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 you to obtain your osteopathic medical license after graduation. It is the osteopathic equivalent to the United States Medical Licensing Examination (USMLE). You’ll take levels one and two during medical school and the third level during your residency.

Upcoming Changes

Enhancements to the examination series will be released beginning with COMLEX-USA Level 3 in September 2018.

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.

When do I take COMLEX-USA Level 1?

You’ll take the first level of the exam near the end of your second year of osteopathic medical school.

Visit the NBOME website to register, submit payment and schedule COMLEX-USA Level 1. If you have trouble registering, contact the Dean’s Office of your school because eligibility is initiated by your dean through a secure webpage.

Be sure to read the “Bulletin of Information” before 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.

What to Expect

The exam is split into a four-hour session in the morning and four-hour session in the afternoon. You’ll complete the exam in a workstation at a Prometric Testing Center.

You’ll need to bring with:

  • Your driver’s license or other current government-issued ID with your full name.

  • Snacks and drinks.

On testing day, you will be asked a series of 400 multiple choice questions assessing your medical knowledge and clinical problem solving skills. You’ll be tested on foundational and basic biomedical sciences in the following areas:

  • Anatomy

  • Behavioral science

  • Biochemistry

  • Health promotion and disease prevention

  • Microbiology

  • Osteopathic principles

  • Pathology

  • Pharmacology

  • Physiology

You can prepare for the exam by:

  • Becoming familiar with the most current content on the NBOME website.

On exam day, you can take two optional 10-minutes breaks as well as an optional 40-minute lunch break. You’ll need to leave the testing room during your break and show your ID to return to the testing room. During the breaks, you can access a locker for food, drink, medications or other stored items.

After the Exam

You’ll need to pass COMLEX-USA Level 1 in order to advance in the examination series. A passing score is based on how many questions you answer correctly on the total examination, not individual content areas. Note also that scores are not adjusted or based on any curve due to the performance of others who tested at or about the same time.

You will get an email approximately one month after you complete the exam that your scores are available through your COMLEX-USA account.

Typically the three-digit score for all levels of COMLEX is 500-550. All test questions count equally toward your final score, except the pretest or “tryout” questions you take at the very beginning of the exam, which don’t count toward your final score.

To convert your score from three-digit to a two-digit percentile, open the Percentile Score Converter and enter your three-digit score. Next select the examination level and testing cycle of the exam before pressing the Convert button.

Visit NBOME for more information on examination scoring.