his or her final rating.

How do I improve my performance or remediate?

Unlike formative assessments used at medical schools, COMLEX-USA Level 2-PE is a summative high-stakes assessment where performance is evaluated against a national standard. The public relies on a system of licensure that incorporates these types of competency-based assessments. To this end, remediation is not provided by the NBOME, and examination content (cases, etc.) must remain secure. Case-specific feedback (e.g., "What questions should I have asked," or "What communication skills did I not demonstrate in the exam") cannot be provided. Prior to retesting, you should consult with your dean or school representative to obtain reference materials and to formulate a remediation plan. Typically, candidates will schedule specific activities with the faculty of their school, including clinical clerkships with direct observation, videotaping with real or standardized patients, and hands-on guided practice for defined skills (e.g., history-taking and physical examination, osteopathic manipulative medicine, documentation of SOAP Notes, doctor-patient communication, etc.).

If I failed, how do I reschedule to take the examination?

Upon receipt of a failing score, you may register for another examination through your NBOME Account. When logging into the registration program, you should have several opportunities to reschedule for the examination, including specific seats that are reserved for students retaking the examination. If you do not see an acceptable date within 6-8 weeks or have specific questions, please call us at 1-866-479-6828 for assistance with scheduling.

When should I reschedule for the examination?

When rescheduling, be sure to allow adequate time to retake the examination prior to your school's graduation deadline, and keep in mind the time required for remediation, rescheduling, and score report release (typically 8-10 weeks). Remember that passing COMLEX-USA Level 2-PE is a requirement for graduation, and is therefore a requirement for starting a postgraduate medical education or residency training program.

Is there a limit on how many times I can take the COMLEX-USA Level 2-PE examination?

Yes. Effective July 1, 2016, you will be limited to a total of six attempts, including but not limited to all attempts prior to July 1, 2016, and a total of three attempts within a 12-month period. Review the COMLEX-USA Bulletin of Information for details.

Standard Setting

What is standard setting?

Standard setting is a process commonly used by organizations involved with high-stakes testing. NBOME's standard-setting process ensures the standards of osteopathic medical licensure assessment reflect current medical education and medical practice.

How often are the standards changed?

The NBOME follows industry-standard best practices in establishing its schedule e.g., every three to five years for review of pass/fail standards. With the adoption of the Master Blueprint, the NBOME revisited standard setting for Level 3 in 2018 and Level 1 and Level 2-CE in 2019.  The new standards for Level 3, Level 2-CE and Level 1 are implemented in the new testing cycle – September 2018 for Level 3, May 2019 for Level 1 and June 2019 for Level 2-CE.

How does the NBOME establish the pass/fail standard for COMLEX-USA examinations?

The NBOME applies criterion-referenced methods for establishing cut scores – the score at or above which a candidate is deemed to have passed. These are sometimes referred to as "absolute standards," and are not "norm-based" or "relative" to the performance of other examinees. A process of triangulation is used to establish cut scores. This process includes standard-setting surveys, standard-setting panel meetings, and a comprehensive final review. For its computer-based testing examinations (e.g. COMLEX-USA Level 1, Level 2-CE, Level 3), the NBOME uses commonly-accepted standard setting methods such as the modified Angoff method. For its clinical skills assessment (COMLEX-USA Level 2-Performance Evaluation), the NBOME uses a generalized examinee-centered method – where panelists involved in the standard-setting process make judgments based on actual examinee performances across the entire range of score performances, relative to the skills being assessed.

Why are the standards periodically reviewed and changed?

The NBOME's mission is to protect the public by providing the means to assess competencies for osteopathic medicine and related health care professions. Consistent with our mission, the NBOME periodically reviews and resets pass/fail standards for COMLEX-USA to ensure the standards of osteopathic medical licensure examinations reflect current medical education and medical practice.

How does the NBOME notify the colleges, students, and other stakeholders about changes to the COMLEX-USA standards?

We use a number of outlets to inform interested parties about new standards. These include updates on the NBOME website, mailings to stakeholders (e.g. all deans), NBOME presentations to the American Association of Colleges of Osteopathic Medicine and the Council of Osteopathic Student Government Presidents, as well as updates at the annual meetings of the Assembly of Osteopathic Graduate Medical Educators, the AOA’s Leadership, Education, Advocacy & Development and the American Association of Osteopathic Examiners. The NBOME is continuously working to improve the effectiveness of our communications regarding standards and other areas that are important to our stakeholders. You are welcome to contact us with your feedback.

Does the NBOME monitor the consequences of the new standards?

The NBOME studies test data and their consequences quite rigorously in a process of continuous quality improvement, ever guided by our mission and mandate to "protect the public."