American Osteopathic Association

Advancing the distinctive philosophy and practice of osteopathic medicine


This portion of the COMLEX exam, typically taken during your first year of residency, assesses your clinical skills through a computerized exam that tests your knowledge and your decision-making skills in providing patient care. Each state requires DOs to obtain a license to practice medicine after the first year of residency and after passing COMLEX-USA Level 3.

Upcoming Changes

Beginning in September 2018, COMLEX-USA Level 3 will become a two-day computer-based examination consisting of multiple choice questions. You’ll also be tested on clinical decision-making cases that could include short answer items to images, video or audio questions. 

The one-day exam is no longer offered. However, registration for the two-day exam is now open. The two-day exam will be offered beginning Sept. 10, 2018.

New test specifications for each level of COMLEX-USA are not yet available to the public, but updated format specifications can be found on the NBOME website, and the NBOME has already begun sharing updates with educators.

When do I take COMLEX-USA Level 3? 

Most DOs take COMLEX-USA Level 3 during their first year of residency. Before you can take the exam, you’ll need to:

  • Pass both COMLEX-USA Level 2-CE and Level 2-PE.

  • Earn your osteopathic medical degree from an accredited college of osteopathic medicine.

Beginning in September 2018, NBOME also will require an attestation from an AOA- or ACGME- accredited residency program director that you are in good academic and professional standing. While it’s not required, NBOME also will recommend waiting until you’ve completed six months of residency training before taking COMLEX-USA Level 3.

Visit NBOME for more information, including registration and fees and upcoming test dates.

What to Expect

The exam is split into a four-hour session in the morning and four-hour session in the afternoon. You’ll complete the exam in a workstation at a Prometric Testing Center.

You’ll need to bring with:

  • Your driver’s license or other current government-issued ID with your full name.

  • Snacks and drinks.

On testing day, you will be asked a series of a total of 350 multiple choice questions testing your clinical medical knowledge and decision-making skills to provide care in clinical science areas, including:

  • Emergency medicine

  • Family medicine

  • Health promotion and disease prevention

  • Internal medicine

  • Neuromusculoskeletal medicine

  • Obstetrics/gynecology

  • Osteopathic principles

  • Pediatrics

  • Psychiatry

  • Surgery

Test items include multiple choice questions, extended matching items, and short answer questions, as well as questions with audio and visual images. You’ll be able to review your answers to each section of exam questions before you advance to the next section.

The last section, clinical decision-making (CDM) cases, will test your patient management skills. Through a series of clinical scenarios, you’ll be tested on your ability to:

  • Acquire patient data.

  • Interpret data, such as a patient’s history or test results, to make a diagnosis.

  • Develop a treatment plan.

Beginning in September 2018, COMLEX-USA Level 3 will be spread out over two days instead of taking place during one day. The CDM cases will be enhanced to include images, videos or audio exhibits.

Be sure to prepare in advance by taking practice examinations.

On exam day, you can take two optional 10-minutes breaks as well as an optional 40-minute lunch break. You’ll need to leave the testing room during your break and show your ID to return to the testing room. During the breaks, you can access a locker for food, drink, medications or other stored items.

After the Exam

You will get an email approximately one month after you complete the exam that your scores are available through your COMLEX-USA account. 

You’ll need a score of at least 350 to pass COMLEX-USA Level 3. Typically the three-digit score for all levels of COMLEX is 500-550. All test questions count equally toward your final score, except the pretest or “tryout” questions you take at the very beginning of the exam, which don’t count toward your final score.

To convert your score from three-digit to a two-digit percentile, open the Percentile Score Converter and enter your three-digit score. Next select the examination level and testing cycle of the exam before pressing the Convert button.

Visit NBOME for more information on examination scoring.