What is the COMLEX?

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  • Written By: Mary McMahon
  • Edited By: Bronwyn Harris
  • Last Modified Date: 19 October 2019
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The Comprehensive Osteopathic Medical Licensing Examination (COMLEX) is a three stage standardized test administered to osteopathic physicians in the United States during various stages of their training. Successful passage of all three stages of the COMLEX is required before an osteopathic doctor may practice medicine. The test is analogous to the United States Medical Licensing Exam (USMLE), and both tests are commonly referred to as “board exams.” Since this test must be passed before someone can practice medicine, it is taken extremely seriously by both test takers and examiners.

Several things are tested on the COMLEX. The first is basic clinical skills and osteopathic knowledge. Test takers also must use problem solving skills, logic, critical thinking, and analysis. The COMLEX also places a heavy emphasis on patient care, professionalism, and written and spoken communication. Each stage of the exam has two basic sections: physician tasks and patient presentation.


The first stage of the COMLEX is administered after the second year of medical school, before students start clinical rotations. It tests basic clinical knowledge of major conditions, presented in a multiple choice question format which also includes simulated patient situations. At the end of the fourth year, students must pass the second stage, which is a two day test. On the first day, test takers take an eight hour long standardized test which includes breaks for snacks, stretching, and other needs. On the second day, candidates interact with simulated patients, demonstrating clinical skills, communication abilities, and a knowledge of osteopathic principles.

The third stage of the COMLEX is administered during residency, typically during the second year. The one day test ensures that the physician is capable of practicing medicine independently, and it requires the doctor to make rapid and very important decisions with confidence. All of the stages of the COMLEX cover a range of medical disciplines including surgery, pediatrics, obstetrics and gynecology, psychiatry, and internal medicine, among others.

Once a physician has successfully passed the COMLEX, she or he must still complete residency requirements before applying to practice medicine. COMLEX scores are accepted by all states. An osteopathic doctor may also elect to take the USMLE, although allopathic doctors are not eligible to take the COMLEX. These two tests are very different, although both focus on ensuring that doctors can safely practice medicine. Study strategies for the USMLE and COMLEX require very different approaches, and as a general rule osteopathic doctors prefer to take the COMLEX since it more closely reflects their experiences in medical school.


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Post 1

Many osteopathic students also take the USMLE in addition to the COMLEX, because most D.O. graduates end up in residency programs alongside the M.D.'s. The non-osteopathic sections on both exams are very similar.

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