COMLEX Level 2 overview

The COMLEX licensing exams are created by the NBOME (The National Board of Osteopathic Medical Examiners) and consists of three separate exams. The medical student will have to have completed COMLEX Level 1 within the NBOME requirements before he is able to take Level 2. They must also have completed the third year at a college of osteopathic medicine accredited by the COCA (Commission on Osteopathic College Accreditation). Successful completion of levels 1 and 2 is prerequisite to taking COMLEX level 3.

COMLEX Level 2 format

There are two components of the Comlex Level 2 exam.

1) Written exam -COMLEX-USA Level 2-CE (Cognitive Evaluation)

2) Clinical skills exam -COMLEX-USA Level 2-PE (Performance Evaluation)

The medical student must complete both of these components independently in order to have successfully passed Comlex Level 2.

Why is a performance evaluation component added to COMLEX Level 2?

As the medical student develops more clinical knowledge, an assessment is carried out in order to assure public safety and to document the clinical skills of medical students before their first post-graduate year. The examination in this regard will allow the student to adequately prepare and augment their clinical skills before they treat patients independently. It is a seven-hour exam period in which the medical students go through 12 standardized patient encounters. Unlike the other Comlex examinations in which an exact score is given, the Performance Evaluation exam is scored as either a “Pass/Fail.”

What does the COMLEX-USA Level 2-CE (Cognitive Evaluation) test me on?

It is problem-based and symptoms-based, integrating the clinical disciplines of:

  • Emergency medicine
  • Family medicine
  • Internal medicine
  • Obstetrics/gynecology
  • Osteopathic principles
  • Pediatrics
  • Psychiatry
  • Surgery

COMLEX Level 2 score distribution

Just as is the case for levels 1 and 3, the mean 3-digit score on COMLEX Level 2-CE is 500. The minimum passing score on the CE portion is 400. Scoring is different for the PE section, but the student must pass both the CE and PE portions to pass the exam (COMLEX 2-CE and PE information)

COMLEX Level 2 preparation materials

The most reliable COMLEX practice tools come from the NBOME, in the form of the Comprehensive Osteopathic Medical Self Assessment Examination (COMSAE). The COMSAE Phase 2 closely resembles COMLEX Level 2. There are multiple forms for phase 2, so a candidate could take it more than once. COMSAE serves as a self-assessment tool with a format, structure and scoring very similar to that of the COMLEX.

Unfortunately, there are few other COMLEX-specific prep materials, so most of the prep comes from USMLE step 2 materials. Among the most recommended sources for succeeding on the Level 2 exam are:

  • Kaplan has a very strong USMLE question bank
  • First Aid for the Boards
  • Prescription for the Boards, USMLE Step 2, Lippincott, Williams & Wilkins
  • Underground Clinical Vignettes, Student to Student Medical Publishing
  • Insider’s Guide to the USMLE, Step 2, John M. Stang

Also, take the time also to complete any practice questions that you can get your hands on including Kaplan questions, First Aid Rx, and USMLEworld. Doing questions are the key to success AFTER proper studying.


1. Osteopathic medical school and COMLEX forum

2. National Board of Osteopathic Medical Examiners, Inc. (NBOME).