What is COMLEX Exam?
What is COMLEX Exam?
The Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) is a series of medical licensure examinations for osteopaths. It is designed to evaluate osteopathic medical expertise and clinical skills considered necessary for osteopathic general practitioners in the practice of osteopathy.
The COMLEX exam series follows a progressive series broken down into three levels: Level 1, Level 2 (CE/PE), and Level 3. It is administered continuously throughout the year by the National Board of Osteopathic Medical Examiners (NBOME) and is accepted in all the 50 states.
The COMLEX-USA concept is focused on the osteopathic theory of general health care, self-healing and self-regulatory processes, the basic structure-function relation as well as the interdependence of body systems, and the full extent of the osteopathic method to patient care, including osteopathic coercive treatment.
COMLEX Format and Test Structure
As mentioned above, the COMLEX is a series of licensing examination broken into three levels:
COMLEX Level 1
A problem-and-symptom-based test, conducted in a time-based setting that combines fundamental biomedical sciences and other fields of medical knowledge related to the resolution of clinical issues and the promotion and preservation of health in the delivery of osteopathic medical treatment to patients.
Foundational Biomedical Sciences:
- Anatomy
- Behavioral Science
- Biochemistry
- Genetics
- Health Promotion and Disease Prevention
- Immunology
- Microbiology
- Osteopathic Principles and Practice
- Pathology
- Pharmacology
- Physiology
| Subsection | No. of Questions | Description |
| 1 | 50 | Morning Session: 4 Hours Total Testing Time |
| 2 | 50 | |
| Authorized 10-minute break | ||
| 3 | 50 | |
| 4 | 50 | |
| Authorized 40-minute lunch break | ||
| 5 | 50 | Afternoon Session: 4 Hours Total Testing Time |
| 6 | 50 | |
| Authorized 10-minute break | ||
| 7 | 50 | |
| 8 | 50 | |
| Total | 400 | 8 hours |
Note: Questions can be answered, reviewed, and changed one subsection at a time. Individual subsections are not timed.
COMLEX Level 2
- Cognitive Evaluation (CE) – a one-day computer-based test that combines the integration of expertise in clinical science and basic biomedical and osteopathic disciplines with other medical skills relevant to patient care and health promotion in regulated clinical settings.
Clinical Sciences Disciplines
- Emergency Medicine
- Family Medicine
- Health Promotion and Disease Prevention
- Internal Medicine
- Neurology
- Obstetrics/Gynecology
- Osteopathic Principles and Practice
- Pediatrics
- Psychiatry
- Surgery
| Subsection | No. of Questions | Description |
| 1 | 50 | Morning Session: 4 Hours Total Testing Time |
| 2 | 50 | |
| Authorized 10-minute break | ||
| 3 | 50 | |
| 4 | 50 | |
| Authorized 40-minute lunch break | ||
| 5 | 50 | Afternoon Session: 4 Hours Total Testing Time |
| 6 | 50 | |
| Authorized 10-minute break | ||
| 7 | 50 | |
| 8 | 50 | |
| Total | 400 | 8 hours |
Note: Questions can be answered, reviewed, and changed one subsection at a time. Individual subsections are not timed.
- Performance Evaluation (PE) – a patient-based evaluation of the core clinical skills measured across 12 sessions with regular patients. The applicant must personally conduct the clinical skills of standardized clients in a timely, secure, effective, and safe way, as necessary.
Fundamental Clinical Skills Assessed
- Humanistic Domain
- Physician-Patient Communication
- Interpersonal skills
- Professionalism
- Biomedical/Biomechanical Domain
- Medical History-Taking and Physical Examination Skills
- Osteopathic Principles and Osteopathic Manipulative Treatment (OMT)
- Documentation Skills (including synthesis of clinical findings, integrated differential diagnosis, and formulation of a diagnostic and treatment plan)
| Section | Amount Per Segment | Length |
| Registration | — | 30 Minutes |
| Candidate Orientation | — | 50 Minutes |
| Standardized Patient (SP) Case Encounters | 4 Cases | 14 Minute Encounter with SP + 9 Minute eSOAP (Subjective Objective Assessment Plan format) completion per case |
| Lunch | 30 Minutes | |
| Standardized Patient Case Encounters | 4 Cases | 14 Minute Encounter with SP + 9 Minute eSOAP (Subjective Objective Assessment Plan format) completion per case |
| Break | 15 Minutes | |
| Standardized Patient Case Encounters | 4 Cases | 14 Minute Encounter with SP + 9 Minute eSOAP (Subjective Objective Assessment Plan format) completion per case |
| Closing Survey | — | — |
| Total | 12 cases | 194 minutes (3 hours and 14 minutes) |
COMLEX Level 3
A two-day computer-based assessment of competence in the field of basic competence needed for general practitioners to provide effective and safe osteopathic medical treatment and to improve health in unmonitored clinical settings.
| Subsection | Questions | Description | |
| Day 1 | 1 | 70 multiple-choice questions | Morning Session: 3.5 Hours Total Testing Time |
| Authorized 10-minute break | |||
| 2 | 70 multiple-choice questions | ||
| Authorized 40-minute lunch break | |||
| 3 | 70 multiple-choice questions | Afternoon Session: 3.5 Hours Total Testing Time | |
| Authorized 10-minute break | |||
| 4 | 70 multiple-choice questions | ||
| Day 2 | 5 | 13 clinical decision-making cases | Morning Session: 3.5 Hours Total Testing Time |
| Authorized 10-minute break | |||
| 6 | 13 clinical decision-making cases | ||
| Authorized 40-minute lunch break | |||
| 7 | 13 clinical decision-making cases | Afternoon Session: 3.5 Hours Total Testing Time | |
| Authorized 10-minute break | |||
| 8 | 13 clinical decision-making cases | ||
| Total | |||
Note: Questions can be answered, reviewed, and changed one subsection at a time. Individual subsections are not timed.
COMLEX Scoring System
Scoring for the COMLEX tests is determined by the number of questions answered correctly (raw score), which is converted to a standard score for the sake of reporting the results and providing the pass-fail rating.
| COMLEX Level | Passing Scores |
| COMLEX-USA Level 1 | 400 |
| COMLEX-USA Level 2-CE | 400 |
| COMLEX-USA Level 2-PE | Pass |
| COMLEX-USA Level 3 | 350 |
NBOME does not disclose percentile scores in the applicant’s score reports. When the evaluation process is finished, percentile scores are measured and can be obtained using the Percentile Conversion Tool.
To get your COMLEX percentile score, you must:
- Open the Percentile Score Converter on the NBOME website.
- Enter your 3-digit score into the respective field
- Select the examination level being converted
- Pick the date of the test using the drop-down menu
- Click the ‘CONVERT’ button
- The numbers appearing to the right will be the corresponding percentile scores.
Applicants will be notified via email once their scores have been posted. Applicants may view their pass/fail status and/or scores for any COMLEX test via the CRS portal on the NBOME website (Account Access Login could be found at the upper right corner of the homepage).
Score Reports are usually published to the applicant’s account under the “View Score Report” and the protected school site of the NBOME CRS portal.
| Level | COMLEX Score Release |
| Level 1 | Approximately 4 to 6 weeks from the date of examination administration. |
| Level 2-CE | Approximately 4 to 6 weeks from the date of examination administration. |
| Level 2-PE | Approximately 8 to 10 weeks from the date of examination administration. |
| Level 3 | Approximately 8 to 10 weeks from the completion of the examination. |
Note: After the initial score release, please see the score release schedule on the NBOME website.
COMLEX Registration and Fees
Before you can enroll for and schedule a COMLEX-USA test, you will have to create your personal NBOME login credentials-protected account in the NBOME Client Registration System (CRS) following the instructions sent to you via email. Once an account has been created, registrants may:
- Confirm examination eligibility & requirements
- Select & purchase examinations
- Change an existing examination date
- Manage payment & personal information
- Read & agree to the required terms & conditions for registration
To take a COMLEX-USA test, the name on your registration form and the valid government-issued photo ID shown at the test center must be the same. If the candidate’s name has changed, he/she must download and submit a name change request form along with a copy of the supporting document stating the name change (e.g. divorce decree, marriage license, naturalization document). Documents may be scanned and emailed to clientservices@nbome.org or faxed to 773-714-0606.
Note: Name changes should be made five business days prior to the test date. If applicable, submit the name-change request and the documents before applying for the test.
| COMLEX Cognitive Examinations | JULY 2019-JUNE 2020 | JULY 2020-JUNE 2021 |
| Level 1 | $660 | $675 |
| Level 2-CE | $660 | $660 |
| Level 2-PE | $1,295 | $1,300 |
| Level 3 | $875 | $890 |
Additional Fees
| Computer-based Exams | Level 1 | Level 2-CE | Level 3 | |
| Reschedule or Cancellation Fee | More than 30 days before the scheduled date | $0 | $0 | $0 |
| Reschedule or Cancellation Fee | 6 to 30 days before the scheduled date | $85 | $85 | $170 |
| Cancellation Fee | 1 to 5 days before the scheduled date | $190 | $190 | $290 |
| No Show Fee | Within 24 hours of the scheduled date | $225 | $225 | $340 |
| Computer-based Exams | Level 2-PE | |
| Reschedule or Cancellation Fee | More than 90 days before the scheduled date and time of the exam | $0 |
| Reschedule or Cancellation Fee | 15 to 90 days before the scheduled date and time of the exam | $50 |
| Reschedule or Cancellation Fee | 48 hours to 14 days before the scheduled date and time of the exam | $400 |
| Reschedule or Cancellation Fee | 24 to 48 hours before the scheduled date and time of the exam | $750 |
| Reschedule or Cancellation Fee | Within 24 hours of the scheduled date and time of the exam | $1295 |
Note: Examinations cannot be rescheduled later than 5 days before the scheduled date. Cancellations must be made online through the candidate’s NBOME account.
| Non-Examination Related | Level 1 | Level 2-CE | Level 2-PE | |
| Score Confirmation Fee | $50 | $50 | $50 | |
| Insufficient Funds Checking Fee | $20 | $20 | $20 | |
| Transcript Fee | $60 | $60 | $60 | |
| Score Report Fee | $5 | $5 | ||
Frequently Asked Questions
What are good COMLEX scores?
The majority of test-takers score between 250 and 800. The minimum passing score for level 1 and 2 is 400, and 350 for level 3 of COMLEX-USA.
Can you retake the COMLEX?
Applicants who have failed COMLEX examination may retake the test at a total of four times in any 12-month span.
What are the differences between the USMLE and the COMLEX?
The most significant difference between COMLEX and USMLE is the number of questions in the test. COMLEX has 400 questions, which make it 42% greater than the USMLE; however, it must be taken in a similar time period. With USMLE, you can go through each section twice.
What is an osteopath?
A Doctor of Osteopathic Medicine (DO), also known as an osteopath, is a licensed doctor whose mission is to enhance people’s general health and wellbeing through osteopathic therapeutic medicine, which includes stretching, massaging, and shifting the musculoskeletal system.
Why aren’t chiropractors considered doctors?
Chiropractors don’t possess medical degrees, so they’re not medical doctors. Nonetheless, they have comprehensive chiropractic treatment training and are licensed professionals.
Could MD students take part in COMLEX?
Yes, you may. You have to complete either COMLEX or USMLE to have a license, however, since osteopathic medical schools require COMLEX, you don’t need to take both.
COMLEX Prep Guide
- Set a goal – Pick a score for each exam level that you think is attainable and set it as your goal. This will help keep you driven to study and work hard to meet and surpass your goal.
- Start studying as soon as possible – The ideal preparation for the COMLEX is 8 to 12 months before you take the tests. If you’re studying for your first COMLEX, you have to make sure that you’re going to be as over-prepared as possible because not knowing what to expect could add some stress.
- Do a minimum of 5 practice questions each day – In order to be adequately prepared for a test of 400 questions, you would need to review more than 400 questions. Doing at least 5 each day will enable you to absorb the amount of information you require. It is important to set up a study schedule, choose a starting date, and then stick to it.
- Do not use too many resources to study – Limit your study resources to 1-2 online question banks and 1-2 books for additional study materials. This guarantees that you get the most from your study resources rather than stretching yourself thin and gaining very little from each study tool.
- Take notes – Taking notes while reviewing helps imprint information into your brain more than memorization does.
- Do at least one timed COMLEX practice test – To feel totally prepared for the test date, you must take at least one timed, 400-question practice test to make you feel better about what answering the questions would be like on the test day.
COMLEX Sample Question
Question #1
You are working in the local urgent care center and a normally healthy 37-year-old male presents with abdominal pain that he describes as epigastric and worsening when leaning forward with associated nausea and vomiting. You are highly considering acute pancreatitis in your differential diagnosis simply based upon this provided history. Based on the epidemiology of acute pancreatitis, the most suspected etiology would be which of the following in the United States:
- Gallstones
- Viral
- Alcohol
- Medications
Question #2
A 42-year-old white female presents with severe nasal congestion, dry cough, low-grade fever and sinus congestion for the last three days. She has a history of hypothyroidism and controlled diabetes mellitus. She states that she would like to get rid of this “crud” soon so that she could go on her vacation in five days. She has had three similar episodes in the past year with no symptoms in between. What should be recommended?
- Obtain x-ray of sinuses
- Prescribe oral antibiotics for 2 weeks
- Prescribe oral corticosteroids for 7 days
- Symptomatic treatment with oral decongestant
Question #3
A teenager was hit in the head during a football game. He lost consciousness (LOC) for more than a minute and was managed in the emergency department. He has a Glasgow coma scale of 15 and is alert. He would like to return to school sports. You recommend that he first have complete rest with no activity and then start with light aerobics, followed by sport-specific activity. Based on current guidelines what is the time interval between each step of the recovery protocol?
- 6 to 12 hours
- At least 24 hours
- 48 to 72 hours
- He can progress every hour as long as he feels fine