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April 16, 2019 | 7:00PM EST

Submitted Questions

COMLEX-USA Enhancements

The COMLEX-USA, the licensure examination for osteopathic medical students, is transitioning to a contemporary, two-decision point, competency-based COMLEX-USA blueprint and evidence-based design informed by extensive research on actual osteopathic physician practice, expert consensus, and stakeholder surveys. The new COMLEX-USA assesses representative measurable outcomes of the seven competency domains and focused on high-frequency clinical presentations or high-impact health issues and clinical presentations that affect patients across the lifespan.


For exams dates after:

  1. COMLEX-USA Level 1 – May 2019
  2. COMLEX-USA Level 2CE – June 2019
  3. COMLEX-USA Level 2PE – March 2019
  4. COMLEX-USA Level 3 -September 2018

The new COMLEX-USA Master Blueprint focuses on two dimensions that maps content to competency domains and clinical presentations.

Dimension 1 of the blueprint consists of seven competency domains—related sets of foundational abilities representing the required elements and outcomes that define the knowledge, skills, experience, attitudes, values, behaviors, and established professional standards.

Dimension 2 of the blueprint consists of the 10 clinical presentations, which represent the manner in which a particular patient, group of patients, or a community present(s) for osteopathic medical care.



Computer based, application of osteopathic medical knowledge concepts related to foundational sciences, patient presentations and physician tasks.

Two test sessions of four hours each taken on one day. It contains approximately 400 items divided into 8  sections of 50 question each.


Computer based, application of osteopathic medical knowledge concepts related to clinical sciences, patient presentations and physician tasks

Two test sessions of four hours each taken on one day. It contains approximately 400 items divided into 8  sections of 50 question each.


Standardized patient based assessment of fundamental clinical skills essential for osteopathic patient care.

The examination format is a one-day test session administered in seven hours on-site at one of the NBOME National Centers for Clinical Skills Testing in Philadelphia and Chicago. The candidate will see 12 standardized patient-based cases: 14 minute duration for each patient encounter plus 9 minutes to document findings in a SOAP note (Subjective, Objective Assessment, Plan) format.

Update: As of the test cycle beginning March 25th, 2019, the standardized patient stop phrase will be updated to“Just a moment, doctor.”


Two-day computer-based, application of osteopathic medical knowledge concepts related to clinical sciences, patient safety and independent practice, foundational competency domains and clinical presentations.

The COMLEX-USA two-day Level 3 examination consists of approximately 420 multiple-choice questions (items) with a single best answer and approximately 26 Clinical Decision-Making (CDM) cases. The examination is divided into two 3.5-hour sessions per day.


Breaks: After you check in the total examination day will last approximately nine hours, consisting of a brief tutorial, two optional 10-minute breaks, an optional 40-minute lunch break and eight hours total exam time divided into two four-hour sessions of four sections each.


The minimum passing 3-digit standard score for Level 1 and Level 2-CE is 400, and Level 3 is 350, regardless of when the examination is taken.

COMLEX-USA 3-digit scores are NOT raw scores or the number of items answered correctly. Similarly, they are NOT the percentage of items answered correctly.

Study Strategies

SPACED PRACTICE: Spread out retrieval sessions with a meaningful time gap between practice session.

INTERLEAVING: Alternate topics at you take practice questions. This is more effective than focusing on the same problem or topic for an extended period of time.

INTRODUCE VARIATION: Rather than repeat the same retrieval practice every time, vary the type and context of your retrieval efforts. Similar to interleaving, variation enhances your ability to compare similarities and differences across various scenarios, and to integrate related ideas and/or skills into meaningful schema or mental models for better solutions.

TESTING MODE: Higher performing students used timed mode tests more often than lower performing students, with high performing students taking 77% of all questions in timed mode.

TESTING EFFECT: Psychological effect that the mere act of testing someone’s memory will strengthen the memory, regardless of whether there is feedback.

SELF-REGULATED LEARNER: Self-regulated learners are successful because they control their learning environment. This starts with an accurate assessment of current capabilities and an understanding of what you already know vs. what you need to know… and the approach to get there.

SmartTips : Utilize adaptive technology to provide insightful information about individual testing habits and behaviors to residents.

SmartTexts: Incorporate the power of spaced repetition by re-exposing test-takers to the key learning point on missed questions at specific intervals to enhance learning and retention.

SmartSearch: Narrows down questions from the SmartBank by specific keywords for further study of previously taken questions or to quickly create a focused test.

The single-best predictor of COMLEX performance is the COMBANK 1/2-day assessment taken closest to your exam date. This assessment has a high correlation with actual performance (r2 = .82 – .87).

We have a library of articles about the most efficient and effective ways to study. Please reach out to if you are interested in receiving more information.

The testing effect is a vital strategy in the facilitation of long term retention. The more questions you take, the better you will retain the information and retrieving he to-be-remembered information. Generally, taking more questions will result in better performance.

Please contact if you are interested in reviewing your data and study approach with our Director of Academic Success.

COMBANK Enhancements

  • Increased the number of graphs, tables, and images
  • Better explain incorrect answer choices
  • Incorporate lab values and vitals into item stems
  • Ensure higher-order type questions – targeting 70% 2nd or 3rd-level items
  • All items mapped to new 2019 blueprint – (March 2019)
  • Launch of new simulated prometric exam interface (March 2019)
  • Create additional items on key competencies (communication skills, professionalism, cost of care, etc.)
  • Fill in Blueprint category gaps

We follow an iterative item writing process.  Items are reviewed, added, revised, and retired after reviewing feedback from you, faculty, our authors, as well as analyzing various psychometrics. As a result, your total question count may periodically change.

  • Incorporation of more basic science faculty into Level 1 item-writing
  • New COMBANK PE Video Series for 2019, interactive soap notes – Scheduled release for June 2019

General Questions

Standard setting is a process commonly used by organizations involved with high-stakes testing. NBOME’s standard-setting process ensures the standards of osteopathic medical licensure assessment reflect current medical education and medical practice. The NBOME follows industry-standard best practices in establishing its schedule e.g., every three to five years for review of pass/fail standards.

Great question! There are many studies indicating strong predictors and suggest other measures to consider.

A great place to start is to look at the data from the National Residency Director survey. Identify where other Osteopathic students matched and the average performance on COMLEX Level 1 and Level 2.

The NBOME understands the desire for a “conversion formula” for osteopathic medical students applying to ACGME-accredited residency programs. The NBOME is currently developing a study plan for the development of a valid and reliable conversion formula.  Meanwhile, NBOME publishes a guide to residency program directors which includes the proper use of the percentile score converter and secondary uses of COMLEX-USA exam scores.