The Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) is a series of three
osteopathic
Osteopathy is a pseudoscientific system of alternative medicine that emphasizes physical manipulation of the body's muscle tissue and bones. In most countries, practitioners of osteopathy are not medically trained and are referred to as osteo ...
medical licensing examinations administered by the
National Board of Osteopathic Medical Examiners (NBOME) similar to the United States Medical Licensing Examination (
USMLE
The United States Medical Licensing Examination (USMLE) is a three-step examination program for medical licensure in the United States sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). ...
). COMLEX-USA is the most common pathway by which
osteopathic physicians (
D.Os) apply for medical licensure, and is accepted in all 50 states. The 3-digit standard scores of COMLEX-USA Level 1, Level 2- Cognitive Evaluation (CE), and Level 3 have a range of 9-999 and a mean of 500. Most candidates score between 250 and 800. 400 is the minimum passing score for COMLEX-USA Levels 1 and 2; 350 for COMLEX-USA Level 3. It was announced on January 24, 2022, that the COMLEX-USA Level 1 examination will be moving from a 3-digit numeric score to solely pass/fail beginning on May 10, 2022.
COMLEX-USA Level 1
COMLEX-USA Level 1 is typically taken after completion of the second year of
medical school
A medical school is a tertiary educational institution, professional school, or forms a part of such an institution, that teaches medicine, and awards a professional degree for physicians. Such medical degrees include the Bachelor of Medicine, ...
. The exam consists of 352 questions administered in one day and consists of two, four-hour exam sessions separated by a 40-minute break. Each of the four-hour sessions allows a ten-minute break in addition to the time allotted for the respective four-hour sessions. Candidates are expected to know the basic mechanisms of health and disease process. The mean score for the COMLEX-USA Level 1 is approximately 500-540 (for first time test-takers), with a standard deviation of about 85 (although this may vary slightly from year to year). It was announced on January 24, 2022, that the COMLEX-USA Level 1 examination will be moving from a 3-digit numeric score to solely pass/fail beginning on May 10, 2022.
[
Specifically, Level 1 covers basic medical sciences, including:
*]Anatomy
Anatomy () is the branch of morphology concerned with the study of the internal structure of organisms and their parts. Anatomy is a branch of natural science that deals with the structural organization of living things. It is an old scien ...
*Behavioral Science
Behavioural science is the branch of science concerned with Human behavior, human behaviour.Hallsworth, M. (2023). A manifesto for applying behavioural science. ''Nature Human Behaviour'', ''7''(3), 310-322. While the term can technically be ap ...
*Biochemistry
Biochemistry, or biological chemistry, is the study of chemical processes within and relating to living organisms. A sub-discipline of both chemistry and biology, biochemistry may be divided into three fields: structural biology, enzymology, a ...
*Microbiology
Microbiology () is the branches of science, scientific study of microorganisms, those being of unicellular organism, unicellular (single-celled), multicellular organism, multicellular (consisting of complex cells), or non-cellular life, acellula ...
* Osteopathic Principles and Practice
*Pathology
Pathology is the study of disease. The word ''pathology'' also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices. However, when used in the context of modern medical treatme ...
*Pharmacology
Pharmacology is the science of drugs and medications, including a substance's origin, composition, pharmacokinetics, pharmacodynamics, therapeutic use, and toxicology. More specifically, it is the study of the interactions that occur betwee ...
*Physiology
Physiology (; ) is the science, scientific study of function (biology), functions and mechanism (biology), mechanisms in a life, living system. As a branches of science, subdiscipline of biology, physiology focuses on how organisms, organ syst ...
*Public Health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the de ...
COMLEX-USA Level 2 CE
COMLEX-USA Level 2-Cognitive Evaluation (CE), is generally taken during the third or fourth year of medical school
A medical school is a tertiary educational institution, professional school, or forms a part of such an institution, that teaches medicine, and awards a professional degree for physicians. Such medical degrees include the Bachelor of Medicine, ...
. Level 2-CE requires candidates to demonstrate knowledge of clinical concepts and medical decision-making. The mean score for the COMLEX-USA Level 2 CE is approximately 540 (for first time test-takers), with a standard deviation of about 100 (although this may vary slightly from year to year).
The examination is problem-based and symptoms-based, integrating the clinical disciplines of:
*emergency medicine
Emergency medicine is the medical specialty concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency physicians (or "ER doctors") specialize in providing care for unscheduled and undifferentiated pa ...
*family medicine
Family medicine is a medical specialty that provides continuing and comprehensive health care for the individual and family across all ages, genders, diseases, and parts of the body. The specialist, who is usually a primary care physician, is ...
*internal medicine
Internal medicine, also known as general medicine in Commonwealth nations, is a medical specialty for medical doctors focused on the prevention, diagnosis, and treatment of diseases in adults. Its namesake stems from "treatment of diseases of ...
*obstetrics
Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a su ...
/gynecology
Gynaecology or gynecology (see American and British English spelling differences) is the area of medicine concerned with conditions affecting the Female reproductive system, female reproductive system. It is often paired with the field of obste ...
* osteopathic principles
*pediatrics
Pediatrics (American English) also spelled paediatrics (British English), is the branch of medicine that involves the medical care of infants, children, Adolescence, adolescents, and young adults. In the United Kingdom, pediatrics covers many o ...
*psychiatry
Psychiatry is the medical specialty devoted to the diagnosis, treatment, and prevention of deleterious mental disorder, mental conditions. These include matters related to cognition, perceptions, Mood (psychology), mood, emotion, and behavior.
...
*surgery
Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery s ...
COMLEX-USA Level 2 PE (discontinued)
In 2005 the NBOME introduced the COMLEX-USA Level 2-Performance Evaluation (PE). It was announced on February 14, 2021, that the COMLEX-USA Level 2-PE examination will be discontinued indefinitely and a commission will be set up "to consider and identify new ways to evaluate fundamental competencies currently assessed in the Level 2-PE." The exam was a one-day, seven-hour clinical skills examination and utilized standardized patients (actors trained to present clinical symptoms) to test clinical skills. The exam was graded as pass/fail. Testing sites were available in Conshohocken, PA
Conshohocken ( ; ) is a borough on the Schuylkill River in Montgomery County, Pennsylvania in suburban Philadelphia. Historically a large mill town and industrial and manufacturing center, after the decline of industry in recent years Conshohock ...
, and in Chicago, IL
Chicago is the List of municipalities in Illinois, most populous city in the U.S. state of Illinois and in the Midwestern United States. With a population of 2,746,388, as of the 2020 United States census, 2020 census, it is the List of Unite ...
. Candidates were required to complete 12 standardized patient encounters, each 14 minutes in duration. Following each encounter, candidates had 9 minutes to type a SOAP note. Candidates were strongly encouraged to make full use of the allotted time for each encounter to ensure thoroughness in both components of an encounter.
The exam required candidates to demonstrate proficiency in:
*history taking and physical examination skills
*integrated differential diagnosis
In healthcare, a differential diagnosis (DDx) is a method of analysis that distinguishes a particular disease or condition from others that present with similar clinical features. Differential diagnostic procedures are used by clinicians to di ...
and clinical problem solving
*written communication and synthesis of clinical findings ( SOAP note format)
*osteopathic principles and/or osteopathic manipulative treatment
COMLEX-USA Level 3
The final examination, COMLEX-USA Level 3, is generally taken after starting a residency program. The exam is a two-day computer-based examination consisting of up to 420 multiple choice questions, and up to 26 additional clinical decision-making cases. The mean score for COMLEX-USA Level 3 is approximately 520 (for first-time test takers), with a standard deviation of about 85.
It covers the clinical disciplines of medicine, including:
*emergency medicine
Emergency medicine is the medical specialty concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency physicians (or "ER doctors") specialize in providing care for unscheduled and undifferentiated pa ...
*family medicine
Family medicine is a medical specialty that provides continuing and comprehensive health care for the individual and family across all ages, genders, diseases, and parts of the body. The specialist, who is usually a primary care physician, is ...
*internal medicine
Internal medicine, also known as general medicine in Commonwealth nations, is a medical specialty for medical doctors focused on the prevention, diagnosis, and treatment of diseases in adults. Its namesake stems from "treatment of diseases of ...
*obstetrics
Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a su ...
/gynecology
Gynaecology or gynecology (see American and British English spelling differences) is the area of medicine concerned with conditions affecting the Female reproductive system, female reproductive system. It is often paired with the field of obste ...
* osteopathic principles
*pediatrics
Pediatrics (American English) also spelled paediatrics (British English), is the branch of medicine that involves the medical care of infants, children, Adolescence, adolescents, and young adults. In the United Kingdom, pediatrics covers many o ...
*psychiatry
Psychiatry is the medical specialty devoted to the diagnosis, treatment, and prevention of deleterious mental disorder, mental conditions. These include matters related to cognition, perceptions, Mood (psychology), mood, emotion, and behavior.
...
*surgery
Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery s ...
USMLE comparison
In 2020, the ACGME
The Accreditation Council for Graduate Medical Education (ACGME) is the body responsible for accrediting all graduate medical training programs —internships, residencies, and fellowships (subspecialty programs) — for physicians in the United ...
(former MD residency system) and AOA GME (former DO residency system) merged and became one GME. All allopathic and osteopathic medical students, therefore, now apply to and train in ACGME-accredited residencies. Prior to the merger, DO students could apply to both ACGME and AOA residencies, while MD students could only apply to ACGME residencies. Although not a requirement, to be competitive, many osteopathic medical students have a pressure to take both USMLE
The United States Medical Licensing Examination (USMLE) is a three-step examination program for medical licensure in the United States sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). ...
and COMLEX. There are several residency programs that specifically require USMLE scores. Based on data from recent results of the COMLEX-USA examination, for level 1 and level 2, a score of 500-540 is considered the 50th percentile with scores falling slightly under and over this mark to be considered similarly. A score of 600 is historically considered to be around the 80th percentile.
References
External links
National Board of Osteopathic Medical Examiners
American Osteopathic Association
{{Osteopathic medicine3
Medical education in the United States
Medical regulation in the United States
Osteopathic medicine
Osteopathy in the United States