Prepare for COMLEX Level 2: An Exam Breakdown

Preparing for the COMLEX-USA Level 2-Cognitive Evaluation (Level 2-CE) can be unnerving. It’s one of the many benchmarks on your journey to becoming a doctor of osteopathic medicine (DO) and tests not only your medical knowledge, but also your ability to apply it in a clinical context. 

While passing the COMLEX Level 2-CE is required for graduation and residency, the higher your score, the better. A high COMLEX Level 2-CE score can provide the competitive edge you need when applying to your dream fellowship or residency program.

The best thing you can do to conquer this exam is to prepare. In this COMLEX Level 2-CE breakdown, we’ll cover everything you need to know from the exam’s structure and content to the best high-yield resources. Let’s go!

COMLEX Level 2 vs Level 1: What’s the Difference?

There are a few differences between the COMLEX Level 2-CE and Level 1. COMLEX Level 1 is a pass/fail exam taken during the second year of your DO program. Level 2-CE, however, is taken during your third year, and unlike Level 1, you’ll receive a three-digit score for this exam.

Level 1 captures everything you’ve learned in the first year of medical school. This includes foundational biomedical knowledge, clinical problem-solving skills, and promoting health maintenance. Level 2-CE, on the other hand, primarily tests your application of clinical and foundational biomedical knowledge, focusing on care in clinical settings, ethics, systems-based practice, and communication. 

Both exams have the same dimensions, or categories, within which questions fall. However, the minimum percentages are different in Dimension 1: Competency Domains. 

Try getting familiar with the differences between the COMLEX Level 1, 2, and 3 blueprints to identify where your focus should lie when studying.

COMLEX Level 2 Exam Format

The COMLEX Level 2-CE format is similar to the COMLEX Level 1. It is a one-day computer-based exam with 8 sections. Each section contains 44 questions, meaning there are 352 questions total. They are multiple-choice items and require a single best answer.

Note #1: The National Board of Osteopathic Medical Examiners (NBOME) has announced that the number of questions on COMLEX Level 2-CE will be changing from 352 to 320, which is currently targeted to go into effect in June 2026.

The exam is 8 hours long, and you’ll have a 60-minute pool for breaks. Each scheduled break occurs after you’ve completed two exam sections. If you need to take more breaks than scheduled, it will cut into your exam time.

High-Yield Study Tools for COMLEX Level 2

Flashcards

Anki digital flashcards are a convenient and effective study tool. You can create a digital deck yourself, or feel free to scour a forum or two to see what your peers recommend! For example, plenty have cited the Zanki Step 2 deck as a go-to set, though it is missing some images. Another popular set is the OMMedicine Anki deck, which is free to download.

Self-Guided Study Videos

Picmonic for DO Students makes studying for the COMLEX Level 2-CE enjoyable. It captures the essential osteopathic medical facts in concise, impactful videos using memorable picture mnemonics. With spaced repetition quizzes and an app for studying on the go, it’s a unique tool to enhance your COMLEX study routine. Picmonic’s study scheduler can also help you stay organized so you can cover all the exam material before test day.

Question Banks 

Did you know that more than 91% of OMS3s nationwide use COMBANK to outperform on COMLEX Level 2-CE? COMBANK is TrueLearn’s SmartBank for the exam. It offers over 2,500 Level 2-CE questions, OMM videos, board-style vignettes, and thorough explanations to help you understand the reasoning behind each answer. Furthermore, the interface is expertly designed to familiarize you with the exam, helping ease those pesky nerves on exam day.

To predict your COMLEX Level 2-CE performance, you can also purchase TrueLearn’s 180-question, half-day predictive assessment to take a few weeks before you plan to sit for the exam. It will identify your strengths and weaknesses, provide you with a three-digit score, and show you how you’re likely to perform on the real COMLEX. 

COMLEX Level 2 Scoring: Everything You Need to Know

COMLEX Level 2-CE scores can fall anywhere between 9 and 999. A passing score is 400, and the scoring scale is centered around a mean of 500. 

You’ll receive your results four to six weeks after you’ve completed the exam. In July or August, you can check your COMLEX Level 2-CE percentile using the percentile score converter—that’s when the NBOME has the full score data for the current testing cycle. 

How to Use Your Results to Prep for COMLEX Level 3

COMLEX Level 3 is a bit more complex than the COMLEX Level 2-CE, as it evaluates if you’re fully competent to practice as an unsupervised DO.

The COMLEX Level 3 exam spans two days and has additional item types like short-answer and extended multiple-choice. These types appear for clinical decision-making (CDM) questions, which are unique to this exam.

Note #2: In addition to the changes coming to Level 2-CE, the NBOME announced that Level 3 will become a one-day exam starting January 2027.

With that in mind, we highly recommend using your COMLEX Level 2-CE scores to identify areas for improvement, both in your study routine and knowledge gaps. The stakes feel higher for the COMLEX Level 3, but anything is possible with the right mindset, tools, and preparation.

No matter which COMLEX you’re preparing for, you can level up your study routine with TrueLearn—we guarantee you’ll pass with a 90-day+ subscription. Good luck!