COMLEX Level 3 overview

The COMLEX level 3 is the final licensing exam administered by the NBOME (The National Board of Osteopathic Medical Examiners). COMLEX Level 1 and COMLEX Level 2 are taken during medical school, but to be eligible for Level 3 a candidate must have graduated from an AOA accredited college of osteopathic medicine (see the NBOME bulletin for the full official eligibility criteria).

COMLEX Level 3 content breakdown

  • History and Physical 12%
  • Diagnostic Technology 23%
  • Management 33%
  • Scientific Understanding of Disease 08%
  • Health Promotion/Disease Prevention 16%
  • Health Care Delivery Issues 08%

This composition breakdown differs from Levels 1 and 2 which deal mainly with Scientific Understanding of Disease and and History and Physical, respectively.

The exam is eight sections of 50 questions each divided into four morning sections and four afternoon sections. There are four hours for the morning sections and four hours for the afternoon ones. In addition to the forty minute lunch break between sections, there are two ten minute breaks

The COMLEX Level 3 basically tests the ability to understand essential concepts and principles that will be necessary for problem solving as independently practicing osteopathic generalist physicians. It also focuses primarily on the management of common diseases and the appropriate response during emergency situations. Level 3 also contains computer-based case simulations (CCS).

What does the COMLEX-USA Level 3-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 3 score distribution

Just as is the case for levels 1 and 2, the mean 3-digit score on COMLEX Level 2-CE is 500. Unlike the previous two exams, however, the minimum passing score on the CE portion is 350 (minimum two digit score is 75). The pass rate for first time takers is 93%.

According to the NBOME, COMLEX-USA Level 3 score reports will be mailed to both the candidate and the dean of the candidate’s school and may be released by the NBOME to the Director of Medical Education at the candidate’s internship hospital.

COMLEX Level 3 preparation materials

Many residents are encouraged to prepare for this examination from the first day they step into the clinical facilities by paying attention during morning rounds, taking adequate notes on clinical procedures and management, and making sure that a concept is grasped properly and not merely memorized. Residents are also encouraged to seek assistance from chief residents or attendings in learning aspects of clinical medicine.

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 3 is designed to resemble COMLEX Level 3, and the multiple forms available for phase 3 means a candidate could take it more than once.

Unfortunately, other than COMSAE there are few COMLEX-specific prep materials, so most of the prep comes from USMLE step 3 materials. Among the most recommended sources for succeeding on the Level 3 exam are:


1. Osteopathic medical school and COMLEX forum

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

3. MomMD COMLEX information.

Topics #comlex #comlex level 3 #D.O. school #level 3 #medical school #osteopathic #osteopathy