What Are the COMLEX-USA Exams? | MedSchoolCoach

What Are the COMLEX-USA Exams?

Joel Ramirez MD

Posted in: USMLE & COMLEX

Table of Contents

The Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) series of tests are the board exams that students in osteopathic medical schools must take in order to receive their license to practice.

Broken into 3 parts, this licensure examination tests your comprehension of what you’ve learned during your medical education and how well you can apply that knowledge to clinical practice.

Similar to USMLE, the COMLEX exams are used by residency program directors to select applicants for their graduate medical education training programs (residency programs).

You must pass the COMLEX-USA examination series to graduate with a Doctor of Osteopathic Medicine degree and be fully licensed to practice in the United States.

COMLEX Examination Series

There are three levels in the COMLEX-USA medical licensure examination series of DO board exams.

Level 1 focuses on foundational biomedical sciences and osteopathic principles. Level 2-CE tests Cognitive Evaluation (CE), looking at clinical knowledge and skills. Level 3 assesses the advanced clinical competencies required for unsupervised osteopathic medical practice.

 COMLEX Level 1COMLEX Level 2-CECOMLEX Level 3
What is tested?Application of osteopathic medical knowledge, osteopathic patient care, osteopathic principles and practice, communication skills, professionalism, and ethicsCognitive Evaluation (CE) assesses osteopathic medical knowledge concepts as they relate to clinical sciences and patient careAssessment patient presentations, seven defined competency domains, and the ability to independently practice as a osteopathic generalist physician
When to take itNear the end of your second year of medical school (M2)During your third or fourth year of medical school (M4)During residency
Exam length8 hours (two computer-based sessions, 4 hours each)8 hours (two computer-based sessions, 4 hours each)14 hours (four computer-based sessions, 3.5 hours each)
Number of questions352 multiple-choice questions352 multiple-choice questions (some involving audio-visual components)420 multiple choice questions, 26 clinical decision-making cases with 2-4 questions each
Score reportingPass/FailScaled scoreScaled score

How Is COMLEX Scored?

Each level of the COMLEX (Comprehensive Osteopathic Medical Licensing Examination) is scored based on the number of correctly answered multiple-choice questions. The raw score (the number of questions answered correctly) is converted into a standard 3-digit scaled score to allow for small variations in individual test questions.

For the Level 1 exam, you will receive a report comparing your results with other test takers and a pass/fail designation. Levels 2 and 3 provide your scaled score as part of your score report.

For all levels, the National Board of Osteopathic Medical Examiners (NBOME) ensures that the scoring process is fair and reflects a candidate’s ability to practice osteopathic medicine. The NBOME establishes the passing standard for each level through a rigorous process that involves panels of practicing osteopathic physicians.

Want to be sure to pass your COMLEX exams? Get guidance and tutoring from our experts and impress residency directors with your score.

COMLEX Study Tips

Studying begins with planning. Making a schedule for studying is the best tip we can give you for preparing for exams. If you have a realistic view when you need to know all your material, you can work in time to study and know how far out you’ll need to start your routine for each level.

More study tips you can use include:

  • Put extra effort in during your courses to learn and understand the material. This way, you’ll review before the exams and not try to cram new material in at the last minute.
  • Use question banks and flashcards. Repetition does help, and there are plenty of options for apps or old-fashioned flashcards to review your material.
  • Take the COMLEX practice exams on the NBOME website. These practice exams will help you get a baseline of your knowledge the first time you take them so you know where to focus your study efforts.
  • Don’t forget to take time for yourself. You must rest and recharge for your brain and body to perform well!


Both the United States Medical Licensing Examination (USMLE) and COMLEX are licensing exams for medical students, but they cater to different medical programs.

USMLE is the exam that allopathic (MD) medical students will take for NBME accreditation, whereas COMLEX is designed for students attending colleges of osteopathic medicine (DO) and is overseen by the NBOME. COMLEX emphasizes osteopathic principles and manipulative treatment methods.


Taking the COMLEX is a must, but USMLE is not a requirement for osteopathic medical students. You can opt to take both MD and DO board exams to improve your chances of getting into residency. 

You have to take the exams in order. You must complete and pass Level 1 prior to sitting Level 2-CE.

With a well-planned study schedule and dedication to your future career, the COMLEX exam will be a challenge, but the majority of test-takers do pass. First-time test taker pass rates are:

  • Level 1: 90%+
  • Level 2-CE: 94%+
  • Level 3: 95%+

Don’t feel ready to take COMLEX for the first time? Need to improve a poor score from last time? Students who work with our tutors improve their COMLEX scores by 105-220 points on average. Learn more about how we can help you.

To take your first of the three COMLEX exams, you must have completed one year of study at an accredited college of osteopathic medicine and be in good academic and professional standing. You must pass each level before taking the next exam. Once you are ready to take Level 3, the dean must verify your clinical skills.

From 2004-2020, COMLEX Level 2 was divided into two parts: Cognitive Evaluation and Performance Evaluation (PE). As of 2021, the PE exam was discontinued — for now, each student’s COM dean must attest to their specific clinical skills previously tested on Level 2 PE before the student may sit the Level 3 exam.

A new assessment, the Core Competency Capstone for DOs (C3DO), will include hands-on exams and assessment of Osteopathic Manipulative Treatment (OMT) skills and patient-physician communication skills. Pilot exam sessions for this new assessment will begin in March of 2024.

IMGs cannot sit for the COMLEX exams. To take the COMLEX-USA exam, a student will need to attend an accredited college of osteopathic medicine. While there are international osteopathic schools, the medical degree, Doctor of Osteopathic Medicine, is only offered by 37 medical schools in the United States.

Ace Your Boards with MedSchoolCoach

Passing the COMLEX exams is a huge milestone in the practice of osteopathic medicine. Make sure you’re prepared to succeed with a proper study schedule. 

Our experienced tutors have mastered COMLEX Levels 1 and 2 and specialize in particular areas of the examinations. Students who study with our tutors increase their scores by 105-220 points on average! Learn how you can benefit from COMLEX tutoring.
Joel Ramirez MD

Joel Ramirez MD

Dr. Ramirez is an integrated vascular surgery resident at UCSF who is passionate about teaching and tutoring for several board exams. He has served on the University of California, San Francisco School of Medicine admissions committee and is committed to being a leader in medical education.

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