American Osteopathic Association

Advancing the distinctive philosophy and practice of osteopathic medicine


This portion of the COMLEX exam emphasizes the medical concepts and principles necessary for making appropriate medical diagnoses through patient history and physical examination findings. 

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

What is the difference between Level 2-CE and Level 2-PE?

  • Level 2-Cognitive Exam (CE) measures your clinical skills and problem-solving techniques over the course of a day-long computerized exam. 

  • During the Level 2-Performance Evaluation (PE), you’ll be tested on your clinical examination skills through physical examinations you’ll conduct on actors posing as patients.

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 2?

Typically you’ll take Level 2-CE and Level 2-PE during your third or fourth year of osteopathic medical school. The two parts of the Level 2 exam can be taken in any order, but both must be completed before you can take Level 3.

Before you can take either Level 2 exam, you’ll need to:

  • Pass COMLEX-USA Level 1.

  • Complete your second year of study at an accredited college of osteopathic medicine (COM).

  • Obtain attestation from your COM that you are a student in good standing.

Ideally you will want to schedule your Level 2-PE (performance evaluation) in January to May of your third year and your Level 2-CE (computerized cognitive evaluation) in the summer between third and fourth year of med school, although these exams can be taken in either order. 


The COMLEX Level 2-CE is a day-long computerized exam that measures your clinical skills and problem-solving techniques. Level 2-CE is split into a four-hour session in the morning and a 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 testing your ability to make problem- and symptom-based assessments. You’ll be tested in the following clinical areas:

  • Emergency medicine

  • Family medicine

  • Health promotion and disease prevention

  • Internal medicine

  • Neuromusculoskeletal medicine

  • Obstetrics/gynecology

  • Osteopathic principles

  • Pediatrics

  • Psychiatry

  • Surgery

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.

Visit NBOME for more information, including the COMLEX-USA Level 2-CE blueprint and the practice exam.


In COMLEX Level 2-PE, you’ll be tested on your clinical examination skills through encounters with actors posing as patients during a seven-hour exam that takes places at an NBOME National Center for Clinical Skills Testing in Philadelphia or Chicago. You should arrive at least half an hour early to allow time for registration. Students then meet for orientation before beginning three separate rounds of examining four patient cases. The first round will end with a 30 minute lunch break and the second round will end with a 15 minute break.

You’ll need to bring with:

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

  • Your white lab coat and a standard stethoscope.

  • Snacks and drinks.

You’ll be scored in two examination domains:

  • Humanistic Domain: Physician/patient communication, interpersonal skills and professionalism.

  • Biomedical/Biomechanical Domain: Medical history-taking and physical examination skills; osteopathic principles and osteopathic manipulative treatment; and documentation skills, including synthesis of clinical findings, integrated differential diagnosis and formulation of a diagnostic treatment plan.

You’ll get 14 minutes for each patient encounter. You can use this time to take the patient’s history, perform a physical exam, talk to the patient and perform OMT if indicated. After each encounter, you’ll have nine minutes to document your findings.

Visit NBOME for more information, including the COMLEX-USA Level 2-PE blueprint.

After the Exam

Each level of the COMLEX-USA is important because you cannot progress to the next level until you pass the previous level, with the exception of Level 2-CE/PE which may be taken in any order.

You will get an email approximately one month after you complete the Level 2-CE exam that your scores are available through your COMLEX-USA account. Scores for Level 2-PE are available within eight to 10 weeks.

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 about Level 2-CE examination scoring and the Level 2-PE scoring principles.