COMLEX (DO Medical Licensing)
NBOME
Complete guide to passing the COMLEX (DO Medical Licensing) exam on your first attempt.
$680
~92%
7 years
USA
NBOME
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Complete Overview
COMLEX-USA is the Comprehensive Osteopathic Medical Licensing Examination of the United States, a three-level sequence run by the National Board of Osteopathic Medical Examiners for licensure as an osteopathic physician. It is taken by students and graduates of colleges of osteopathic medicine accredited by the AOA Commission on Osteopathic College Accreditation, and passing Levels 1 and 2-CE is a graduation requirement at those schools. NBOME sets the fee at $745 each for Level 1 and Level 2-CE and $950 for Level 3.
The levels must be taken in numerical order and each one passed before you can sit the next. Level 1 is usually taken in the second year of medical school, Level 2-CE in the third or fourth year, and Level 3 during residency, with NBOME recommending you wait six months after starting residency before attempting Level 3.
Level 1 and Level 2-CE share a format: a one-day, computer-based test of 320 single-best-answer multiple choice questions, split into two four-hour sessions of four 40-question sections each. NBOME reduced the item count from 352 to 320 for test cycles beginning in spring 2026 while keeping the eight hours of testing time. The full day at the centre runs about nine hours once the tutorial and breaks are included, and you receive a pool of 60 minutes of break time per exam day that you may spend across seven scheduled breaks.
Level 3 is currently a two-day exam delivered within a 14-day window, with four 3.5-hour sessions, 420 multiple choice questions and 26 clinical decision-making cases. From 13 January 2027 it becomes a one-day exam of four two-hour sessions, 240 multiple choice questions and 16 CDM cases, with the same 60-minute pooled break allowance.
Scoring differs by level. Level 1 reports pass or fail with no numeric score, alongside a Formative Performance Profile. Level 2-CE and Level 3 report a three-digit standard score plus a pass or fail designation. The passing standard is 400 for Level 2-CE and 350 for Level 3.
The blueprint is what distinguishes COMLEX-USA from the USMLE. Dimension 1 sets seven competency domains with published minimum percentages, and Osteopathic Principles, Practice and Manipulative Treatment carries a minimum of 10 percent on Level 2-CE and 12 percent on Level 1. Dimension 2 sets ten clinical presentations, with musculoskeletal the largest at a minimum of 13 percent.
In the 2025 to 2026 cycle, 9,096 first-time takers sat Level 2-CE with a 92.5 percent pass rate, against 82.1 percent for the 780 repeat takers and 90.0 percent overall. Level 1 first-time takers passed at 90.2 percent that cycle. Level 3 first-time takers passed at 97.1 percent in 2025. Candidates get four scored attempts per level, and NBOME grants an exception only at the explicit request of a medical licensing agency.
Why Get COMLEX (DO Medical Licensing) Certified?
COMLEX-USA is required for osteopathic licensure in the United States and passing Levels 1 and 2-CE is a graduation requirement at COCA-accredited colleges of osteopathic medicine.
The blueprint gives osteopathic principles, practice and manipulative treatment a published minimum of 12 percent on Level 1 and 10 percent on Level 2-CE, which is content no other licensing sequence assesses.
First-time takers passed Level 2-CE at 92.5 percent in the 2025 to 2026 cycle across 9,096 candidates, so a first attempt taken after proper preparation carries strong odds.
NBOME reduced Level 1 and Level 2-CE from 352 items to 320 for cycles beginning spring 2026 while keeping the full eight hours, which raises the time available per question.
Level 2-CE and Level 3 return a three-digit standard score plus a Performance Profile mapped to the blueprint, so a failed attempt tells you which competency domains to rebuild.
Level 3 moves to a single day on 13 January 2027, dropping from 420 multiple choice items and 26 CDM cases to 240 items and 16 cases, which cuts a two-day residency-year commitment in half.
NBOME lets you schedule up to six months ahead and advises booking at least 120 days out, which makes it possible to place the exam where it does least damage to your clerkship schedule.
Exam Format & Structure
Duration
Level 1 and Level 2-CE: two timed sessions of four hours each, eight hours of testing, with the full day at the centre running about nine hours including the tutorial and breaks. Level 3: currently four sessions of 3.5 hours across two days within a 14-day window, becoming four two-hour sessions in one day from 13 January 2027.
Questions
Level 1 and Level 2-CE: 320 single-best-answer multiple choice questions in eight sections of 40, reduced from 352 for cycles beginning spring 2026. Level 3: 420 multiple choice questions plus 26 clinical decision-making cases, changing to 240 questions plus 16 CDM cases from 13 January 2027.
Passing Score
Level 1 is reported as pass or fail with no numeric score. Level 2-CE has a passing standard of 400 and Level 3 a passing standard of 350, both on the three-digit standard score scale.
Question Types
- Single best answer multiple choice questions
- Questions carrying audiovisual exhibits including images, videos and audio clips, opened with an Exhibit button
- Clinical decision-making cases on Level 3, each presenting a scenario followed by two to four questions
- Level 3 CDM responses in extended multiple choice format, where more than one correct answer may be required, or short answer format
Delivery Method
Computer based at Pearson VUE test centres, with digital photo and palm vein biometric check-in and video monitoring throughout the session
Exam Domains & Topics
The first competency domain in Dimension 1 of the COMLEX-USA blueprint and the content that separates this sequence from allopathic licensing exams. Items test structural diagnosis, the indications and contraindications for manipulative techniques, and the reasoning that links somatic dysfunction to the presenting clinical problem.
Key Topics to Master:
- Structural examination and diagnosis of somatic dysfunction
- Viscerosomatic and somatovisceral reflex relationships including Chapman points
- Direct techniques including muscle energy, high velocity low amplitude and articulatory
- Indirect techniques including counterstrain, myofascial release and facilitated positional release
- Cranial osteopathy and lymphatic pump techniques
- Absolute and relative contraindications to manipulative treatment
- Osteopathic tenets applied to case management decisions
- Documentation and billing implications of osteopathic manipulative treatment
The largest published minimum on the Level 2-CE blueprint. This domain covers the direct work of caring for patients: gathering and interpreting data, forming a differential, choosing management and performing or ordering procedures in a supervised clinical setting. Its weight jumps fivefold between Level 1 and Level 2-CE.
Key Topics to Master:
- History and physical examination findings interpretation
- Diagnostic test selection and result interpretation
- Differential diagnosis construction from an undifferentiated presentation
- Pharmacologic management including dosing, interactions and monitoring
- Non-pharmacologic and procedural management decisions
- Health promotion, screening and disease prevention planning
- Acute stabilisation and triage decisions
- Follow-up planning and referral thresholds
The knowledge application domain, which includes a nested foundational biomedical sciences knowledge base carrying a minimum of 25 percent on Level 2-CE and 75 percent on Level 1. The inversion between levels is the clearest signal of how your preparation should change: Level 1 is a science exam applied to cases, Level 2-CE is a clinical exam that still expects the science underneath.
Key Topics to Master:
- Pathophysiology linking mechanism to clinical presentation
- Pharmacology including mechanism, adverse effects and drug interactions
- Microbiology and the organism to syndrome mapping
- Immunology applied to hypersensitivity and immunodeficiency presentations
- Anatomy applied to procedural and manipulative reasoning
- Biochemistry and genetics in metabolic and inherited disease
- Biostatistics and epidemiology in study interpretation
Items in this domain ask how a physician improves their own practice: appraising evidence, interpreting the medical literature, and using data to change what they do. Expect study design questions, statistical interpretation and scenarios about applying a published result to the patient in front of you.
Key Topics to Master:
- Study design identification and its limitations
- Sensitivity, specificity and predictive values applied to a clinical decision
- Relative risk, odds ratios, absolute risk reduction and number needed to treat
- Bias, confounding and internal versus external validity
- Applying guideline recommendations to an individual patient
- Self-assessment and lifelong learning practices
- Interpreting quality metrics and outcome data
Communication items test how information moves between physician, patient, family and team. Since the Level 2-Performance Evaluation was formally discontinued in June 2022, this written domain carries the communication assessment that a standardised patient encounter used to cover.
Key Topics to Master:
- Delivering bad news and responding to emotion
- Shared decision making and eliciting patient values
- Communicating across language and health literacy barriers
- Motivational interviewing and behaviour change conversations
- Handoff and team communication structures
- Documentation that communicates clinical reasoning
- Managing a difficult or angry patient encounter
Ethics and professional conduct items, carrying a higher minimum on Level 2-CE than on Level 1. These questions typically present a conflict between what a patient wants, what a colleague has done and what the physician is obliged to do, and ask for the next appropriate action rather than a diagnosis.
Key Topics to Master:
- Informed consent and assessment of decision-making capacity
- Confidentiality and its legal exceptions
- Advance directives, surrogate decision makers and end of life care
- Conflicts of interest including industry relationships
- Reporting an impaired or unprofessional colleague
- Boundaries in the physician patient relationship
- Disclosure of medical error
The smallest competency domain on both levels, covering how care is organised, financed and made safe. Items cover the mechanics of the health system rather than disease, including insurance structures, transitions of care and the systems approaches used to prevent harm.
Key Topics to Master:
- Health care financing including Medicare, Medicaid and private insurance
- Cost-conscious care and resource stewardship
- Patient safety frameworks and error prevention systems
- Care coordination and transitions between settings
- Interprofessional team roles and scope of practice
- Population health and community resources
- Public health reporting obligations
The second dimension of the blueprint organises content by how patients present rather than by competency. Published minimums for Level 2-CE are musculoskeletal 13 percent, community health and wellness 12 percent, nervous system and mental health 10 percent, gastrointestinal and nutritional health 10 percent, circulatory and hematologic 10 percent, respiratory 10 percent, and 5 percent each for human development and reproduction, endocrine and metabolism, genitourinary and renal and breasts, and integumentary.
Key Topics to Master:
- Musculoskeletal presentations, the largest Dimension 2 category at a 13 percent minimum
- Community health and wellness presentations at a 12 percent minimum
- Nervous system and mental health presentations
- Gastrointestinal system and nutritional health presentations
- Circulatory and hematologic system presentations
- Respiratory system presentations
- Human development, reproduction and sexuality presentations
- Endocrine system and metabolism, genitourinary and renal and breasts, and integumentary presentations
Recommended Study Plan
- 1Read the COMLEX-USA Blueprint pages for Dimension 1 competency domains and Dimension 2 clinical presentations, noting the published minimums for the level you are sitting
- 2Sit a COMSAE Phase 2 self-assessment from NBOME to get a baseline against the 400 passing standard for Level 2-CE
- 3Read the COMLEX-USA Bulletin of Information sections on eligibility, retaking an examination and examination administration
- 4Confirm your dean has provided the good academic and professional standing attestation, since you cannot register without it
- 5Book your date, allowing the 120 days ahead that NBOME advises given limited seats
- 1Work through structural diagnosis by region, then the direct and indirect technique families
- 2Drill viscerosomatic reflex levels and Chapman point locations until recall is automatic
- 3Memorise the absolute and relative contraindications for high velocity low amplitude technique
- 4Complete an OMM-focused question set from TrueLearn COMBANK or COMQUEST, since this domain carries a published 10 percent minimum on Level 2-CE
- 5Review Savarese OMT Review or your school's equivalent text for technique indications
- 1Cover rheumatology, orthopaedics and sports medicine, the largest Dimension 2 category at a 13 percent minimum
- 2Link each musculoskeletal presentation to the manipulative treatment that would be appropriate or contraindicated
- 3Drill imaging selection for back pain, joint pain and fracture presentations
- 4Complete a mixed musculoskeletal question block in timed mode
- 1Work cardiology and pulmonology question blocks covering the two 10 percent minimum categories
- 2Drill ECG interpretation and chest imaging pattern recognition, since audiovisual exhibits appear on the exam
- 3Review anticoagulation decisions, anaemia workup and transfusion reactions
- 4Practise linking rib and thoracic somatic dysfunction to respiratory presentations
- 1Cover gastrointestinal and nutritional health at a 10 percent minimum plus endocrine and metabolism at 5 percent
- 2Work diabetes management, thyroid disorders and adrenal presentations
- 3Review gastrointestinal bleeding, liver disease and pancreatitis pathways
- 4Complete a timed mixed block and review every incorrect answer against the competency domain it maps to
- 1Work neurology and psychiatry, which together form the 10 percent minimum nervous system and mental health category
- 2Drill stroke, seizure and headache decision pathways
- 3Review psychiatric diagnostic criteria and first line pharmacotherapy
- 4Cover dermatology presentations at the 5 percent integumentary minimum, focusing on image recognition
- 1Cover renal and genitourinary presentations alongside breast disease at the 5 percent minimum
- 2Work obstetrics, gynaecology and paediatric development under human development, reproduction and sexuality
- 3Drill electrolyte and acid base disorders as clinical vignettes rather than isolated calculations
- 4Review screening schedules across the lifespan, which cross into the community health category
- 1Cover community health and patient presentations related to wellness, the second largest Dimension 2 category at a 12 percent minimum
- 2Work preventive care, immunisation schedules and screening guideline questions
- 3Study health care financing, care coordination and patient safety for the systems-based practice domain
- 4Drill professionalism and ethics vignettes, which carry a 7 percent minimum on Level 2-CE
- 1Work every biostatistics question in your bank, covering study design, bias and the calculation set
- 2Practise applying a published trial result to an individual patient, the core of practice-based learning and improvement
- 3Drill communication vignettes on breaking bad news, shared decision making and handoffs
- 4Sit a second COMSAE self-assessment to measure movement against the passing standard
- 1Sit a full 320 question simulation split into two four-hour sessions of four 40-question sections
- 2Rehearse spending your 60-minute pooled break across the seven scheduled break points rather than exhausting it early
- 3Practise the review screen workflow inside each section, since NBOME states that time spent reviewing questions or adding comments counts toward your total testing time
- 4Review the NBOME sample questions to confirm you can use the highlight, strikeout and calculator tools without hesitation
- 1Rebuild the two weakest competency domains from your COMSAE Performance Profile with fresh question blocks
- 2Redo previously missed OMM questions, since that domain is the one most candidates leave until last
- 3Rewrite your viscerosomatic reflex and technique contraindication sheets from memory and check them
- 4Sit a final COMSAE self-assessment under full timing
- 1Taper question volume and revise your own summary sheets rather than opening new resources
- 2Confirm the name on your government-issued photo ID matches your NBOME portal record, and email [email protected] at least 5 days ahead if a name change is needed
- 3Check your ID is unexpired and carries both a photograph and a signature
- 4Plan to arrive at the Pearson VUE centre at least 30 minutes before your start time
- 5Pack nothing you cannot store: no watch, no eyeglass case, no pens, and no hair clips wider than a quarter inch
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Best Study Resources
COMLEX-USA Blueprint
Official blueprintNBOME's published two-dimension blueprint, giving the seven Dimension 1 competency domains and the ten Dimension 2 clinical presentations with a minimum percentage for each level. Every question on the exam is built against it.
Free
COMLEX-USA Bulletin of Information
Official policy documentCovers eligibility, registration and scheduling, examination administration, irregular conduct, scoring and transcripts. It contains the four scored attempt limit and the rules on adverse testing conditions that you must report within 10 calendar days.
Free
COMSAE Phase 1, Phase 2 and Phase 3
Official self-assessment examinationsNBOME's own self-assessment series, aligned to Level 1, Level 2-CE and Level 3 respectively. These are the only practice exams written by the organisation that writes the real exam.
Paid, priced per form by NBOME
COMLEX-USA practice resources and sample questions
Official practice materialsSample questions for each level plus tutorials for the exam tools. Use these to learn the highlight, strikeout and calculator functions before the day, since the tutorial must be completed in 16 minutes or the surplus comes out of your testing time.
Free
TrueLearn COMBANK
Commercial question bankA COMLEX-specific question bank with dedicated osteopathic principles and manipulative treatment coverage, which general USMLE-oriented banks do not provide at the depth the blueprint minimum requires.
Subscription pricing by duration
COMQUEST
Commercial question bankAnother COMLEX-focused bank with question sets organised by level. Useful as a second bank when you have exhausted your primary one and need unseen items for timed practice.
Subscription pricing by duration
Savarese OMT Review
Review bookA long-standing osteopathic manipulative medicine review text organised by region and technique. Most candidates use it for the contraindication lists and the viscerosomatic reflex tables.
Standard textbook pricing
UWorld Step 2 CK question bank
Commercial question bankNot COMLEX specific, but widely used by DO students because the clinical reasoning content overlaps with the osteopathic patient care domain, which carries a 30 percent minimum on Level 2-CE. Pair it with an OMM-specific resource rather than relying on it alone.
Subscription pricing by duration
COMLEX-USA testing windows and score release dates
Official scheduling calendarNBOME publishes the testing windows and the corresponding score release dates. Scores are generally available two to six weeks from the end of a Level 1 or Level 2-CE testing window, so the window end date matters more than your individual test date.
Free
NBOME Candidate Assistance Program
Fee relief programmeNBOME's programme for candidates who have to cancel or reschedule because of circumstances outside their control, such as a cancelled flight on the way to the test centre. It is the route to relief from the rescheduling and no-show forfeitures, which run to $400 on Level 1 and Level 2-CE and $500 on Level 3.
Free to apply
Common Mistakes to Avoid
Preparing entirely from USMLE-oriented resources and treating osteopathic manipulative treatment as a small add-on in the final week.
Osteopathic principles, practice and manipulative treatment carries a published minimum of 12 percent on Level 1 and 10 percent on Level 2-CE. On a 320 item paper that is at least 32 questions on Level 2-CE. Give it a dedicated block early, not a weekend at the end.
Preparing for Level 2-CE the way you prepared for Level 1.
The foundational biomedical sciences knowledge base drops from a 75 percent minimum on Level 1 to 25 percent on Level 2-CE, while osteopathic patient care and procedural skills rises from 6 percent to 30 percent. Shift from mechanism recall to management decisions.
Spending the tutorial adjusting fonts and colours until it runs long.
NBOME warns that the tutorial must be completed in 16 minutes or less or the extra time comes out of your testing time. The tutorial is also the only point at which you may write on the whiteboard before testing starts, so set preferences fast and use what remains for notes.
Going to the locker between sections to grab a snack or check a phone.
Items in your locker may only be accessed during scheduled breaks. NBOME states that accessing your locker at any other time will be reported as irregular conduct and may trigger a review of your examination.
Burning the break pool early because the sessions feel long.
You get a pool of 60 minutes per exam day to spend across seven scheduled breaks. Level 1 and Level 2-CE keep you at the centre roughly nine hours, so plan the split before you arrive rather than deciding at each break screen.
Wearing a watch, a wide hairband or removable jewellery to the centre.
Watches are prohibited outright. Barrettes and hair clips wider than a quarter inch, headbands wider than half an inch, and removable jewellery larger than a quarter inch are all barred. Wedding and engagement rings are the only jewellery permitted.
Assuming you can retake a passed level to raise a Level 2-CE score for residency applications.
NBOME states that candidates who have passed an examination may not retake it to improve their score or for any purpose other than to pass a previously failed examination. Your first passing Level 2-CE score is the one programs see.
Treating incomplete or voided attempts as though they do not count.
Candidates are limited to four scored attempts per level and may not take a level more than four times in a 12-month period, including incomplete or voided attempts. The only exception beyond four scored attempts requires a written petition from a medical licensing agency.
Reporting a testing problem to Pearson but not to NBOME.
An adverse testing condition must be reported both to Pearson at the time of the examination and to NBOME within 10 calendar days following the exam. Missing the 10 day window closes the route to relief.
Exam Day Tips
- 1
Arrive at the Pearson VUE centre at least 30 minutes before your start time. A test administrator will review the candidate rules and security protocols with you and ask you to sign them.
- 2
Bring one unexpired government-issued photo ID that includes both your picture and your signature. A driving licence or passport works. A military ID is accepted but must be paired with a second ID carrying your signature.
- 3
Check that the name on your ID matches your name in the NBOME portal. If your legal name changed after you registered, email [email protected] at least 5 days before the exam.
- 4
Expect a digital photo and a palm vein scan before you enter the room, and another palm vein scan every time you enter or leave it. You will be monitored in person by the administrator and on video for the whole session.
- 5
You may keep only your ID and your locker key with you at the desk. Phones, watches, wallets, bags, coats, hats, eyeglass cases, pens, pencils, books and notes all go in the locker.
- 6
You will be asked to remove your eyeglasses for close visual inspection at check-in, part of Pearson's measures against camera devices hidden in frames.
- 7
Food and water stay in the locker and can only be reached during scheduled breaks, so plan what you eat and when around the seven break points rather than around hunger.
- 8
Test the headphones during the tutorial. Some questions carry audiovisual exhibits opened with an Exhibit button, and a headphone fault should go to the test administrator immediately rather than mid-section.
- 9
Use the review screen at the end of each section to check unanswered and flagged items, but remember that time spent reviewing or adding comments counts against your total testing time.
- 10
After you finish there is a post-exam survey, which NBOME confirms is not counted as part of your testing time. Then sign out and return the locker key.
Career Paths & Salary Ranges
Osteopathic medical student progressing to graduation
Passing COMLEX-USA Levels 1 and 2-CE is a graduation requirement for a DO degree from a COCA-accredited college of osteopathic medicine. Level 1 comes after the first year of study and Level 2-CE after the second, each requiring a dean's attestation of good academic and professional standing.
DO residency matching
ACGME residency applicant
COMLEX-USA is used for entry into and promotion within graduate medical education programs. Level 2-CE returns a three-digit standard score against a passing standard of 400, and NBOME reports growing acceptance of COMLEX-USA for DO applicants across surgical specialties.
DO residency matching
Osteopathic resident completing licensure
Level 3 is taken during residency, with NBOME recommending you wait six months after starting. Eligibility requires passing Levels 1 and 2-CE, graduating from an accredited COM, a program director attestation and a clinical skills attestation from the COM dean.
DO residency matching
DO who also sits the USMLE
Students at COCA-accredited schools are eligible for both sequences. First-time takers from DO-granting schools passed USMLE Step 2 CK at 96 percent in the 2024 to 2025 reporting year, and many take both to broaden their residency options.
DO residency matching
Osteopathic physician seeking state licensure
COMLEX-USA is the licensure pathway for osteopathic practice in the United States. Individual state medical boards set their own attempt limits and timing rules, which may differ from NBOME's own four attempt policy.
DO residency matching
Candidate outside a residency program
NBOME created an alternate pathway for Level 3 candidates who cannot obtain a residency program director attestation. It considers cases individually and will accept an attestation from the dean of the COM the candidate graduated from, submitted with a petition.
DO residency matching
Prerequisites & Requirements
- For Level 1: completion of the first year of study at a college of osteopathic medicine accredited by the AOA Commission on Osteopathic College Accreditation, plus a good academic and professional standing attestation from the COM dean.
- For Level 2-CE: a passing result on Level 1, completion of the second year of study at an accredited COM, and a good academic and professional standing attestation from the COM dean.
- For Level 3: passing results on Levels 1 and 2-CE, graduation from an accredited COM, a good academic and professional standing attestation from a residency program director, and a clinical skills attestation from the COM dean or a passing Level 2-PE result. NBOME recommends completing six months of graduate medical education first.
- The levels must be taken in numerical order and each level passed before you become eligible for the next.
- You must establish and maintain an online NBOME account, agree to the Terms and Conditions, and provide proof of identity at the examination.
- Candidates dismissed from or withdrawing from a COM or residency program are ineligible, and you must inform NBOME promptly of any change to your status.
Frequently Asked Questions
How much does COMLEX-USA cost?
NBOME sets the fee at $745 for Level 1, $745 for Level 2-CE and $950 for Level 3. Rescheduling or cancelling more than 30 days before your scheduled date costs nothing. Between 6 and 30 days out the fee is $85, between 1 and 5 days out it is $250, and a no show within 24 hours of the scheduled date costs $400.
What is the passing score for COMLEX-USA?
Level 1 reports only pass or fail with no numeric score. Level 2-CE has a passing standard of 400 and Level 3 a passing standard of 350, both reported as three-digit standard scores. The raw number of questions answered correctly is converted to a model-based standard score that accounts for the psychometric properties of the form.
How many questions are on COMLEX-USA Level 2-CE?
320 single-best-answer multiple choice questions, delivered in two four-hour sessions with four 40-question sections each. NBOME reduced the count from 352 to 320 for test cycles beginning in spring 2026 while keeping the total testing time at eight hours, which increased the time available per question.
How much break time do I get?
You receive a pool of 60 minutes of break time for each examination day, which you may use across seven scheduled breaks. Level 1 and Level 2-CE keep you at the test centre for approximately nine hours in total once the tutorial and breaks are counted. Level 3 currently runs approximately eight hours on each of two days.
What happens if I fail a COMLEX-USA level?
You may retake it, but you are limited to four scored attempts per level and may not take a level more than four times within a 12-month period, counting incomplete and voided attempts. For Level 2-CE and Level 3 the score report includes a Performance Profile mapped to the blueprint that shows where you underperformed. An exception beyond four scored attempts is granted only at the explicit request of a medical licensing agency, and requires a written petition plus documentation from your COM dean or program director confirming good standing.
How long do COMLEX-USA results take?
Scores are generally available two to six weeks from the end date of the testing window for Level 1 and Level 2-CE, and eight to 10 weeks from the end date of a Level 3 testing window. The clock runs from the close of the window rather than from your individual test date. You are notified by email and access reports through the NBOME Portal.
What are the COMLEX-USA pass rates?
In the 2025 to 2026 cycle, 9,096 first-time takers sat Level 2-CE with a 92.5 percent pass rate, while 780 repeat takers passed at 82.1 percent, for a 90.0 percent overall rate. Level 1 in the same cycle had 9,678 first-time takers at 90.2 percent and 1,080 repeat takers at 77.5 percent. Level 3 in 2025 had 8,596 first-time takers passing at 97.1 percent.
Can I retake a level to improve my score?
No. NBOME states that candidates who have passed an examination may not retake it to improve their score or for any purpose other than to pass a previously failed examination or one where the score has been voided. Candidates also may not take a level for practice.
What identification do I need at the test centre?
One unexpired government-issued photo ID that includes both your picture and your signature. NBOME names driving licences, passports and military IDs as acceptable, with the caveat that a military ID must be accompanied by a secondary ID showing your signature. The name on the ID must match your name in the NBOME portal, and name changes must be submitted to [email protected] at least 5 days before the exam.
Can I bring a calculator?
You do not need to. A standard calculator is built into the examination software, alongside text highlighting and text strikeout tools, and you can adjust font size and text and background colour during the tutorial or at any point in the exam. Pens, pencils, books and notes are all prohibited in the testing room; note-taking materials such as a whiteboard and marker are provided.
How do I request test accommodations?
Apply directly to NBOME with the accommodations form, objective documentation of your disability under the ADA and a personal statement, submitted to [email protected] or by certified mail. NBOME advises requesting accommodations at least 90 days before the first day of your preferred testing window, and states that a complete application is generally decided within approximately 75 days of receipt. You may apply once you have completed one year of medical school, even before your COM has made you eligible for Level 1.
How far ahead should I schedule?
NBOME advises attempting to schedule at least 120 days ahead of your desired test date because dates and seats are limited. Testing dates for all three levels are generally available for scheduling up to six months in advance, and you must be made eligible by your COM or residency program director before you can register.
How long are COMLEX-USA results valid?
NBOME does not expire a passing result, but state medical licensing agencies set their own time limits and attempt policies for licensure, and these can differ from NBOME's own rules. NBOME directs candidates to individual licensing agency websites or the Federation of State Medical Boards for state-specific requirements.
What happened to COMLEX-USA Level 2-PE?
The Level 2-Performance Evaluation, the standardised patient clinical skills exam, was formally discontinued in June 2022. NBOME replaced it for Level 3 eligibility with a clinical skills attestation, in which the dean of an accredited COM attests that the candidate graduated with a DO degree and demonstrated the fundamental osteopathic clinical skills required for graduation. That attestation model remains in place through the Class of 2028.
How does COMLEX-USA compare with the USMLE?
Both lead to physician licensure in the United States, but COMLEX-USA is the osteopathic sequence and assesses osteopathic principles, practice and manipulative treatment, which carries a published minimum of 10 percent on Level 2-CE and 12 percent on Level 1. USMLE has no equivalent content. COMLEX-USA Level 2-CE costs $745 against $695 for USMLE Step 2 CK in 2026 and 2027. DO students are eligible for both, and many sit Step 2 CK as well to widen their residency options.
What is the Level 3 format change in January 2027?
From 13 January 2027 Level 3 becomes a one-day exam. The current two-day version delivered within a 14-day window has four 3.5-hour sessions, 420 multiple choice questions and 26 clinical decision-making cases. The new version has four two-hour sessions, 240 multiple choice questions and 16 CDM cases, with optional breaks deducted from a 60-minute pooled allowance and a 10-minute CDM tutorial before the case sessions.
What are clinical decision-making cases?
They appear only on Level 3. Each case presents a clinical scenario followed by two to four questions on key decisions an independently practising osteopathic physician would face. They assess data acquisition such as ordering tests, data interpretation such as generating a diagnosis, and treatment and management such as prescribing or planning follow-up. Responses use extended multiple choice, where more than one correct answer may be required, or short answer format.
What should I do if something goes wrong during my exam?
Report it twice. An adverse testing condition is an event outside your control that significantly interrupts the normal administration of the exam and affects your performance. You must report it to Pearson at the time of the examination and to NBOME within 10 calendar days immediately following your exam. NBOME also offers a score confirmation service, for a fee, if you want your results reviewed one extra time.
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