American Osteopathic Association

Advancing the distinctive philosophy and practice of osteopathic medicine


The COMLEX-USA sequence is an examination series with three levels that serve as pathways for candidates to obtain their osteopathic medical license after graduation. It is the osteopathic equivalent to the United States Medical Licensing Examination (USMLE). 

Created by the National Board of Osteopathic Medical Examiners (NBOME), Level 1 of COMLEX-USA is administered near the end of your second year of osteopathic medical school. You will typically take Level 2-CE and Level 2-PE during your third or fourth year, and Level 3 is taken during your first year of residency.

Enhancements to the examination series will be released in 2018 with COMLEX-USA Level 3. New test specifications for each level of COMLEX-USA are not yet available to the public, but updated format specifications can be found on the NBOME website, and the NBOME has already begun sharing updates with educators.

Where to Begin

All students must register, submit payment and schedule their COMLEX-USA examination by using the registration program available on the NBOME website, If you are unable to register online, contact the Dean’s Office of your school because eligibility is initiated by your dean through a secure webpage.

Osteopathic medical students are advised to familiarize themselves with the most current content on the NBOME website. Furthermore, osteopathic medical students are required to read the information contained in the “Bulletin of Information” as a prerequisite to registering for the test. The NBOME has strict regulations regarding confidentiality and irregular conduct prior to, during and after the administration of any COMELX-USA examination. 

The Student Osteopathic Medical Association's Level 1 Board Prep Guide outlines the information you need to know about COMLEX and highlights resources available to help you. 

What to Expect

COMLEX-USA is a medical problem-solving examination in which you're asked to employ osteopathic principles and practices to solve clinical problems. Each level of the exam contains problems that involve clinical presentations and tasks.

  • The clinical presentation identifies high-frequency or high-impact health issues that osteopathic primary care physicians commonly encounter in practice. 

  • The physician task evaluates the steps osteopathic physicians take in solving medical problems. 

Osteopathic medical students are tested on medical concepts and principles necessary for understanding the mechanisms of medical problems and disease processes in the first level.

All osteopathic medical schools require that osteopathic medical students pass the first and second levels of COMLEX-USA to graduate. In addition, residency programs often use examination results to select students for their residency training.

Level 1 Exam Scores

The percentage of examinees that pass or fail the COMLEX-USA is not predetermined. The passing score for each level is based on a candidate’s performance on the total examination, not individual content areas. In addition, scores are not adjusted or based on any curve due to the performance of others who tested at or about the same time.

To arrive at each score, the number of items answered correctly in the cognitive examination of Level 1 is converted to a standard. The standard score is also calculated to allow comparisons with other Level 1 exams administered on different dates. Then, the score is used to report a pass or fail status.

The NBOME issues a two-digit and a three-digit score to each student. Scores are also forwarded to the dean of the student's osteopathic medical school. Upon students’ request, NBOME will forward scores to Electronic Residency Application Service, residency programs, and other regulatory agencies.

The two-digit score is not a raw score or a percentile ranking of the candidate. Instead, the two-digit score is offered to comply with some licensing boards that use this format. In these cases, osteopathic medical students must receive a score of at least 75 to pass. However, in the three-digit format, the standard scores for Level 1 have a mean of 500 and osteopathic medical students pass with a score of 400. Therefore, a two-digit score of 75 equates to a three-digit score of 400 for Level 1.