COMPLEX
Overview
The Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) is a licensing exam required for students in osteopathic medical schools.
The three-part computer-based examination evaluates your understanding of medical concepts and how well you can apply that knowledge to clinical practice. You must pass all three levels to earn full licensure as an osteopathic physician in the U.S.
Residency program directors also use COMLEX scores when selecting applicants for residency programs. Strong performance can significantly enhance your residency application and signal your readiness for advanced clinical training.
COMLEX-USA Exam Series
There are three levels in the COMLEX-USA series of DO board exams:
Level 1
Level 1 focuses on foundational biomedical sciences and osteopathic principles.
Level 2-CE
It is a Cognitive Evaluation (CE) that measures your ability to apply clinical knowledge and make safe, evidence-based decisions in patient care scenarios.
Level 3
It assesses the advanced clinical competencies required for unsupervised osteopathic medical practice.
About Taking the COMPLEX-USA Exam
To take your first of the three COMLEX exams, you must have completed one year of study at an accredited college of osteopathic medicine and be in good academic and professional standing. Osteopathic medical students must pass each level before taking the next exam.
The National Board of Osteopathic Medical Examiners (NBOME) recently announced changes to the format of the exam. The number of questions on COMLEX Level 1 and Level 2-CE exams will be reduced to 320, and the two-day Level 3 will be modified to a one-day format. Changes will be phased in starting May/June 2026 for Levels 1 and 2-CE, and January 2027 for Level 3.
Key Aspects of the COMPLEX-USA
Three Levels: COMLEX-USA consists of Level 1, Level 2-CE (Cognitive Evaluation), and Level 3, each testing different stages of medical competency.
Computer-Based: All levels are computer-based, with questions often incorporating audio-visual elements.
Content: Covers foundational biomedical sciences, osteopathic principles (OMT), and clinical application, focusing on patient care across various systems.
Format: Typically involves multiple sessions on one day, with pooled break time that candidates manage.
Purpose: Required for DO graduation, licensure in all states, and entry/promotion in residency.
Scoring
Each level of COMLEX is scored by converting your raw score, or the number of questions you answer correctly, into a three-digit scaled score. This scaled score accounts for small differences in difficulty across test forms and gives programs a consistent way to compare results.
Level 1 reports only a Pass or Fail designation, while Levels 2-CE and 3 include both your scaled score and your pass status.
Passing scores vary by level. Level 2-CE currently requires a scaled score of 400 or higher. Level 3 requires a scaled score of 350 or higher. Although Level 1 is now Pass or Fail, the standard-setting process determines the level of performance needed to earn a passing result.
For all levels, the NBOME ensures that the scoring process is fair and reflects a candidate’s ability to practice osteopathic medicine. The NBOME establishes the passing standard for each level through a rigorous process that involves panels of practicing osteopathic physicians.
Residency program directors rely on COMLEX results to assess an applicant’s academic strengths and clinical readiness. For most specialties, a solid pass meets the requirement for licensure, but competitive programs may expect scores well above the minimum threshold.
For example, among matched U.S. DO seniors across specialties, the mean COMLEX Level 2-CE score has been reported to be around the mid‑500s. Scores are still considered within the context of your application.
Eligibily
COMLEX-USA eligibility requires graduating from an accredited osteopathic medical school, passing each level sequentially (Level 1, 2-CE, 3), and receiving attestations of good academic/professional standing from your school/residency for Levels 1, 2, and 3, respectively. Specific timing involves Level 1 in early med school (after 1st year), Level 2-CE in third/fourth year, and Level 3 during residency (recommended 6 months in), with a four-attempt limit per exam.
General Requirements for All Levels
Sequential Order: You must pass COMLEX-USA Level 1, then Level 2-CE, then Level 3.
Good Standing: Your osteopathic medical school and/or residency program must attest that you are in good academic and professional standing.
Attempt Limit: You have a maximum of four attempts for each COMLEX-USA examination.
Eligibility by Level
COMLEX-USA Level 1
When: Typically taken at the end of the second year (OMS-II).
Requirements: Completion of OMS-I and OMS-II coursework and academic requirements.
COMLEX-USA Level 2-CE (Cognitive Evaluation)
When: Usually during the third or fourth year (OMS-III/IV)
Requirements: Successful completion of all OMS-III curricular requirements, including clerkships and required Osteopathic Principles & Practice (OPP) elements, often with passing scores on NBOME COMAT exams.
COMLEX-USA Level 3
When: During residency, typically after completing at least six months of graduate medical education (GME).
Requirements: Graduation from an accredited COM, passing Levels 1 & 2-CE, and clinical skills competency attestation.
Future Changes: For classes graduating 2029 and beyond, new competency assessments (like C3DO) will replace older attestation models.
How we assist candidates in clearing this exam.
Exact examination Q&A bank
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Direct certificate:
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