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Examination Format

COMLEX-USA Computer-Based Examinations

The COMLEX-USA examinations are administered only in the English language in a standardized, time-measured environment to assess the candidate’s ability to interpret, process, and apply clinical knowledge and skills with fluency.

This is fundamental to an osteopathic generalist physician’s competence to practice osteopathic medicine. Passing Levels 1 and 2 of COMLEX-USA is required to graduate medical school and begin postgraduate medical education or a residency training program.

The COMLEX-USA two-day Level 3 examination consists of 420 multiple-choice questions (items) with a single best answer and 26 Clinical Decision-Making (CDM) cases. The examination is divided into two 3.5-hour sessions per day. During each examination day, three optional breaks can be taken: two 10-minute breaks and a 40-minute lunch break. Use of these optional breaks does not reduce candidates’ available testing time.

What Are CDM cases?

COMLEX-USA Level 3 includes two sections containing CDM cases. The cases assess the ability to make appropriate patient management decisions as an independently practicing osteopathic generalist physician. The cases are meant to assess not only factual knowledge but also the ability to apply knowledge and skills in caring for patients. This ability is especially important in the Level 3 examination because it is the pathway to licensure for osteopathic generalist physicians to practice in an unsupervised setting.

The CDM portion of the examination contains a series of clinical scenarios, each typically followed by two to four questions. The cases focus on key, critical decisions or challenges related to patient care that are routinely faced by osteopathic generalist physicians. CDM 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, planning follow-up care).

A CDM exam tutorial and a practice examination with sample cases can be found on the Practice & Preparation page.


COMLEX-USA Two-Day Level 3 Outline

Session Time
MORNING 3.5 Hours Total testing time for sections 1 and 2
Tutorial/instructions - standard 14 minutes
Section 1: 70 MCQ items
Authorized break 10 minutes
Section 2: 70 MCQ items
Authorized lunch break 40 minutes
AFTERNOON 3.5 Hours Total testing time for sections 3 and 4
Section 3: 70 MCQ items
Authorized break 10 minutes
Section 4: 70 MCQ items

Session Time
MORNING 3.5 Hours Total testing time for sections 5 and 6
Tutorial/instructions - standard 14 minutes
Section 5: 13 CDM cases
Authorized break 10 minutes
Section 6: 13 CDM cases
Authorized lunch break 40 minutes
AFTERNOON 3.5 Hours Total testing time for sections 7 and 8
Section 7: 70 MCQ items
Authorized break 10 minutes
Section 8: 70 MCQ items

Examination Features

Multiple Choice Question (MCQ) Section Review Screen
A review page is presented upon the completion of each MCQ section. Candidates can review the status of the MCQs in the current section, including questions answered, questions marked for further review, and questions not answered.

Advancing Through Examination Sections

Once a candidate submits all answers and ends a section, they cannot return to review or change any answers within that section.

Time Limitations

Although each session is 3.5 hours in total, the two individual sections within a session are self-paced. A clock is provided to assist with time management. Warnings are given of the time remaining before the end of each 3.5-hour session.

Examination Visual References

Use of an “Exhibit” button may be required in order to see media related to a test question. These exhibits include images, videos, or audio avatars. In some cases, multiple exhibits may be used in order to answer a question.

Additional Tools

Functional features are available, including a standard calculator and laboratory values with reference ranges (where applicable) embedded directly into exam questions.

Reference Materials

Fundamental Osteopathic Medical Competency Domains


Client Registration System Tutorial


Candidate Assistance Program: Rescheduling Fee Waivers

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