The Comprehensive Osteopathic Medical Licensing Examination (COMLEX) helps test an osteopathic physician’s medical knowledge and clinical skills necessary to have a license to practice medicine in an unsupervised setting. Divided into three separate levels, the series is intended to reflect the knowledge a physician should have at certain levels of his or her medical school and upper-level training. Individuals who wish to work as osteopathic physicians must pass all three levels of the exam to practice medicine and surgery.

COMLEX Level 1

The COMLEX Level 1 evaluates a student’s medical knowledge and clinical skills at a basic level. Osteopathic principles will be covered throughout the various content areas of the examination. The test is structured by problem- and symptom-based assessment, and covers knowledge of fundamental sciences such as anatomy, physiology, pharmacology, pathology, microbiology, biochemistry, and behavioral science.

Taking the COMLEX Level 1

Testing candidates must fulfill certain requirements before they will be permitted to take the COMLEX Level 1. They must successfully complete their first academic year at an steopathic medical school accredited by the American Osteopathic Association’s Commission on College Accreditation. Candidates must be in good standing with the school and must be approved to take the exam by the school’s dean.

Not only are candidate requirements fairly strict, but the day of the exam will be quite regimented, as well. Plan to spend one day taking the Level 1 exam. Testing sessions are broken into two 4-hour blocks. The National Board of Osteopathic Medical Examiners (NBOME) encourages test candidates to arrive at the testing center at least 30 minutes early. Examinees must sign in once they enter the waiting area, and the proctor will then call candidates when it is time to begin the test. Any level of the COMLEX is administered under very secure circumstances. Test takers are monitored continually, and only limited personal effects may be taken into the test center; other items must be left in secure lockers.

Students may take the Level 1 exam no more than four times in a 12-month period. While examinees may not retake the test for the purpose of improving their exam scores, they can retake the test in an attempt to pass it if they have failed previously.

Scoring for the test is in the form of both a 3-digit standard score and a 2-digit standard score to help determine passing and failing scores and report exam results. According to the Bulletin of Information, a passing score on the Level 1 exam is 400, or 75; note that the 2- and 3-digit scores are not percentage scores or a representation of how many items the examinee answered correctly. Scores are based on how the examinee performs on the exam overall, rather than in specific content areas. Results will be sent to both the candidate and the dean of the candidate’s school.

COMLEX Level 2

The second level of exams in the COMLEX series is divided into two parts: the Cognitive Evaluation (CE) and Performance Evaluation (PE). The tests measure a candidate’s proficiency in the clinical concepts and principles required for medical problem-solving, and include a demonstration of clinical skills, as well.

The Level 2-CE is a symptom- and problem-based assessment of clinical disciplines of emergency medicine, internal medicine, obstetrics/gynecology, family medicine, pediatrics, psychiatry, and surgery, as well as osteopathic and other principles that aid in solving medical problems. This portion of the test is similar in approach to the problem and symptom emphasis found in the Level 1 exam. The test is administered over two 4-hour sessions. Passing this part of the Level 2 test indicates that a candidate has the knowledge necessary to solve medical problems in a supervised setting and begin graduate medical studies.

In the Level 2-PE, candidates spend seven hours on their test day working with twelve standardized patients and demonstrating the clinical skills they have acquired. The PE is intended to help improve patient safety by documenting that osteopathic medical school graduates have the skills necessary to practice medicine. Some of those skills include taking a patient history,performing a physical exam, and utilizing osteopathic manipulative treatment. Students are also judged on their ability to interact with patients of either gender, and with those of varying ethnic and cultural backgrounds and diverse ages. The test is administered at the NBOME

National Center for Clinical Skills Testing near Philadelphia, Pennsylvania. NBOME has detailed the test format and examination design at its website. Like the CE component of the exam, the PE portion also helps demonstrate that a candidate has the abilities necessary to pursue graduate medical studies.


Eligibility for the COMLEX Level 2

Several eligibility requirements apply to candidates who wish to take the COMLEX Level 2-PE and Level 2-CE. First, a student cannot take either portion of the Level 2 exam without first passing the Level 1 test. Students must also finish their second year of study at an osteopathic medical school accredited by the American Osteopathic Association’sCommission on Osteopathic College Accreditation, and must be in good standing at the accredited school. Additionally, the Office of the Dean of the accredited school must approve a candidate to take the Level 2 exam.

The COMLEX examinations must be taken in sequential order. However, it does not matter in which order the candidate takes the Level 2-CE and Level 2-PE. Both parts of the Level 2 exam must be successfully completed for a candidate to move on to the Level 3 test, unless the individual has received an exemption. Those who have graduated from an accredited osteopathic medical school before January 1, 2005, and who have completed the Level 2-CE before June 30, 2005, do not have to take the Level 2-PE before becoming eligible to take the Level 3 portion of the COMLEX series.

As with all levels of the COMLEX exams, Level 2 is scored with both a three-digit and a two-digit number. Passing scores for the test are 400 and 75. Score reports for the CE will be mailed to the test candidate and the dean of the candidate’s school within four to six weeks of the test date. Reports for the PE will be mailed within eight to ten weeks.

COMLEX Level 3

As the final step in the COMLEX series, the Level 3 exam requires candidates to demonstrate that they have the skills and knowledge required to make appropriate patient management choices. The Level 3 exam follows a problem- and symptom-based format, focusing on disciplines such as emergency medicine, internal medicine, obstetrics and gynecology, family medicine, pediatrics, surgery, psychiatry, and others. Successfully passing the Level 3 exam can serve as a sound indicator to state medical licensing boards that a candidate is ready to practice medicine in an unsupervised setting.

Taking the COMLEX Level 3

To be eligible to take the Level 3 test, candidates must have successfully passed the COMLEX Level 1 and Level 2 examinations, and must have graduated with a Doctor of Osteopathic Medicine (DO) degree from an osteopathic medical school accredited by the American Osteopathic Association’s Commission on Osteopathic College Accreditation. Additionally, the National Board of Osteopathic Medical Examiners (NBOME) must either receive confirmation from the candidate’s Office of the Dean that the candidate has graduated, or must receive a copy of the candidate’s medical school diploma.

Ordinarily, the different levels of the COMLEX series must be taken in order. Candidates are generally not eligible to take the Level 3 exam until they have successfully completed the Level 1 and Level 2 tests. However, those who graduated from an accredited college of osteopathic medicine before January 1, 2005, and who have passed the COMLEX Level 2 Cognitive Evaluation before June 30, 2005, do not need to pass the COMLEX Level 2 Performance Evaluation before taking the Level 3.

Plan to spend one day completing the Level 3 exam. The test is broken into two 4-hour testing sessions. The questions on the test will be varied, relating to an array of clinical presentations and osteopathic principles. How well you perform on the test, and the score you ultimately receive, will be presented in a standardized format. Each level of the COMLEX comes with two-digit and three-digit scores. On the Level 3 test, a two-digit score of 75 or a three-digit score of 350 are considered passing. The NBOME mails score reports to the candidate and the Director of Medical Education of the candidate’sresidency/internship program, if requested, within four to six weeks after the examination.

The NBOME does not limit the number of times candidates may retake an exam they did not pass. However, the agency suggests that state authorities permit no more than three attempts to pass a level without candidates demonstrating that they have acquired additional educational experience acceptable to the NBOME.

The time frame set for passing all three levels of the COMLEX can vary from state to state. However, the NBOME suggests that the sequence be completed within seven years from the date that Level 1 was passed. Candidates should contact their individual state licensing authorities for further information.

Format of the COMLEX

The structure of the exams emphasizes the use of osteopathic medicine in solving medical problems. Each test in the series can be categorized into two dimensions: Clinical Presentation and Physician Task. The Clinical Presentation dimension pinpoints various “high-frequency” or “high-impact” issues faced in an osteopathic physician’s practice. The Physician Task dimension reviews the steps osteopathic physicians must follow to solve medical problems.

The National Board of Osteopathic Medical Examiners, Inc. (NBOME) initiated the current COMLEX exam series in 1995. The exam results are accepted in all 50 states and in certain provinces in Canada. The exams must be taken in numerical order, and NBOME has advised medical licensing authorities that it is best for the tests to be completed successfully within a seven-year period, starting with the date the COMLEX Level 1 was passed.

For more specific information regarding medical licensure in a particular state, examinees should contact that state’s licensing authority.

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