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NBOME


Dimension 1 of the COMLEX-USA blueprint consists of seven Competency Domains, which represent the related sets of foundational abilities representing the required elements and outcomes that define the knowledge, skills, experience, attitudes, values, behaviors, and established professional standards.

Dimension 1: Competency Domains Minimum % Level 3
1 Osteopathic Principles, Practice, and Manipulative Treatment 10%
2 Osteopathic Patient Care and Procedural Skills 40%
3 Application of Knowledge for Osteopathic Medical Practice 17%
3.1 Foundational Biomedical Sciences Knowledge Base 10%
4 Practice-Based Learning and Improvement in Osteopathic Medical Practice 8%
5 Interpersonal and Communication Skills in the Practice of Osteopathic Medicine 3%
6 Professionalism in the Practice of Osteopathic Medicine 6%
7 Systems-Based Practice in Osteopathic Medicine 6%

Dimension 2 consists of 10 Clinical Presentations, which represent the manner in which a particular patient, group of patients, or a community presents for osteopathic medical care.

Dimension 2: Clinical Presentations Minimum
% Level 3
1 Community Health and Patient Presentations Related to Wellness 12%
2 Human Development, Reproduction, and Sexuality 5%
3 Endocrine System and Metabolism 5%
4 Nervous System and Mental Health 10%
5 Musculoskeletal System 13%
6 Genitourinary/Renal System and Breasts 5%
7 Gastrointestinal System and Nutritional Health 10%
8 Circulatory and Hematologic Systems 10%
9 Respiratory System 10%
10 Integumentary System 5%
Contents
Contents

The practice exams include examples of test items found on the actual exam and begin with a tutorial. During practice, answers will not be recorded for scoring or saved when the next item is viewed. Please record responses on paper if this is something that should be tracked. A special function in the practice exam is provided to view the correct answer for each item.

The NBOME is pleased to announce the expansion of its staff with two additional senior osteopathic physician leaders.

On July 9, J. Michael Finley, DO, began his new role as Senior Vice President for Assessment, joining Joel Dickerman, DO, who was appointed Vice President for Assessment Services on June 18. Drs. Dickerman and Finley join Gretta A. Gross, DO, and MEd, who was named Vice President for Clinical Skills Testing in April. In welcoming the arrival of the newest members of the NBOME team, John R. Gimpel, DO, MEd, President and CEO, said “With the addition of these exceptional physicians, who are well known to the osteopathic medical education and graduate medical education communities, we look forward to reaching new heights in advancing our mission to protect the public and affecting the quality of osteopathic medical education, training and practice.”

Joel Dickerman, DO,began as NBOME Vice President for Assessment Services on June 18, 2018 and is based in the NBOME Chicago offices. At the NBOME, Dr. Dickerman will lead the Department of Assessment Services. Most recently he served as senior associate dean for clinical affairs at Rocky Vista University College of Osteopathic Medicine in Parker, Colorado, in addition to holding leadership positions in graduate medical education, continuous quality improvement and continuous professional development. Dr. Dickerman was named an “Item Writer of the Year” by the NBOME and formerly served the organization as a clinical decision-making case author, a continuous professional development consultant/coordinator and a standard-setting panelist. A graduate of the Chicago College of Osteopathic Medicine, Dr. Dickerman is board certified in family medicine with certificates of added qualifications in geriatrics, sports medicine, and hospice and palliative care.

J. Michael Finley, DO, was named NBOME’s first Senior Vice President for Assessment and began in his full-time role on July 9, 2018. A former member of the NBOME Board of Directors from 2010-2018 and on the Executive Committee from 2013-2016, Dr. Finley was most recently the associate dean of graduate medical education at the Western University College of Osteopathic Medicine of the Pacific in Pomona, CA, where he served since 2000. While at the Western University College of Osteopathic Medicine, he held numerous administrative roles, including as chair of the department of internal medicine, chief academic officer of the OPTI-West graduate education consortium, and as a residency program director in internal medicine. A graduate of the Chicago College of Osteopathic Medicine, Dr. Finley is board certified in internal medicine and rheumatology and was named the 2015 recipient of the American Osteopathic Foundation’s Educator of the Year Award. In addition to his involvement as a member of the NBOME Board, Dr. Finley has been involved with the NBOME since 2000 as a an active member of the National Faculty, participating in standard setting, COMAT, standards and assurances, facilities and space planning, and numerous COMLEX-USA Level 2-PE committees. Dr. Finley will primarily be located in the NBOME Chicago offices.

 

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About the NBOME
The NBOME is an independent, non-governmental, non-profit assessment organization committed to protecting the public by providing the means to assess competencies for osteopathic medicine and related health care professions. NBOME’s COMLEX-USA examination series is a requirement for graduation from colleges of osteopathic medicine and provides the pathway to licensure for osteopathic physicians in the United States and numerous international jurisdictions. For more information, visit www.nbome.org or call 866-479-6828.

Dimension 1: Patient Presentation
Population Health Concepts and Patients with Presentations Related to Health Promotion, Chronic Disease Management, and Human Development 8 – 16%
Patients with Presentations Related to Digestion and Metabolism 4 – 10%
Patients with Presentations Related to Cognition, Behavior, Sensory & Central Nervous Systems, Substance Abuse, and Visceral and Sensory Pain 28 – 38%
Patients with Presentations Related to the Musculoskeletal System, including Somatic Pain 6 – 12%
Patients with Presentations Related to the Genitourinary System and Human Sexuality 3 – 8%
Patients with Presentations Related to Circulation and the Respiratory System 8 – 16%
Patients with Presentations Related to Thermoregulation 2 – 6%
Patients with Presentations Related to Trauma, Masses, Edema, Discharge, and the Skin, Hair, and Nails 8 – 16%
Patients with Presentations Related to Pregnancy, the Peripartum, and the Neonatal Period 3 – 8%

Dimension 1 Categories



Dimension 2: Physician Tasks Level 1 Level 2 CE Level 3
Health Promotion & Disease Prevention 1 – 5% 15 – 20% 15 – 20%
History & Physical Examination 5 – 15% 30 – 40% 10 – 20%
Diagnostic Technologies 1 – 5% 10 – 20% 15 – 25%
Management 2 – 7% 10 – 20% 25 – 40%
Scientific Understanding of Health & Disease Mechanisms 70 – 85% 5 – 15% 5 – 10%
Health Care Delivery Issues 1 – 3% 5 – 10% 5 – 10%

Dimension 2 Categories


Download 2020-2021 COMAT Test Administration Guide PDF

 

I. Overview

The purpose of this guide is to provide a reference to the colleges of osteopathic medicine (COMs) for the Comprehensive Osteopathic Medical Achievement Test (COMAT) administration.

II. Description of the COMAT Series

The NBOME COMAT series includes eight core clinical discipline exams, a comprehensive foundational biomedical sciences exam, and fourteen targeted foundational biomedical sciences (FBS) exams.

The COMAT Clinical subject exams are designed for standardized assessment in core osteopathic medical disciplines, such as end-of-course or clinical rotation student assessment, and assess an osteopathic student's achievement level on those disciplines. Each Clinical examination in the series has osteopathic principles and practice integrated throughout, making it the obvious choice for COMs for student assessment needs. The Clinical exams are also the only osteopathically distinctive discipline-specific examinations available.

The FBS Comprehensive exam is designed for standardized assessment in overall basic sciences, as studied in the first and second years of medical school, and assesses an osteopathic student’s achievement level across both basic science disciplines and body systems.

The FBS Targeted exams are designed for standardized assessment in specific basic science disciplines and body systems, as studied in the first and second year of medical school, and assess an osteopathic student’s achievement in individual basic science disciplines and body systems.

All exams in the COMAT series are:
  • Presented in a style and format comparable to the COMLEX-USA licensure series
  • Created to reflect osteopathic physician practice
  • Written by osteopathic and FBS discipline subject matter experts

III. COMAT Use Policy

The NBOME develops and provides the COMAT series to be administered by the COMs to assess the osteopathic medical knowledge of their medical students in the following areas:

Clinical Subjects
  • Emergency Medicine
  • Family Medicine
  • Internal Medicine
  • Obstetrics and Gynecology
  • Osteopathic Principles and Practice
  • Pediatrics
  • Psychiatry
  • Surgery
Foundational Biomedical Sciences
  • FBS – Comprehensive
  • Foundational Anatomical Sciences
  • Foundational Neurosciences
  • Microbiology and Immunology
  • Molecular, Biochemical, Tissue, and Cellular Basis of Health and Disease, including Medical Genetics
  • Pharmacologic Principles and Concepts
  • Physiologic Basis of Health and Disease
  • Cardiovascular and Hematologic Systems
  • Endocrine System and Metabolism
  • Gastrointestinal (GI) System and Nutritional Health
  • Genitourinary/Renal System
  • Human Development, Reproduction and Sexuality
  • Integumentary System
  • Musculoskeletal System
  • Respiratory System
COMs must maintain the security and integrity of the COMAT series.

IV. Examination Information

Information about the exam specifications follows.
  • COMAT Clinical Subjects
    • 125 Questions
    • 2.5 Hours
    • 8 Subject Exams
  • COMAT Foundational Biomedical Sciences - Targeted
    • 62 Questions
    • 1.5 Hours
    • 14 Content Areas
  • COMAT Foundational Biomedical Sciences - Comprehensive
    • 200 Questions
    • 4 Hours*
    • 16 Content Areas
*Optional break after section 1 is completed.

V. Roles and Responsibilities

A. COM Dean and Administrator

Determine the utilization of COMAT exams and work with the NBOME to execute a COMAT Master Agreement for exam administration.

B. COMAT Coordinator

A COMAT Coordinator is designated by the dean to manage COMAT administrations for their COM students. The primary responsibilities of the COMAT coordinator are to:
  • Oversee administrative tasks for the COMAT administrations
  • Ensure that all COMAT examinations are administered in a secure, proctored setting
  • Report and follow up with NBOME on adverse testing conditions that might impact the administration. Please refer to the COMAT Proctor Guide.
  • Manage COMAT invoices and payment
C. COMAT Proctor

All COMAT examinations must be proctored by a COM-approved proctor. The primary responsibilities of the COMAT proctor include:
  • Secure a quiet location to administer the COMAT examination
  • Follow the proctor guidelines and conduct the examination according to the specified procedures in the COMAT Proctor Guide
  • Run system checks and resolve any issues prior to COMAT administrations and ensure that the secure browser has been downloaded to all work stations and devices used for testing
  • Ensure test security and minimal disturbance
  • Monitor examinees throughout the examination
  • Report to COMAT administrator of adverse testing conditions that might impact the administration
D. COMAT Students

COMAT students are expected to:
  • Prepare any personal equipment (conduct system check and download browser) prior to examination date
  • Follow instructions provided by proctor during the administration

VI. Delivery Options

A. COM Approved Location
The COMAT series must be administered in a secure, proctored setting.

PC/MAC/Apple iPad
Delivered via a secure browser on a desktop or laptop computer provided by either the COM or student
Delivered through NBOME’s custom application (eCOMAT) on any standard Apple iPad device.

B. Prometric Testing Center (available only for COMAT Clinical Subject examinations)
COMAT administration for the clinical subject examinations is available at Prometric testing centers. The Foundational Biomedical Sciences examinations will not be available at Prometric. Prometric testing may be preferred for students who are unable to take the examination at the COM approved location. This option requires a five-day minimum advance scheduling and an additional administrative fee for the seat at Prometric. See the Registration and Scheduling section.

VII. Registration and Scheduling

A. Registration

a) COM Approved Location

The NBOME has provided a means for the COM to designate students for individual COMAT disciplines. It is available through the COMAT tab on the dean’s page in the Client Registration System (CRS). The registration includes selecting the student from the class list, choosing the specific examination, assigning location and proctor.

b) Prometric Testing Center (available only for COMAT Clinical Subject examinations)

The NBOME has provided a means for the COM to designate students for an individual COMAT discipline. It is available through the COMAT tab on the dean’s page. The registration includes adding “Prometric Eligibility,” selecting Eligibility Start Date and End Date.

B. Scheduling

a) COM Approved Location

The COMAT Coordinator registers and schedules a date for an upcoming administration as part of the registration process via CRS.

b) Prometric Testing Center (available only for COMAT Clinical Subject examinations)

The COMAT Coordinator sets a date range for students via CRS. Students will then receive an email notification to schedule with Prometric. Students must schedule with Prometric at least five days before the examination date.

C. Rescheduled, Canceled, or Missed Scheduled Examination

a) COM Approved Location

COMs can make changes to a scheduled examination date at any time unless the examination is in progress. A missed examination can be rescheduled for a new date at no cost to the COM.

b) Prometric Testing Center (available only for COMAT Clinical Subject examinations)

COMs can make changes to a scheduled examination date up to 30 days prior to their examination date at no cost to the COM. A change made within 30 days will incur the full seat fee.

VIII. Retaking an Examination

Students are allowed to retake COMAT exams under the direction of their COM. COMs should allow students to retake the same COMAT examination subject only after receiving the prior examination result.

IX. Test Accommodations Requests

The COM is responsible for review and approval of all test accommodations requests for the COMAT administrations. The COM is responsible for all additional costs required to provide the approved accommodation. NBOME will make a good faith effort to provide such reasonable test accommodations as the COM determines are warranted for the students.

Special Assistance

a) COM Approved Location

A student may not have any family member, assistant, or other person for any reason except approved by the COM as a special accommodation in the testing area.

b) Prometric Testing Center (available only for COMAT Clinical Subject examinations)

Prometric may provide limited special assistance if sufficient notification is provided to NBOME. Under no circumstance may the Prometric testing center professional staff permit any additional time to take the examination or modify the examination or testing conditions in any way that would alter the standards for measurement of the knowledge or skill being tested by the examination. Examples of special assistance that may be permitted include, but are not limited to, the use of earplugs, dietary needs, or taking medication.

X. Examination Administration

A. Arrival and Identification

a) COM Approved Location

The COM establishes the arrival time for an examination. Proctors will be responsible for verifying the identity of all students.

b) Prometric Testing Center (available only for COMAT Clinical Subject examinations)

Students must arrive 30 minutes prior to the start time of the scheduled administration, and must bring with them one piece of identification, which must be a valid government-issued picture ID with signature, such as a current driver’s license or passport.

B. Late Arrival

a) COM Approved Location

The COM will determine whether a student is allowed to sit for the examination upon late arrival.

b) Prometric Testing Center (available only for COMAT Clinical Subject examinations)

Any student who arrives after the scheduled start time may be permitted to take the examination only if the testing center is able to deliver the examination in its entirety.

C. No Outside Information or Access

a) COM Approved Location

During the full test session, students are not permitted to access any information or data, including but not limited to any access to a cellular phone or PDA, text, notes or other materials, and may not communicate in any manner with anyone outside the testing area.

b) Prometric Testing Center (available only for COMAT Clinical Subject examinations)

During the full test session, students are not permitted to access any information or data not provided to the student by Prometric at the testing center, including but not limited to any access to a cellular phone or PDA, text, notes or other materials, and may not communicate in any manner with anyone outside the testing center. Students are required to place all personal property, including watches, in the secure lockers provided at the testing centers.

D. Interruption of Examination or Computer Malfunction for All Approved Locations

In the event of an examination interruption, the proctor will determine whether the examination will resume from the point the examination was stopped and if the examination interruption will still permit the examination to be administered in its entirety.

If the examination is interrupted for a period of time that will not permit the examination to be administered in its entirety, or the examination is canceled for emergency or safety purposes, the COM must inform NBOME immediately and NBOME will not score the examination. Otherwise, if the issue is not reported to the NBOME, the score will be released to the COM.

E. Cancellation Due to Inclement Weather, Other Force Majeure

a) COM Approved Location

If a student is unable to test due to inclement weather, force majeure, or other event beyond the control of the COM, the examination can be rescheduled.

b) Prometric Testing Center (available only for COMAT Clinical Subject examinations)

In the event of severe inclement weather, force majeure, or other event beyond the control of Prometric, Prometric may in its sole discretion cancel a scheduled examination. If this occurs, students should contact his/her COM to arrange a new period of eligibility.

F. Emergency Evacuation for All Approved Locations

Students will follow the emergency evacuation instructions of the testing site.

G. Test Day Issues

Students who encounter test day issues must report to their proctor or Prometric testing center staff immediately. After reporting the incident to the staff on premises, the student must inform their COM of the incident. NBOME will work with the COM to review the issue to determine the appropriate resolution. If a student does not complete the exam for any reason, the school will be responsible for payment of the exam.

XI. Conduct

The COM should follow its policy to prevent any possible irregularities in test administration, student behavior, breach of test security, or confidentiality. Any proctor, who suspects irregular conduct by a student during a COMAT administration should report the conduct to the COM and NBOME.

XII. Voided Examination Administration

The NBOME can remove a score for an examination requested by the COM or under circumstances where NBOME determines the test administration was materially adversely impacted and/or the test administration or results is otherwise deemed by NBOME to be not be valid. Students may not void their COMAT examination score for any reason.

XIII. Fees and Invoice

A. Examination Fee

The fees for all COMAT examinations will follow the pricing structure set forth on the COMAT Master Agreement.

B. Rescheduling and Cancellation Fee

The rescheduling and cancelation fees for all COMAT examinations will follow the pricing structure set forth on the NBOME Master Agreement.

C. Invoice

All fees are invoiced after the examination administrations and are issued to the COM monthly. NBOME will not collect any fee directly from the students.

XIV. Scoring and Reporting

NBOME provides summary reports for single COMAT administrations, as well as cumulative reports for individual subjects within a COMAT testing cycle. Reports for single administrations may include summary statistics, performance profile, cumulative frequency distribution, score roster, and item key phrase report.

For the COMAT Clinical subject exams, score reports are scheduled to be released 5 to 10 business days after administration regardless of the number of administrations, typically on Thursday afternoons. For COMAT FBS exams, score reports are typically scheduled to be released on Wednesdays within 15 business days after administration. The reports are posted on the dean’s page. COMs can release individual score reports to student’s CRS account. The NBOME does not send the COMAT student score reports to students directly.

Reported scores for most COMAT exams are nationally normed standard scores, which reflect equating between different forms. Standard scores for COMAT Clinical subjects are set to have a mean of 100 and a standard deviation of 10, based on a representative norming sample. For COMAT FBS Comprehensive exams, scores have a mean of 200 and an approximate standard deviation of 10, based on a national sample of examinees in their 2nd year in osteopathic medical school.   Currently, normed standard scores are not available for COMAT FBS Targeted exams but percent correct score reports are used.

Standard score scales are reviewed annually, and may be reestablished at the discretion of the NBOME. Reported scores initially provided for new exam subject are percent correct scores. After approximately one year of availability, percent correct scores are converted to standard scores, and all subsequent reported scores for the subject are standard scores.

XV. Score Confirmation

The NBOME will confirm a COMAT examination score if a COMAT coordinator submits a written request to NBOME for score confirmation within 30 days after the scores are released. Individual students may not request score confirmations. The fee per examination score confirmation is $25, and the request must be accompanied by a check, credit card payment information or the option to invoice the school. A score confirmation entails retrieving the original test responses, rescoring and comparing the rescored results with the originally reported scores. Results of a score confirmation will be sent to the COMAT coordinator by NBOME Client Services within two weeks of the request.

XVI. NBOME and ITS Administration

NBOME will provide telephone support for all COMAT administrations between the hours of 7 AM-7 PM (Eastern Time) Monday through Friday with the exception of NBOME holidays. NBOME Client Services can be reached at (866) 479-6828, and ITS Technical Support can be reached at (800) 514-8494 between the hours of 8 AM and 8 PM (Eastern Time).

XVII. Blackout Testing Days

No COMAT exams will be administered on Saturdays and Sundays, NBOME holidays and during exam blackout periods. Please check our Non-Testing Days for those dates.

Security & Support

Security

We are committed to the convenient and secure delivery of all computer-based tests, including the COMAT examination series, whether administered on-site at a COM or at a Prometric test center. Every exam is proctored and the NBOME provides pre-examination proctor training. Each exam in the COMAT series has multiple forms, allowing COMs to securely administer a given COMAT subject exam up to 10 times per year.

In addition to ensuring the confidentiality and integrity of the electronic exams, neither the NBOME nor Prometric will disclose personal data to any individual or entity without written, signed consent or a court order.

Support

Through Client Services, we provide support to COMs for COMAT scheduling, registration, administration, security, online resources, proctor training, sample examinations, score reporting and technical support.

For system specification and test administration questions, please call NBOME Client Services at 866-479-6828 or contact us.

For in-depth information, please review the COMAT Test Administration Guide as well as the pages dedicated to each discipline.

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DEPARTMENT: Assessment Services
LOCATION: 8765 W. Higgins Rd Suite 200 · Chicago, IL 60631-4174
STATUS: Full-time

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POSITION DESCRIPTION

The Assistant Editor will assist with all facets of item editing as designated by the Managing Editor. The Assistant will provide support to the team in activities related to item-writing workshops, resource organization and maintenance, and item editing. Specific responsibilities include, but are not limited to:

REQUIREMENTS
The ideal candidate will have:

TO APPLY

Please submit resume and letter of interest summarizing your qualifications to Human Resources by email at HRadmin@nbome.org.

The NBOME is an equal opportunity employer. All applicants must be legally eligible to work in the United States.

* NBOME is an E-Verify participant

Osteopathic Concepts and Philosophy
The foundation that defines the distinctive osteopathic approach to health care based on the unity of mind, body, and spirit and the interrelatedness of structure and function. 40%
1.2 Understand and describe vascular and lymphatic organization and drainage
1.3 Have a basic knowledge of osteopathic history
1.4 Describe the osteopathic philosophy and tenets
1.5 Understand and describe applied anatomy and physiology
1.6 Define the concepts of facilitation and viscerosomatic, somatovisceral, viscerovisceral, and somatosomatic reflexes
1.7 Understand the concepts of Chapman reflexes
1.8 Obtain medical, family, social, and cultural histories from or about the patient pertinent to the presenting complaint, with emphasis on assessing potential structure-function and mind-body-spirit relationship influences
1.9 Describe the concept of interrelatedness of structure and function in the human body and how it guides physical examination for patient presentations, including biomechanical, respiratory-circulatory, neurologic, biopsychosocial, and metabolic structure-function relationships and their effect on the body's self-regulating and self-healing capabilities
1.10 Describe the underlying mechanisms, signs, symptoms, and physical findings that are associated with viscerosomatic, somatovisceral, viscerovisceral, and somatosomatic reflexes
1.11 Understand the application of osteopathic principles and practice in health and disease with particular emphasis on optimizing homeostasis and maximizing the patient's comfort and health, to resolve complaints and concerns with which patients commonly present
Osteopathic Diagnosis
The examination of a patient with emphasis on the neuromusculoskeletal system, including the diagnosis of somatic dysfunction and its role in visceral disease processes. 40%
2.1 Locate and identify Chapman reflexes (diagnostic only)
2.2 Properly palpate landmarks as well as skin, fascia, muscle, and bone to identify somatic dysfunction
2.3 Have a knowledge of cranial anatomy to identify basic strain pattern dysfunctions
2.4 Understand somatic dysfunction diagnostic principles, including barrier concept
2.5 Properly evaluate posture, gait, and motor function
2.6 Use biomechanics of spinal movement and extremities in the diagnosis of somatic dysfunction
2.7 Name and define the types of physical examination findings that are consistent with somatic dysfunction
2.8 Perform an appropriate osteopathic structural examination before and reassessment after administration of OMT
2.9 Name, define, and diagnose the types of somatic dysfunction found within the 10 body regions (head, cervical, thoracic, lumbar, sacral, pelvic, lower extremity, upper extremity, rib, and abdominal/visceral regions)
2.10 Develop and prioritize a differential diagnosis and use it to develop an appropriate care plan
2.11 Identify viscerosomatic relationships and the role of the musculoskeletal system in the patient presentation by performing an osteopathic structural examination
2.12 Document diagnostic information to allow for appropriate coding for evaluation, management services, and OMT
Osteopathic Treatment Methods
The therapeutic application of manual techniques designed to improve disorders of physiologic function and homeostasis resulting from somatic dysfunction. 20%
3.1 Describe the basic principles of manipulation, including indications, contraindications, and integration with standard medical care
3.2 Understand when to use OMM in all patient populations, especially pediatric, adult, obstetrical, geriatric, postoperative, and hospitalized patients for treating systemic illnesses involving all body systems, especially cardiovascular, upper and lower respiratory, gastrointestinal, genitourinary, neurologic, and musculoskeletal
3.3 Understand when to use OMM for treating patients for all common clinical problems and syndromes related to all anatomic regions, especially cranium, cervical spine, thoracic spine, lumbar spine, sacrum, innominates, rib cage, sternum and thoracic contents, upper extremities, lower extremities, and abdomen as well as abdominal and pelvic contents
3.4 Describe the scientific knowledge supporting the use of osteopathic principles, practice, and OMT, including the basic science of the mechanisms of OMT and somatic dysfunction, the current evidence base for the clinical application of OMT, and the role of the osteopathic physician to facilitate health
3.5 Name and describe the diagnostic examination, initial positioning, monitoring, motion barriers, activating forces, therapeutic timing, repetition, and reassessments used in indirect and direct technique types of OMT, including counterstrain, muscle energy, myofascial release, HVLA, soft tissue, lymphatic, osteopathic cranial manipulative medicine, articulatory, BLT, LAS, FPR, Still, visceral, treatment of Chapman reflexes, and treatment of trigger points
3.6 Communicate principles of and demonstrate use of appropriate therapeutic and rehabilitative exercises, activity modification, and supportive and adaptive devices in the management of neuromusculoskeletal dysfunction and facilitation of health
3.7 Compare and contrast the relative value, advantages, and disadvantages of different OMT techniques
3.8 Provide for the safety of the patient and demonstrate respect of heterogeneous and diverse populations, including but not limited to diversity in ethnicity, culture, gender identity and/or sexual orientation, and religious beliefs who may express symptoms of their somatic and/or visceral dysfunctions in unique or unconventional ways while administering OMT
3.9 Integrate scientific knowledge supporting the use of osteopathic principles, practice, and OMT into the clinical evaluation and management of the patient
3.10 Determine the limits of his/her knowledge and clinical skills and seek an appropriate referral in regard to the use of OMT or the application of osteopathic principles and practice
Reference Materials

Resources

DEPARTMENT: Clinical Skill Testing
LOCATION: 101 West Elm Street Suite 150 · Conshohocken, PA 19428
STATUS: Full-time

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RESPONSIBILITIES
Daily front desk office operations:

QUALIFICATIONS

TO APPLY

Please submit resume and letter of interest summarizing your qualifications to Human Resources by email at HRadmin@nbome.org.

The NBOME is an equal opportunity employer. All applicants must be legally eligible to work in the United States.

* NBOME is an E-Verify participant

Please review the Registration and Scheduling section of the COMLEX-USA Bulletin of Information before submitting this form.

Download Waiver Form

Examination Scoring

For the COMLEX-USA computer-based cognitive examinations, the number of items answered correctly (the raw score) is converted to a standard score for the purposes of reporting results and providing a pass-fail designation.

With the exception of pretest questions, which do not contribute to the scores candidates receive, each test question contributes equally to the candidate’s score. The total reported score is a model-based standard score that takes into account the response to each question and the psychometric properties of the examination.

A passing score for all COMLEX-USA Levels is based solely on a candidate’s performance on the total examination, not on a candidate’s performance in individual content areas. Score reports display a graphical representation of performance profiles that summarizes strengths and weaknesses in relation to the examination blueprint.

COMLEX-USA computer-based examinations are administered continuously throughout the year. Osteopathic medical schools receive summary reports at the end of the annual testing cycle. COMLEX-USA school summary reports provide school-level in comparison to the national average performance.

COMLEX-USA Level 1, Level 2-CE and Level 3 examinations replaced the Part I, II and III examinations in 1998, 1997, 1995 respectively.

The scores reported for Parts I, II and III after 1988 are 3-digit standard scores for the whole examinations. Scores reported for Parts I and II before 1987 are the minimum standard scores (2-digit) among all the component scores of the examinations. Score reported for Part III are standard scores (2-digit) for the whole examination.

Dimension 1 – The Patient Presentation
Population Health Concepts and Patients with Presentations Related to Health Promotion, Chronic Disease Management, and Human Development
Patients with Presentations Related to Digestion and Metabolism
Patients with Presentations Related to Cognition, Behavior, Sensory & Central Nervous Systems, Substance Abuse, and Visceral and Sensory Pain
Patients with Presentations Related to the Musculoskeletal System, including Somatic Pain
Patients with Presentations Related to the Genitourinary System and Human Sexuality
Patients with Presentations Related to Circulation and the Respiratory System
Patients with Presentations Related to Thermoregulation
Patients with Presentations Related to Trauma, Masses, Edema, Discharge, and the Skin, Hair, and Nails
Patients with Presentations Related to Pregnancy, the Peripartum, and the Neonatal Period


Dimension 2 – Physician Tasks
Health Promotion / Disease Prevention
History & Physical Examination
Diagnostic Technologies
Management
Scientific Understanding of Health & Disease Mechanisms
Health Care Delivery
Evaluation Components

The content of COMSAE Phase 3 is defined by the same seven categories as the COMLEX-USA content outline for Dimension 1 – Competency Domains and the same ten categories for Dimension 2 – Clinical Presentations.

 

Each of the three COMSAE phases consists of content, scoring, and reporting similar to the corresponding COMLEX-USA cognitive examinations.

NOTE: COMSAE Phase 3 does not include Clinical Decision-Making (CDM) cases. Please refer to the CDM Practice Exam for sample structure and content.

NBOME does not report percentile scores in candidates’ score reports. Upon the completion of a testing cycle, percentile scores are estimated and can be accessed using the Percentile Conversion Tool. The Percentile Score Conversion Tool converts standard scores into percentile scores for computer-based COMLEX-USA Level 1, Level 2-CE, and Level 3.

Percentile Score Converter

How To Find Percentile Scores
  1. Open the Percentile Score Converter
  2. Enter your 3-digit standard score into the respective field
  3. Select the examination level being converted using the drop-down menu options
  4. Select the date taken of the examination using the drop-down menu
  5. Click the ‘CONVERT’ button
  6. The numbers appearing to the right will be the corresponding percentile scores.

The value calculated by the Percentile Score Converter is the percentile rank in relation to other candidates who took a particular Level examination for the first time, during the same testing cycle.  Percentile scores provide normative information about the relative rank of candidates’ performance in comparison to others who took the examination within the same testing cycle. Percentile scores are dependent on the population of candidates for a given year; therefore standard scores for a given Level examination may correspond to different percentiles for different testing cycles.

Score Confirmation

Before releasing examination results or posting score reports NBOME conducts a thorough quality assurance process to ensure scoring accuracy.

Confirmation for any COMLEX-USA examination can be provided by request, if submitted within 120 days of the examination. Requests are processed through your NBOME account, located within the ‘View Scores’ section. The option for submitting this request is listed at the bottom of the page. NBOME does not release information about the scoring of individual examination questions.

COMLEX-USA cognitive computer-based exam score confirmation delivers responses recorded by computer. Because score confirmation is limited solely to the review of the responses recorded by the computer, it is unlikely to change the candidate score. We ensure that all subsections were complete and that your responses were graded against the proper form.

Score Reports

Scores are generally available within 4–6 weeks from the date of the examination. Score reports will be available via secure access to the NBOME account from the CRS portal.

Note: Score reports from the computer-based examinations taken on or after July 1, 2012, are available electronically through the NBOME Account. Candidates and osteopathic medical school dean’s offices will be able to access and print test results immediately after they are available along with the candidate’s examination history. Up-to-date information about student test-taking activities and test results remain online for accessing and printing at the candidate’s and osteopathic medical school’s convenience.

For score reports prior to July 1, 2012
Send a written request to:

Client Services
NBOME Corporate Offices & Conference Center
8765 W. Higgins Rd., Suite 200
Chicago, IL 60631-4174.
Please allow 10 business days for delivery. For questions, contact NBOME Client Services.

Score reports printed from the NBOME’s CRS do not take the place of an NBOME-certified transcript. No scores will be reported by telephone, fax, or email.

Interpreting Examination Scores

In order to avoid misinterpretation, keep in mind that performance profiles:

The conversion of standard scores involves information about the performance of candidates that have taken these examinations previously.

For more information on interpreting COMLEX-USA scores, refer to the FAQs.

Standard Setting

Setting the Pass/Fail Standard

Consistent with other national high-stakes examinations for physician licensure worldwide, the NBOME follows industry standard best practices in determining pass/fail standards for the COMLEX-USA examinations and in periodic resetting of the standards. One of the most important components of a high-quality and defensible examination program is a fair and reasonable approach to identifying a cut score – the score at or above which a candidate is deemed to have passed an examination.

For COMLEX-USA examinations, a passing score means the examinee has demonstrated at least a minimal level of competency by scoring at or above the level judged to be required for the safe and effective practice of osteopathic medicine at the supervised level for COMLEX-USA Level 1, Level 2-CE and Level 2-PE, or at the unsupervised, independent practice of osteopathic medicine for COMLEX-USA Level 3.

Every three to five years, NBOME reviews the standards for minimum competency required to pass COMLEX-USA examinations. The standard setting process may result in a change in the cut score needed to pass an examination.

Periodic review of the COMLEX-USA Standards ensures the skill and proficiency of osteopathic medical knowledge reflect current medical education and practice required for licensure. The process is consistent with the NBOME’s mission of protecting the public by assessing competencies for osteopathic medicine and related health professionals.

Approach to Standard Setting

NBOME applies criterion-referenced methods to establishing cut scores. Sometimes referred to as “absolute standards,” these are not norm-based or relative to the performance of other examinees.

A process of triangulation is used to establish cut scores. The process is widely used for high-stakes examinations for physician licensure around the world and follows industry standard best practices. Triangulation includes standard-setting surveys, standard-setting panel meetings and a comprehensive final review.

Surveys

The NBOME surveys key stakeholders to help gauge perceptions about the abilities of the candidate pool and the appropriateness of the current standards. Those surveyed include osteopathic medical school deans and residency program directors who work regularly with the examinee population. The residency program directors include those from AOA- and ACGME-accredited graduate medical education programs. We also directly survey students and residents.

Panels

Physicians on the standard setting panels are carefully selected to assure broad representation of the profession with respect to clinical expertise and specialty, geographic considerations, age, gender, and ethnicity. Panelists are selected to include representation from clinical practice, colleges of osteopathic medicine, state medical licensing boards and graduate medical education programs. The NBOME regularly seeks panel nominations from deans of the colleges of osteopathic medicine, the American Association of Colleges of Osteopathic Medicine (AACOM), residency program directors from AOA- and ACGME-accredited programs, the Association of Osteopathic Graduate Medical Educators (AOGME), and from the regulation and licensure communities.

Final Review

Consistent with best practices in standard setting used by other physician testing and regulatory organizations worldwide, the NBOME reviews all survey data, panelist judgments, and psychometric analysis to arrive at the final pass/fail standard for each examination. Consideration is also given to recent trends in candidate performance, the relationship of score precision to the pass/fail decision, as well as the political, social and educational implications of the data.

For the computer-based multiple-choice COMLEX-USA examinations, the NBOME uses commonly-accepted standard setting methods such as the modified Angoff method.

In the modified Angoff standard-setting procedure, panelists make judgments based on test content (e.g. the expected performance of a minimally qualified candidate on a given test item).

The Angoff begins with a discussion of the candidate who is minimally qualified to pass the examination. Panelists then review the test items and estimate the probability this minimally qualified candidate will answer the item correctly. A passing score is derived for each panelist by summing these item probabilities. The final passing score is calculated by taking the average passing score across panelists.

The Hofstee method does not require individual item judgments. Instead, panelists are asked to give their impressions of what the minimum and maximum failure rates should be for the examination, as well as what the minimum and maximum percent correct scores should be. These rates and percent correct scores are averaged across panelists and projected onto the actual score distribution to derive a passing score. The Hofstee method is often used to evaluate or adjust the passing score derived using Angoff methodology. When the two methods produce similar passing scores, they validate each other.

This approach is consistent with the approach used around the world by most testing organizations related to physician licensure.

“I have been associated with many standard-setting initiatives over my 35 years in the educational assessment and credentialing exam fields. My impression is that your (standard-setting) study was one of the best that I have seen. You built your plan on best practices in the field, sought technical advice and used it, implemented the plan with sophistication and care, and finally, have comprehensively analyzed the results and nicely documented the process itself.”

Ronald K. Hambleton, Ph.D., Distinguished Professor, leading researcher, author and psychometrician on NBOME’s approach to recent standard setting for COMLEX-USA Level 2-PE

 

The NBOME COMLEX-USA series is the primary pathway to licensure for osteopathic physicians seeking to practice osteopathic medicine and surgery. The primary purpose of COMLEX-USA is for osteopathic physician licensure. Having passed the series of examinations indicates that the candidate’s osteopathic medical knowledge and clinical skills have met an acceptable standard for unsupervised osteopathic medical practice. The COMLEX-USA series is accepted for physician licensure in all 50 states and some international jurisdictions.

Essential objectives of the examination series include the graduation, advancement, and promotion of osteopathic medical students. COMLEX-USA also serves as an assessment tool used by residency program directors to evaluate DO applicants for graduate medical education programs. NBOME follows standards and best practices in assessment when evaluating our passing standards to ensure COMLEX-USA meets and maintains high assessment quality.

Computer-Based Examinations

We encourage candidates to take advantage of the practice and preparation resources provided on our website. These resources are designed to assist the candidate in preparing for and navigating through the examination experience. NBOME is not affiliated with and does not endorse any commercial test preparation resources.

The NBOME provides reasonable and appropriate accommodations in accordance with the Americans with Disabilities Act (ADA) for candidates taking the COMLEX-USA examinations who provide the required documentation substantiating they are a person with a disability.

Instructions to Request Test Accommodations

Request Accommodation

Submit a request by completing the application form and sending it with the required supporting documentation to NBOME Test Accommodations.

A completed application with full supporting documentation is generally evaluated and a decision rendered by the NBOME within approximately seventy-five (75) days of its receipt by the NBOME; however additional processing time may be required if additional documentation is needed.

You can schedule a standard (non-accommodated) examination while your accommodation application is pending. However, if your application is approved by the NBOME and testing accommodations are granted, and you have not yet taken the examination, you will likely need to reschedule the test depending on the nature of the approved accommodation(s). If you have taken the examination without accommodations before being notified of a decision, the NBOME will report your score as if you had not requested an accommodation.

For more details refer to the Bulletin of Information.

The National Board of Osteopathic Medical Examiners (NBOME) strives to provide you with a positive experience testing experience on your exam day. You will be taking your exam at a Prometric Testing Center. Prometric and NBOME have taken steps to protect the security and the integrity of your exam and we appreciate your patience and understanding by following our procedures and guidelines. These Test Day Tips will help you prepare for your visit to the testing center and to familiarize you with what happens during the exam day. For more examination details, refer to the COMLEX-USA Bulletin of Information or the COMLEX-USA Computer Based Testing FAQ. Additional information about taking your examination at Prometric may be found on the Prometric website.

UPDATES TO CHECK-IN AND SECURITY PROTOCOLS RELATED TO COVID – 19

Prometric has enacted the following procedures to help ensure your safety during your testing appointment:

Please Note: if you fall into any of the following categories, you will not be permitted to test until you no longer fit the criteria:

Prometric Testing Center Tutorial

Arrival and Check-In

Plan to arrive at least 30 minutes before your examination start time. You will be greeted by a test center administrator (TCA) who moves around the testing center to routinely monitor testing activity and observe and report any irregular behavior. TCAs prepare each work station for the next candidate after it has been used, which in some cases may be every two hours. TCAs are unable to answer NBOME policy questions. Contact the NBOME Client Services team at clientservices@nbome.org with any policy questions.

Testing Accommodations

Candidates with disabilities, including hearing impairment, should refer to our application for testing accommodations. If you may require test accommodations, please review our test accommodations page.

Identification

Be sure to bring one form of current, non-expired government-issued identification that includes your picture and signature. Acceptable forms of identification are

Important Notice Your first and last name must match what we have in our registration records in order for you to be able to take the examination. To ensure that your identification matches the information we have on file for you, log on to your NBOME online account and check our records as soon as possible. If the name on your identification does not reflect what is on your registration, contact NBOME Client Services at clientservices@nbome.org as soon as possible to update your profile.

Personal Belongings

The Test Center Administrator (TCA) will assign you a secure locker in which you will be required to store all of your personal belongings, including food, water and medicines. You will receive a locker key with a blue tag. You may only keep your identification and locker key with you in the testing room.

Enhanced Security

Prometric has recently implemented enhanced security measures in order to inspect for camera devices that could be used to capture examination content. You will need to remove eyeglasses for close visual inspection by the TCAs. These inspections will take a few seconds and will be done at check-in and upon return from breaks.

Jewelry, except for wedding and engagement rings, is prohibited in the testing room. Hair accessories are subject to inspection. We advise you to not wear ornate clips, combs, barrettes, headbands, and other hair accessories. If you arrive wearing any of these items, you may be prohibited from wearing them in the testing room, and asked to store such items in your locker.

Food and drinks

You will not be permitted to bring food or drink into the testing area of the center. Food and drink will need to be stored in your assigned locker and you can access them during the authorized 10- minute breaks and the 40-minute lunch break. If you have a medical need and require food or drink during the testing period, you must submit the request in writing to NBOME, clientservices@nbome.org, for consideration in advance of the examination.

Headphones

Noise reducing headphones are provided at each testing center.

Ear plugs

You may also bring your own ear plugs to decrease distractions or noise level in the testing area. The TCA may request to inspect your ear plugs.

Biometric check-in

The TCA will complete your biometric-enabled check-in, which includes verifying your identification, signing in, taking a digital photo and scanning your fingerprint. Your fingerprint record will serve as your biometric identification each time you enter and exit the testing room.

Metal detector

The TCA will ask you to turn your pockets out and will use a handheld metal detector wand to ensure that you do not have any remaining personal belongings with you before entering the testing center. This procedure will be repeated each time you depart and re-enter the testing room. Please view this short video of the typical Prometric check-in process.

Examination hours

After you check in the total examination day will last approximately nine hours, consisting of a brief tutorial, two optional 10-minute breaks, an optional 40-minute lunch break and eight hours total exam time divided into two four-hour sessions of four sections each.

Confirmation screen

Once you are seated at your station, a screen will appear, asking you to confirm your name and other pertinent information. You will need to respond within two minutes. It is important to note if you surpass the allotted two minutes, the system will “time out”, preventing you from continuing. A timer will not be displayed on the screen.

Tutorial

There is a brief 10-minute tutorial before you begin your examination. You are strongly encouraged to view the tutorial. It contains important information about the examination format and features that will help you throughout your test day. You will need to begin your examination as soon as the tutorial has ended. If you delay the system will “time out” and prevent you from continuing. Optional

Examination breaks

There are three (3) authorized breaks you can choose to take during the course of the exam day: one (1) optional 40-minute lunch break and two (2) optional 10-minute breaks. For all breaks, you will need to leave the testing room. Remember that when you re-enter the testing room after any break, you will need to show a valid ID and your fingerprint will be taken. Please allow sufficient time to check in and be seated.

Authorized 10-minute breaks
COMLEX-USA Level 1
Includes one optional 10-minute break in the morning between the second and third section, one optional 10-minute break in the afternoon between the sixth and seventh section. For all authorized breaks, candidates will be permitted access to their lockers for food, drink, medicine and other stored items including electronic devices such as cell phones. Candidates may NOT access study materials or electronic devices during any unauthorized breaks. The 10-minute optional break time will not count against total examination time. However, if you exceed the allotted 10-minute break, the additional time will be deducted from the remaining examination time.
COMLEX-USA Level 2-CE
Includes one optional 10-minute break in the morning between the second and third section and one optional 10-minute break in the afternoon between the sixth and seventh section. For all authorized breaks, candidates will be permitted access to their lockers for food, drink, medicine and other stored items including electronic devices such as cell phones. Candidates may NOT access study materials or electronic devices during any unauthorized breaks. The 10-minute optional break time will not count against total examination time. However, if you exceed the allotted 10-minute break, the additional time will be deducted from the remaining examination time.
COMLEX-USA Level 3
Day one includes one optional 10-minute break in the morning between the first and second section, and one optional 10-minute break in the afternoon between the third and fourth section. Day two includes one optional 10-minute break in the morning between the fifth and sixth section and one optional 10-minute break in the afternoon between the seventh and eighth section. For all authorized breaks, candidates will be permitted access to their lockers for food, drink, medicine and other stored items, including electronic devices such as cell phones. Candidates may NOT access study materials or electronic devices during any unauthorized breaks. The 10-minute optional break time will not count against total examination time. However, if you exceed the allotted 10-minute break, the additional time will be deducted from the remaining examination time.
Authorized 40-minute Lunch Break

The 40-minute lunch break will take place when the morning session is completed (after section 4). During the lunch break you will be able to access your locker for food, drink, medicine and other materials you have stored.

Unexcused Breaks

Any breaks in addition to the three authorized breaks will be considered unexcused and will be reported to the NBOME by the TCA.

Examination Features

COMLEX-USA new examination features include a built-in standard calculator and lab values with reference ranges (where applicable) embedded directly into test questions and clinical cases.

Check Out

Upon completion of your examination, you will sign out and return your locker key.

Video/Audio Monitoring

Please be aware that you will be monitored by video and audio recording throughout the duration of your examination.

Testing Accommodations

If you believe you may require testing accommodations under the Americans with Disabilities Act, as amended, please refer to the COMLEX-USA Bulletin of Information. For more information on testing accommodations please consult the Request for Test Accommodation Instructions and Forms.

Adverse Testing Conditions

If you experience adverse testing conditions and believe that those conditions have substantially affected your performance, you will need to provide the NBOME written, verifiable evidence within 10 days of your examination day. If you do not report your concerns according to NBOME guidelines, you waive any objection to the testing conditions and will not have any recourse at a later date or when scores are released. Please refer to the COMLEX-USA Bulletin of Information for more details on adverse testing conditions.

Questions?

Need information or help? Please contact the Client Services department Monday – Friday, 7:00 AM– 7:00 PM Eastern Time, at 866-479-6828.

Retaking An Exam

Candidates may not retake any level of COMLEX-USA to improve their scores or for any purpose other than to pass a previously failed examination. For candidates who have failed an examination, they may retake the examination a maximum of four times in any 12-month period.

Six Attempt Limit

Candidates taking COMLEX-USA examinations are limited to a total of six attempts for each examination.

The only consideration for an exception to this policy for one additional attempt beyond the six-attempt limit is at the explicit request of a Medical Licensing Agency.

For NBOME to waive the limitation of a maximum of six attempts for any COMLEX-USA examination, candidates are required to obtain a written petition for waiver from a Medical Licensing Agency.

NOTICE of PLANNED CHANGE to POLICY:
Effective July 1, 2022, candidates taking COMLEX-USA examinations will be limited to a total of four (4) attempts for each examination (COMLEX-USA Level 1, Level 2-CE, Level 2-PE and Level 3), including but not limited to all attempts prior to July 1, 2022. After June 30, 2022, no candidate will be allowed to take any examination more than four (4) times without obtaining approval from the NBOME.
Additional Fees

Computer-Based Examinations
Reschedule or Cancellation FeeMore than 30 days prior to exam date$0
Reschedule or Cancellation Fee6 to 30 days prior to exam date$85
Reschedule or Cancellation Fee1 to 5 days prior to exam date$190
Reschedule or Cancellation FeeWithin 24 hours prior to exam date$225

Non-Examination Related
Score Confirmation Fee$50
Non-sufficent Funds Checking Fee$20
Transcript Fee$60
Score Report Fee$5
Changes to your Name and Status

In order to take a COMLEX-USA examination, your name on your registration form and the valid government-issued photo ID presented at the testing center must match.

If your name has changed, download and complete a Name Change Request Form and include a copy of the supporting document noting the name change (e.g., marriage license, divorce decree, court document, naturalization document). Documentation can be scanned or emailed to clientservices@nbome.org. Name changes must be made no later than five business days before the scheduled test. If possible, submit the name change form and documentation before registering for an examination.

Log in to your online account to update your mailing address, email address, and phone numbers, located in the in the “Student Information” section under the “My Account” tab.

If you transferred medical schools, you must contact the Dean’s office at your old and new school and request that they forward the information to clientservices@nbome.org.

Registration

COMLEX-USA Level 2-PE

Level 2-PE examinations are scheduled through the NBOME Account portal. buy Approval from an accredited College of Osteopathic Medicine is required.

Level 2-PE exams are administered at one of our two National Centers for Clinical Skills Testing (NCCST) locations.

Register With Prometric

COMLEX-USA Level 1, Level 2-CE & Level 3

Register Now

To schedule a Level 1, Level 2-CE, or Level 3 exam, please visit the Prometric website to locate a test center and follow the registration prompts displayed.

Please make sure NBOME is selected as the test sponsor to receive accurate location offerings.

Through Prometric’s registration system, students can access and manage any examinations they’ve scheduled at Prometric facilities.

The COMLEX-USA Examination Sequence

Candidates for COMLEX-USA must meet the following requirements as well as the requirements of their college of osteopathic medicine. Examinations must be taken in sequence and each level passed before the candidate is eligible to take the next level.

COMLEX-USA Computer-Based Examination Outline
SectionQuestions
144Morning Session: 4 Hours Total Testing Time
Questions can be answered, reviewed, and changed one section at a time. Individual sections are not timed.
244
Authorized 10-minute break
344
444
Authorized 40-minute lunch break
544Afternoon Session: 4 Hours Total Testing Time
Questions can be answered, reviewed, and changed one section at a time. Individual sections are not timed.
644
Authorized 10-minute break
744
844

Available Examination Features

Examination Review Screen
A review page is presented for each section. This provides candidates with information about the status of the items in the current section, which includes questions completed, questions marked for further review, and questions left incomplete (i.e., no answer is given).

Advancing through Examination Sections
Once a section is completed, the candidate cannot return to review or change any answers within that section.

Time Limitations
Although each section is four hours in total, individual sections are untimed. A clock is provided to assist with time management. Warnings are given of the time remaining before the end of each four-hour section.

Examination Visual References
Use of an “Exhibit” button may be required in order to see graphic materials related to a test question. These “Exhibits” consist of images, video or audio avatars. In some cases, two “Exhibits” may be used in order to answer a question.

Additional Tools
New functional features have been added, including a built-in standard calculator and lab values with reference ranges (where applicable) embedded directly into test questions and clinical cases. These features were made available during the COMLEX-USA 2017–18 new test cycles for each examination.


POPULATION HEALTH CONCEPTS AND PATIENTS WITH PRESENTATIONS RELATED TO HEALTH PROMOTION, CHRONIC DISEASE MANAGEMENT, AND HUMAN DEVELOPMENT

Abnormal Findings
Anemia
Bacteriuria
ECG abnormalities
Electrolyte abnormalities
Heart sound abnormalities
Hepatitis
Hyperlipidemia
Hyperuricemia
Lead poisoning
Proteinuria

DISEASE DETECTION & MONITORING
AIDS/HIV
Anemia
Axial/appendicular skeletal somatic dysfunction
Breast cancer
Cardiac/ischemic disease
Colon cancer
Diabetes
Gallbladder disease
Gynecologic cancer
Hepatitis
Hyperlipidemia
Hypertension
Immunologic disorders
Mental retardation
Obesity
Osteoporosis
Other cancer
Prostate cancer
Scoliosis
Sexually transmitted disease, known contact
Substance abuse
Tuberculosis

GENERAL CONCEPTS
Ethical/Legal principles
Practice management
Public health principles
Research and development

PHYSIOLOGIC PROCESSES
Aging physiology
Developmental milestones
Sexual development

SERVICES RENDERED
Contraception
Exercise/sports work-up
Genetic screening
Physical examination
Pre & postoperative care
Vaccinations against specific diseases

PATIENTS WITH PRESENTATIONS RELATED TO DIGESTION AND METABOLISM

DIGESTIVE DIFFICULTIES
Constipation
Diarrhea
Dysphagia/feeding problems/odynophagia
Encopresis
Nausea & vomiting
Weight gain/obesity
Weight loss

PATIENTS WITH PRESENTATIONS RELATED TO COGNITION, BEHAVIOR, SENSORY & CENTRAL NERVOUS SYSTEMS, SUBSTANCE ABUSE, AND VISCERAL AND SENSORY PAIN

COGNITIVE DIFFICULTIES
Anxiety
Behavioral disturbances
Confusion/disorientation
Dementia
Depression
Eating disorders
Learning difficulties
Life adjustment
Suicidal ideation

CONSCIOUSNESS ALTERATIONS
Amnesia
Brain concussion
Coma
Delirium
Sleep disturbances
Syncope

FATIGUE & WEAKNESS
Fatigue
Weakness

SENSORY & CNS DIFFICULTIES
Dizziness/vertigo
Hearing disorders
Olfactory disorders
Paralysis/paresis
Paresthesia
Seizures
Speech disorders
Tactile disorders
Taste disorders
Visual disorders
Voluntary & involuntary abnormal movements

SENSORY PAIN
Abdominal/pelvic pain
Anesthesia
Chest pain
Ear pain
Extremity pain
Eye pain
Face pain
Genital pain
Head pain
Mouth pain
Rectal pain
Throat pain

SUBSTANCE ABUSE
Alcohol abuse
Controlled substance abuse
Non-controlled drug abuse
Tobacco abuse

PATIENTS WITH PRESENTATIONS RELATED TO THE MUSCULOSKELETAL SYSTEM, INCLUDING SOMATIC PAIN

MUSCULOSKELETAL DIFFICULTIES AND MUSCULAR PAIN
Back pain
Fasciculations
Gait disturbance/falls
Joint pain
Muscle spasms
Muscular atrophy
Myofascial pain
Neck pain
Spinal deformities

PATIENTS WITH PRESENTATIONS RELATED TO THE GENITOURINARY SYSTEM AND HUMAN SEXUALITY

GENITOURINARY DISORDERS/ISSUES
Anuria
Dyspareunia
Dysuria
Enuresis/incontinence
Erectile dysfunction
Infertility
Menstrual disorders
Oliguria
Polyuria
Priapism
Pyuria, non-infectious
Urinary frequency
Urinary hesitancy

PATIENTS WITH PRESENTATIONS RELATED TO CIRCULATION AND THE RESPIRATORY SYSTEM

BLEEDING
Hematemesis
Hematochezia/melena
Hematuria
Hemoptysis
Nasal bleeding
Systemic or non-defined
Transfusion practices
Vaginal (abnormal)

RESPIRATORY DIFFICULTIES
Airway obstruction
Cough
Dyspnea
Rate/rhythm abnormalities

PATIENTS WITH PRESENTATIONS RELATED TO THERMOREGULATION

Thermoregulation
Fever
Hypothermia

PATIENTS WITH PRESENTATIONS RELATED TO TRAUMA, MASSES, EDEMA, DISCHARGE, AND THE SKIN, HAIR AND NAILS

DISCHARGE
Anal discharge
Ear discharge
Eye discharge
Nasal discharge
Nipple discharge
Penile discharge
Urethral discharge
Vaginal discharge

MASSES & EDEMA
Abdominal masses
Axillary masses
Breast masses
Chest/Lung masses
Edema
Extremity masses/swelling
Head/Neck masses/swelling
Joint masses/swelling
Pelvic masses
Rectal masses/swelling
Scrotal/Testicular masses/swelling

SKIN, NAIL & HAIR DISORDERS
Alopecia
Cyanosis/Pallor/Pigmentation disturbance
Gangrene
Jaundice
Nail Disorders
Lesions
Pruritus
Rash

TRAUMA
Burns
Child abuse
Crush injury/syndrome
Domestic abuse
Elder abuse
Motor vehicle collisions
Multiple trauma
Poisoning
Rape
Shock
Wounds

PATIENTS WITH PRESENTATIONS RELATED TO PREGNANCY, THE PERIPARTUM, AND THE NEONATAL PERIOD
Bleeding in pregnancy
Labor & delivery process
Lactation
Neonatal assessment
Neonatal complications
Normal obstetrics
Postpartum infections
Pregnancy complications

Health Promotion & Disease Prevention
Biostatistics & Epidemiology
Clinical Prevention
Disease Transmission Processes
International Health Care Issues
Occupational & Environmental Medicine

History & Physical Examination
Examination & Recognition (includes neuromusculoskeletal examination)
Gathering Patient Information

Diagnostic Technologies
Electrophysiologic
Imaging
Laboratory

Management
Complementary & Alternative Medicine
Consultation
End of Life
Inter-Disciplinary Teams
Osteopathic Manipulative Treatment
Common OMT techniques include counterstrain, muscle energy, myofascial release, high velocity low amplitude thrust, soft tissue, lymphatic technique, osteopathy in the cranial field, articulatory techniques, balanced ligamentous tension, ligamentous articular strain, facilitated positional release, Still technique, visceral technique, Chapman reflexes, and trigger points
Non-Pharmacological Medical
Pharmacological
Psychosocial
Rehabilitation
Surgical

Scientific Understanding of Health & Disease Mechanisms
Anatomy
Biochemistry
Genetics
Immunology
Microbiology
Molecular & Cell Biology
Osteopathic Principles: Somatic & Visceral Dysfunction
Pathology
Pharmacology
Physiology

Health Care Delivery Issues
Health Care System Overview
Information Management & Technology
Medical Ethics & Medical Professionalism
Medical Jurisprudence
Medical Management
Patient Confidentiality
Physician-Patient Communication
Population-Based Care
Practice Management
Quality Measurement & Improvement
Teamwork & Collaboration

The COMLEX-USA examination series is designed to assess the osteopathic medical knowledge and clinical skills considered essential for osteopathic generalist physicians to practice osteopathic medicine. The foundation of COMLEX-USA is based on the osteopathic philosophy of whole-person health care, underlying structure-function relationships and the interdependence of body systems, self-healing and self-regulatory mechanisms, and the osteopathic approach to patient care, including osteopathic manipulative medicine. COMLEX-USA is constructed in the context of clinical problem-solving that involves "Patient Presentations" and "Physician Tasks."

The Patient Presentation ("Dimension 1") of the COMLEX-USA examination blueprint identifies high-frequency and/or high-impact health and disease issues that osteopathic generalist physicians encounter in clinical practice.

The Physician Tasks ("Dimension 2") specifies the major physician tasks and competency sets that osteopathic physicians generally use to solve clinical problems and assist in providing patient care.

The major categories of the two dimensions are presented in the table below.

Dimension 1: Patient Presentation
Population Health Concepts and Patients with Presentations Related to Health Promotion, Chronic Disease Management, and Human Development 8 – 16%
Patients with Presentations Related to Digestion and Metabolism 4 – 10%
Patients with Presentations Related to Cognition, Behavior, Sensory & Central Nervous Systems, Substance Abuse, and Visceral and Sensory Pain 28 – 38%
Patients with Presentations Related to the Musculoskeletal System, including Somatic Pain 6 – 12%
Patients with Presentations Related to the Genitourinary System and Human Sexuality 3 – 8%
Patients with Presentations Related to Circulation and the Respiratory System 8 – 16%
Patients with Presentations Related to Thermoregulation 2 – 6%
Patients with Presentations Related to Trauma, Masses, Edema, Discharge, and the Skin, Hair, and Nails 8 – 16%
Patients with Presentations Related to Pregnancy, the Peripartum, and the Neonatal Period 3 – 8%

Dimension 1 Categories



Dimension 2: Physician Tasks Level 1 Level 2 CE Level 3
Health Promotion & Disease Prevention 1 – 5% 15 – 20% 15 – 20%
History & Physical Examination 5 – 15% 30 – 40% 10 – 20%
Diagnostic Technologies 1 – 5% 10 – 20% 15 – 25%
Management 2 – 7% 10 – 20% 25 – 40%
Scientific Understanding of Health & Disease Mechanisms 70 – 85% 5 – 15% 5 – 10%
Health Care Delivery Issues 1 – 3% 5 – 10% 5 – 10%

Dimension 2 Categories


Osteopathic principles and practices, by design, are integrated throughout all areas of the examination to reflect the way they permeate osteopathic medicine.

Implementation of New Blueprint

Based on extensive research and expert consensus, a new two-dimensional blueprint for COMLEX-USA examinations has been developed and will be implemented beginning with COMLEX-USA Level 3 in 2018. COMLEX-USA Level 1, Level 2-Cognitive Evaluation (CE) and Level 2-Performance Evaluation (PE) will implement the new blueprint in 2019. For more information, see the COMLEX-USA Master Blueprint 2018-2019.

COMLEX-USA Content Outline · Patient Presentations and Physician Tasks

While all three COMLEX-USA examination levels contain osteopathic principles and practices, the depth and emphasis of each dimension changes in each level to assess different educational experiences and clinical responsibilities. This progressive design ensures the consistency and continuity of the measurement objectives required for osteopathic medical licensing.

Dimension 1: Patient Presentation
Population Health Concepts and Patients with Presentations Related to Health Promotion, Chronic Disease Management, and Human Development 8 – 16%
Patients with Presentations Related to Digestion and Metabolism 4 – 10%
Patients with Presentations Related to Cognition, Behavior, Sensory & Central Nervous Systems, Substance Abuse, and Visceral and Sensory Pain 28 – 38%
Patients with Presentations Related to the Musculoskeletal System, including Somatic Pain 6 – 12%
Patients with Presentations Related to the Genitourinary System and Human Sexuality 3 – 8%
Patients with Presentations Related to Circulation and the Respiratory System 8 – 16%
Patients with Presentations Related to Thermoregulation 2 – 6%
Patients with Presentations Related to Trauma, Masses, Edema, Discharge, and the Skin, Hair, and Nails 8 – 16%
Patients with Presentations Related to Pregnancy, the Peripartum, and the Neonatal Period 3 – 8%

Dimension 1 Exam Topics

Candidates should request transcripts through their NBOME Account.

If you are a third party, working on behalf of a candidate, please use form below to request a transcript.

Download Request Form

Please submit this form via email to NBOME Client Services, by fax at 773.714.0606, or mail to:

NBOME Client Services
8765 West Higgins Road
Suite 200
Chicago, IL 60631-4174

Please Note There Are Fees Associated With This Request

Practice Creating SOAP Notes

Practice eSOAP Note

The purpose of this practice module is to give candidates the ability to practice and become comfortable with the actual software system used at the National Center for Clinical Skills Testing. Please note, there will be no browser plugins (i.e., spell check, grammar check, etc) when onsite at the testing center. To get a close to real experience, you are encouraged to disable any plugins on your personal computer.When here at the National Center for Clinical Skills Testing, your note will be enabled during the full 23 minute encounter. You may begin typing at any point following the “You may begin your clinical encounter” announcement. Your timer will not begin to count down until the 9 min SOAP note completion period begins.

Before your first practice attempt, you may want to click on the links to the left to: View a Tutorial on how to get the most out of the practice materials available, view doorway information relative to the patient in the video encounter, watch a patient encounter to gain content for your practice note and view a sample completed note.

Upon clicking on the link below, your 9 min timer (top right) will immediately begin counting down. Any note created in this practice module will not be available for viewing upon navigation off of this page (no information will be saved). NBOME cannot provide any feedback on your practice note, please see your COM faculty for feedback if desired.

The Restart button, top center of the page after time expires, is only available in this tutorial. After you are finished reviewing your completed note, click on the Restart button to clear the contents of your previous note and to restart the 9 minute timer to complete additional practice notes.

The doorway information sheet contains a brief statement of the patient’s reason for visit (similar to a nurse’s note), as well as the patient’s vital signs, and instructions to evaluate and treat the patient in 14 minutes “as you see fit.”

Information such as the patient’s vital signs should be accepted as accurate for the patient. Candidates may desire to recheck the patient’s vital signs if the case warrants the physician confirming them, but are advised to always consider the numerical values listed on the doorway information sheet as accurate for the purposes of formulating the differential diagnosis/problem list or evaluation and treatment plan.

Any additional information provided in some cases such as relevant x-ray reports, lab results, or EKGs will be found on this sheet as well.

Example

Sample Patient Encounter

Below is a sample of the type of patient encounter you could experience during your Level 2-PE. This is provided to acquaint you with the general flow a patient encounter and is not meant to illustrate either good or bad techniques or clinical performance. This can be used to gain content for your practice SOAP Note.

 

 

Sample of a Completed SOAP Note

All SOAP Notes should be completed to “stand alone” as the only documentation for that encounter. For more information, please review the COMLEX-USA Level 2-PE Orientation Guide.

 

The COMLEX-USA Level 2-PE examination requires entry of electronic SOAP note to complete clinical skills encounters

The SOAP Note represents an opportunity to demonstrate documentation skills (in English), document clinical findings, exercise clinical problem-solving skills, formulate a differential diagnosis and a diagnostic and treatment plan. It is acceptable to use either a narrative or a more “bullet” or “laundry list” style for the notes, provided they are documented in English and legible.

S = Subjective components
O = Objective findings
A = Assessment diagnosis
P = Plan

Resources:

Completed eSOAP Note Sample

Doorway Information Sheet

Practice an eSOAP Note

Sample Patient Encounter

eSOAP Tutorial

The NBOME provides reasonable and appropriate accommodations in accordance with the Americans with Disabilities Act (ADA) for candidates taking the COMLEX-USA examinations who provide the required documentation substantiating they are a person with a disability.

Instructions to Request Test Accommodations

Request Accommodation

Submit a request by completing the application form and sending it with the required supporting documentation to NBOME Test Accommodations.

A completed application with full supporting documentation is generally evaluated and a decision rendered by the NBOME within approximately seventy-five (75) days of its receipt by the NBOME; however additional processing time may be required if additional documentation is needed.

You can schedule a standard (non-accommodated) examination while your accommodation application is pending. However, if your application is approved by the NBOME and testing accommodations are granted, and you have not yet taken the examination, you will likely need to reschedule the test depending on the nature of the approved accommodation(s). If you have taken the examination without accommodations before being notified of a decision, the NBOME will report your score as if you had not requested an accommodation.

For more details refer to the Bulletin of Information.

Reference Materials

Resources

Client Registration System Tutorial

On December 10, 2016, the National Board of Osteopathic Medical Examiners (NBOME) approved proposed modifications to candidate examination eligibility requirements for COMLEX-USA. These changes are subject to a period of public comment over the next 45 days.

The NBOME COMLEX-USA examination series provides the pathway to licensure for osteopathic physicians in the United States, and is a graduation requirement for earning a DO degree from colleges of osteopathic medicine.

The new eligibility requirements will go into effect in 2018-2019, with the transition to the COMLEX-USA Master Blueprint 2018-2019 and with implementation of a two-day test administration for COMLEX-USA Level 3 in September 2018.

Beginning with the 2018-2019 test cycle for the two-day COMLEX-USA Level 3, eligibility will require an attestation from an AOA- or ACGME-accredited GME program director that the Level 3 resident/exam candidate is in “good academic and professional standing.” In addition, as a recommendation but not a requirement, the NBOME will recommend that Level 3 candidates have completed a minimum of six months of residency training prior to testing.

Beginning with the 2019-2020 test cycles, eligibility for the COMLEX-USA Level 1, Level 2-CE or Level 2-PE will require an attestation from an AOA COCA-accredited COM dean that an osteopathic medical student is in “good academic and professional standing.”

Current eligibility requirements for COMLEX-USA are contained in the COMLEX-USA Bulletin of Information 2016-2017. For more information on guidelines for medical professionalism, the NBOME Fundamental Osteopathic Medical Competency Domains 2016 is also available on the website.

The NBOME invites organizations and individuals involved in osteopathic medical education, training, licensure and regulation to send written comments on the changes to eligibility requirements to communications@nbome.org by March 17, 2017. Following the 45-day public comment period, the NBOME Board will review the comments and respond.

Thank you in advance for sharing your comments. We look forward to receiving your response.

Exam Disciplines

COMSAE examination is scored on 6-7 medical disciplines along with the COMLEX-USA Dimension Topics

Medical Discipline
Emergency Medicine
Family Medicine
Internal Medicine
Obstetrics & Gynecology
Pediatrics
Psychiatry
Surgery

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