Skip to main content

What To Expect With COMLEX Level 2 CE

Wednesday, July 17, 2019
By The TrueLearn Team

Top 9 Real-Time Insight Into The 2019 COMLEX Level 2 CE

The new COMLEX is here and we have some key insights into the new Level 2 CE Exam. We hope these tips will provide you with a better understanding of what can be expected so that you approach the exam feeling well-prepared and confident. So, without further ado…

For more in-depth information, please continue reading below.  We hope you find this to be helpful!


Over the past few years, reports have indicated that COMLEX has shifted closer to the USMLE in terms of item length and structure. This year, expect to see a deviation away from that trend. While Level 1 is largely focused on testing one’s knowledge of the basic sciences, Level 2 CE is far more clinical and tests your medical decision-making abilities.

Oftentimes item stems will include Osteopathic findings followed by a set of answer choices that incorporate Osteopathic treatment modalities. It’s very possible that that same question on both exams could have different “correct” answers, depending on the presence/absence of Osteopathic treatment options. If you’re taking Level 2 CE this year, also be prepared for a significant variation in stem lengths, ranging from two lines of text to two or more paragraphs that will require scrolling in order to read them in their entirety. Both normal and abnormal lab values (with reference ranges) will be included in a table format in the stem.


Buried within the new master blueprint for COMLEX-USA under Dimension 1(Competency Domains) is section 6 – “Professionalism in the Practice of Osteopathic Medicine.” And you should pay attention to it! In this section, there are six subheadings that provide guidance into specific areas you should focus your attention on such as laws and standards related to “Accountability and Duty in the Physician-Patient Relationship.”

If you read the message boards, you’ll notice that students are surprised by the uptick of medical ethics/law-related questions that are showing up on COMLEX Level 2 CE this year. We’re not surprised, however, because if you read the blueprint closely, you’ll notice that roughly 7% of the Dimension 1 items are in this category, which is more than DOUBLE what is stated for COMLEX Level 1 (3%). To become test savvy, we recommend that you review the blueprint closely. The NBOME makes the Blueprint readily available on their website and you can also find it infused within all levels of COMBANK. We’re actively adding lots of medical ethics/law-related items to our Level 2 CE SmartBank in response to the new blueprint.


Historically, COMLEX-USA Level 2 CE has consisted of multiple approved item types presented in a predictable sequence throughout each block of the exam, starting with stand-alone items (A-Type and Extended A-Type), then moving into multi-step/linked items (S-Type), and closing with a short matching section (B-Type and X-Type). With the new exam, you’ll likely only see stand-alone items, so each question will be independent of the next. The NBOME has moved away from the other two item types in recent years, and it has been reported that these item types have been eliminated from COMLEX Level 2 CE altogether. This doesn’t come as a surprise since COMLEX Level 3 was the first exam of the COMLEX series to undergo this change in 2018, and Level 1 has also followed suit.


If you’re someone who tends to finish at the buzzer when testing, you may need to speed things up to finish your COMLEX-USA Level 2 CE exam this year. Due to various stem lengths, a stronger presence of multimedia, and new item types, you may find yourself rushing to get done. The NBOME gives you 72 seconds per item on Level 2 and you’ll likely need all of it. Get in the habit of pacing yourself so that you don’t spend unnecessary time on any single test item. Each item is weighted equally, regardless of the stem length or item difficulty. With that in mind, you may want to mark items with longer stems and/or involved multimedia and revisit them at the end of the section. After all, unless you are faced with an experimental ‘test item” not being scored, every question will be equally weighted.


The integration of new item types into Level 2 CE has led to the presence of more multimedia on the exam. This could include short audio clips, video clips, or even require you to use your mouse. Given that you have 72 seconds to complete each test item, you might expect these clips to be very short. While this may be true on some occasions, this year you may encounter longer video clips that could be up to a minute in length. As mentioned above, you may want to consider marking these items and revisiting them after you have completed the rest of the items in the block. We’re also building longer videos into COMBANK, as we speak, to help you get used to managing your time through the block.


Over the years, the Prometric testing interface has come a long way. For 2019, it’s been completely redesigned and students across the board have been happy with the changes. The new interface features new color options, progress bars indicating your progress through the block, new icons such as coffee cups that tell you when it’s time for a break, and lots of other updates. Overall, students like the new format, and we’ll be incorporating the changes into COMBANK to reflect a similar look and feel. Our goal is to ensure that when you show up to the Prometric center on exam day, you feel like you’re at home using COMBANK on your couch!


If there is one word students traditionally use to describe a COMLEX Level 2 CE test item, it’s “vague.” From the recent posts we’ve seen on Reddit and other sites from the first round of test-takers, this is also a common theme in 2019. Unlike the USMLE, when students sit for COMLEX, they often report feeling as if they have to infer based on clues provided in the stem. Even with longer stems, you may find that information is contained that is not entirely pertinent for answering the question.


According to the new master blueprint, approximately 30% of Dimension 1 test items on COMLEX Level 2 CE fall under the heading of “Osteopathic Patient Care and Procedural Skills.” This is five times the number of questions representing this category than is stated for COMLEX Level 1. So get ready for lots of clinical OMM. Osteopathic principles show up on COMLEX-USA Level 2 CE in two forms. “Pure” OPP items test fundamental Osteopathic concepts and you’ll be able to recognize them from a mile away. “Integrated” OPP items, on the other hand, have been assimilated throughout the exam and they tend to be more clinical in nature. Expect to see more clinically-oriented OPP on Level 2 CE.


If you’re lucky enough to be one of the early test-takers this year, get ready to wait for an extended time to get your score back from NBOME. This year the NBOME will be undergoing a standard-setting change for COMLEX-USA Level 2 CE, which involves setting a minimum passing score and taking time to statistically validate individual candidate performance. Once this process is complete, scores should go back to being released within their typical windows, assuming the process goes smoothly. For more information on how the NBOME handles its standard-setting changes, you can read about it on their website.


So there we have it. The new COMLEX-USA Level 2 CE has finally emerged. So far, the changes are being well-received by students. While the uncertainty of change can bring heightened anxiety (and that’s normal), it doesn’t have to throw you off your game. We are working endlessly to incorporate these changes into COMBANK in real-time and will continue to do everything in our power to make sure you show up to the testing center feeling confident and prepared. Visit us at for more information.

And lastly, we want to recommend that you let your attending know as early as possible that you have your COMLEX Level 2 CE coming up. We can all relate to being on clinical rotations with a board exam looming. You may need some accommodations, and it’s up to you to communicate with your attendings. The last thing you want is to show up to the testing center post-call and exhausted. Leaving the hospital a few hours early the day before your exam is not an unreasonable request. Make sure you get permission early though.

If you found this to be helpful, please share with anyone you know that is planning to take the new COMLEX Level 2 CE and might find this constructive!  If you are planning to take the COMLEX Level 2 CE next year, check out our COMLEX level 2 CE SmartBank designed to fully prepare you for the exam!

Here at TrueLearn, we pride ourselves on being the perfect side assist for your schooling, and on constantly improving to better meet your requirements as a medical student, resident, or program director. Interested in TrueLearn updates? Sign up for our newsletter here. Visit our Facebook and InstagramTwitter, and LinkedIn pages for Test Effect Thursdays, where we post one of our questions every week! Lastly, we love to hear from our customers, please make sure you take a moment and leave us a review!


Contact Us

Feel free to reach us with any comments or questions! Need technical support? Visit our contact page and complete the tech support form.

109 Professional Park Drive

Mooresville, NC 28117

[insert_ajaxcontact id=456]