American Osteopathic Association

Advancing the distinctive philosophy and practice of osteopathic medicine


COMLEX-USA Level 2 emphasizes the medical concepts and principles necessary for making appropriate medical diagnoses through patient history and physical examination findings. You will typically take Level 2-CE and Level 2-PE during your third or fourth year of osteopathic medical school, 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.


Level 2-CE, the computerized cognitive evaluation, is a one-day, computerized, multiple-choice examination, covering the clinical disciplines of:

  • Family Medicine,

  • Emergency Medicine,

  • Internal Medicine,

  • Obstetrics and Gynecology,

  • Osteopathic Principles,

  • Pediatrics,

  • Psychiatry, 

  • Surgery, and 

  • Other areas necessary to solve medical problems in an integrated manner. 

The examination consists of two four-hour test sessions, containing questions related to clinical presentations and clinical disciplines. Basic science, disease prevention, and health promotion principles are also tested.


Level 2-PE, the performance evaluation, is a clinical skills examination that assesses the fundamental clinical skills required for osteopathic medical school graduates. In this evaluation, patient-centered skills are examined in the context of clinical encounters with standardized patients.

The AOA recommends taking the COMLEX-USA Level 2-PE early. By taking it early, you may have your scores before residency program interviews or the Match; and you have time to retake the examination if you do not pass the first time.

Students are eligible upon passing Level 1 and receiving approval from their dean, and test sessions are open more than one year in advance. Another consideration is to get the examination out of the way early, provided that you are ready to test, so that you can focus your energy on finding a residency position.

Does it matter what order I take COMLEX exams?

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. The two parts of the Level 2 exam can be taken in any order, but both must be completed before Level 3.

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.

COMLEX-USA Part 2-CE/PE Scoring

Scoring for Level 2-CE is reported as two- and three-digit standard scores. The number of items answered correctly is converted to a standard score. The standard score is also calculated to allow comparisons with other Level 2-CE exams administered on other dates. Then, the score is used to report a pass or fail status.

There is a mean standard score of 500 for Level-2 CE. Osteopathic medical students who receive a standard score of 400 pass. Level 2-CE scores are typically available within four to six weeks. The COMLEX-USA Level 2-PE is scored on a pass or fail basis within each of two domains:

  1. The humanistic domain: doctor-patient communication, interpersonal skills and professionalism; and

  2. The biomedical of biomechanical domain: history-taking and physical examination skills, osteopathic principles and OMT skills, and the written SOAP notes.

Osteopathic medical students must pass both Level 2-PE domains to receive a passing score for the examination. Scores are typically returned to the student within 10 to 12 weeks after taking Level 2-PE. Some test items may be included in COMLEX-USA solely for research purposes and will not be scored. To assure validity, those items are not identified as research items.