USMLE® Step 1 & 2

What is the COMLEX-USA?


The Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) is the licensing exam administered by the National Board of Osteopathic Medical Examiners (NBOME). Osteopathic medical students are required to pass the COMLEX Level 1 and Level 2 exams to graduate with a doctor of osteopathic medicine (DO) degree. 

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For the latest on the COMLEX-USA licensure examination, visit the NBOME.

As of July 2023, COMLEX-USA is a three-level sequence that tests essential osteopathic medical knowledge and clinical skills in two dimensions:

  • Dimension 1 addresses the patient presentation.
  • Dimension 2 addresses physician tasks.

Scores are reported as pass-fail for Level 1 and numerically for Level 2-Cognitive Evaluation (Level 2-CE) and Level 3. COMLEX-USA scores also play a role in determining or assessing options for residency programs during the residency selection process.

When is the COMLEX-USA exam taken?

COMLEX-USA exams must be taken in order and be successfully completed before taking the next level of the exam.

Level 1 is typically taken after completion of the second year of medical school. Level 2 is typically taken during the third or fourth year of medical school. Level 3 is typically taken during residency.

United States Medical Licensing Examination (USMLE)

The United States Medical Licensing Examination (USMLE) is not part of the required path for DO licensure or graduation, but DO students may opt to take both exams to help during residency selection.

Preparing for COMLEX-USA exams

Most osteopathic medical students will utilize a combination of review materials, practice exams and question banks to improve their knowledge and familiarity with the exam content and concepts. Students can also take advantage of additional study tactics through study partners, study groups or test prep courses.

For osteopathic medical students interested in taking both USMLE series and COMLEX-USA, it may also be beneficial to discuss test-taking options and scheduling with a residency program advisor. 

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2022 COMLEX-USA Level 1 move to pass fail

The first level of the COMLEX-USA began administering the exam as pass-fail for any administrations taken on or after May 10, 2022.

In an AMA webinar event, a panel of medical education experts discussed the Level 1 exam transition from numerical scoring to pass fail and how this might impact osteopathic medical students. Panelists also discussed how the change was aimed in part to support student wellness.

“Nationally we have a big concern that we put our students through a tremendous amount of stress, and we feel like we lose them in the spring of their second year,” noted Isaac J. Kirstein, DO, a dean at the Cleveland campus of Ohio University Heritage College of Osteopathic Medicine. “The national consensus of medical schools was to push back and start the conversation that a licensing exam shouldn’t be so disruptive for medical education.”

AMA members receive a discount on test prep materials for the COMLEX-USA. Read more about the benefits of AMA medical student membership.

Other key AMA resources include:

Reviewed by: Kimberly Lomis, MD, vice president, UME Innovations

Reviewed on: July 5, 2023