What is COMLEX?

COMLEX is the osteopathic medical board exam, required by the American Osteopathic Association and administered by a separate organization, the National Board of Osteopathic Medical Examiners (NBOME). The AOA mandates that the student must pass 3 exams for graduation at any of the osteopathic medical schools: 2 of these are computer-based cognitive exams and one is a practical exam using standardized patients, the PE. The cognitive exams are taken at any Prometric Exam Center, the practical at the NBOME facility in Conshohocken, Pennsylvania, just outside Philadelphia.

In general terms, what is the COMLEX Pass Policy at WVSOM?

If you remove the details of procedure regarding fine points, the policy is very simple: the student must:

  • take and pass Level 1 COMLEX at the end of the 2nd year to remain on rotations,
  • take and pass Level 2-CE COMLEX (computer-based knowledge exam) at the beginning of the 4th year to graduate,
  • take and pass Level 2-PE COMLEX (standardized patient exam) sometime in the 4th year to graduate.
  • In general, a student may accumulate a total of 5 failures over these 3 exams and still graduate. The sixth failure brings dismissal from WVSOM. Few students fail any of them.

How should I prepare for Level 1 COMLEX in the second year?

The material contained in the systems defines the majority of the material that appears on this exam, but there are more specific guidelines:

  • the basic sciences involved in understanding the basis for disease and treatment form the biggest category, covering about 75% of the exam. Pharmacology, pathology, microbiology, and OP and P are responsible for about 70% of that material, the remainder being made up of foundation sciences (anatomy, physiology, and biochemistry) and behavioral science, •
  • the history and physical aspect of clinical diagnosis is the second biggest category, about 10% of the exam, •
  • 4 other areas make up the remaining 15% of the Level 1 material, including o
    • prevention of disease and injury, o
    • the use of diagnostic technology, o
    • disease and injury management, and o
    • societal issues in medicine, such as medical law, ethics, economics, and health administration.

Students are given roughly a month and a half of free time for preparation, depending upon when they take the exam. In addition, all students are provided a board preparation program to assist in their review. Each student is required to take a diagnostic exam provided by the school before they take the Level 1 COMLEX to help determine areas of weakness.

How do WVSOM students perform on the COMLEX exams taken before graduation?

As with all schools, our class performance varies somewhat from year to year in terms of pass rate. Over the past 15 years, the pass rate on COMLEX Level 1 has been as high as 93% and as low as 75% on the first take. We have tended to average in the high 80s in first-time pass rate on Level 1.

On the Level 2-CE, first-time pass rate has varied between 80% and 94%, with an average performance in the high 80s.

On the Level 2-PE, the pass rate for first-time takers has been 96% to 99%. Over that same 15 years, 3 students have been dismissed because of failure to pass COMLEX at one of the levels. A few others have decided to leave school on their own because of board-passage issues.

How will failure or low scores affect an osteopathic medical student?

Board failure is going to affect a student most in obtaining a desired residency. If a student fails one of the COMLEX exams even once, highly competitive residency programs such as dermatology, ophthalmology, surgery of all types, urology, radiology (and radiation oncology) are going to be denied to him or her. Also, scores below 600 will make a student much less competitive in these residencies.

It will be much more difficult for a student who has failed COMLEX to get into residency programs such as in emergency medicine and obstetrics and gynecology. Scores below 500 for these residencies will make a student much less competitive.

Failure of the USMLE will preclude a student from obtaining an MD-residency, though failure of COMLEX one time may not.

What's the difference between COMLEX Level 1 and USMLE Step 1? Is there any reason to take the USMLE?

Obviously, each was developed for different professions, though there is much overlap between them in terms of the material to be reviewed. However, COMLEX was constructed specifically for the osteopathic profession, and includes questions on OPP and OMT as well as the material that is part of the USMLE. Also understand that COMLEX questions are delivered entirely in the context of a clinical encounter, and concern clinical conditions a primary care physician is likely to encounter on a daily basis. USMLE does address some of this, but also includes questions on material that does not apply to patient encounter; there also tends to be a greater emphasis on molecular biology and genetics on the USMLE Step 1.

To qualify for graduation at WVSOM or for all DO-based residency programs, there is no reason to take the USMLE. Some MD-based residency programs may ask for USMLE scores, but most now accept COMLEX. You need to check with the specific programs you wish to try for to determine if the USMLE is necessary. A student who wishes to enter a fellowship after their residency should also seriously consider the USMLE. Each year, about 10% of WVSOM students take the Step 1 USMLE, a smaller number the Step 2.