Eliminating numeric scores for COMLEX-USA Level 1

COMLEX Level 1 is now a pass-fail exam. What does this mean for candidates moving forward?


One of the National Board of Osteopathic Medical Examiners’ (NBOME) strategic goals is to continue to prioritize the wellbeing of our stakeholders — most notably, our students and residents — with hopes to positively impact patient care. Eliminating the numeric score reporting for COMLEX-USA Level 1 is one of the latest ways we are working to achieve this goal.

For well over 10 years, the NBOME investigated making this transition, considering input from various stakeholders including those representing education, training, licensure, faculty and staff, and of course, students and residents. The NBOME conducted a comprehensive analysis which included research, surveys of individuals and solicitation of stakeholder position statements to determine the feasibility of this transition. That culminated in the December 2020 announcement that NBOME would eliminate reporting of numeric scores for COMLEX-USA Level 1 beginning with the 2022-2023 testing cycle in May 2022.  

The purposes of COMLEX

First and foremost, the COMLEX-USA exam series is designed to assess a candidate’s competency, ultimately for licensure and the practice of osteopathic medicine. The transition in score reporting for Level 1 preserves that purpose.

Next, students (and their professional advisors) often use the information provided on the score report to identify strengths and opportunities for their future professional development. There is a second page on every test taker’s report meant to help a candidate understand their areas of relative proficiency. These performance reports, called the Level 1 Formative Performance profile, are meant just for the student and their COM advisors – they are not reported to residency program directors, licensing boards or official transcripts.

The NBOME continues to advocate for holistic review of applicants for residency programs, and for programs to evaluate the unique attributes and qualifications that make each applicant likely to be a good match for the learning environment and happy in the program. Just as our patients are more than their symptoms, our students are more than their exam scores.

But to the extent that residency programs use licensing exam results at all, and consistent with the principles of holistic review, for DO applicants that licensure exam is COMLEX-USA.

Without the pressure of their potential program directors relying heavily on a numeric score, one would hope that candidates would be able to focus more on other activities. These include their curricular program, co-curricular programs, volunteer and research activities and other life pursuits that contribute to wellness of body, mind and spirit.

At the American Association of Colleges of Osteopathic Medicine’s (AACOM) annual Educating Leaders conference in April 2022, we had the opportunity to interact with many DO students who were preparing to take COMLEX-USA Level 1. Anecdotally, these students reported feeling a bit less stressed about taking the exams and more able to focus on what they learned at the conference and on making connections with others in the profession. Several said they would not have been as likely to attend the conference if Level 1 was reporting numeric scores.

Preparing for the exam

In the meantime, we encourage DO students to continue preparing for COMLEX-USA in the ways they always have, most notably by participating enthusiastically in their osteopathic medical school’s curriculum and overall educational program. Faculty have created a program of study and experiences to help students become successful DOs, and there are many things to learn and experience in the first two years that will also add to students’ professional development. 

The NBOME offers several ways for students to garner experience with COMLEX-USA style test content and test administration timing, as well as to gauge their readiness for COMLEX-USA. These include low-cost WelCOM and COMSAE, which can help determine areas in which students are strongest, and areas in which they may need some additional support. Test questions are written and reviewed by the same osteopathic and basic science professionals who write COMLEX-USA, and the sampling of test content mirrors a COMLEX-USA test form, so they are the closest you can get to taking COMLEX-USA before you actually take it.

Osteopathic medical schools can also provide COMAT Foundational Biomedical Sciences exams to garner robust discipline-based diagnostic information on relative strengths and weakness of students in these basic science disciplines and body systems content.

The NBOME is committed to the health and wellness of our candidates, and our hope is that eliminating the reporting of numeric scores on COMLEX-USA Level 1 will benefit them in these areas. We want to see all DO students and residents healthy and successful on their road to DO licensure, while continuing our mission of ensuring the health and safety of the public through assessment of osteopathic medical competencies.

If you encounter any bumps along the road, don’t hesitate to reach out to NBOME Client Services at clientservices@nbome.org.

Editor’s note: The views expressed in this article are the author’s own and do not necessarily represent the views of The DO or the AOA.

Related reading:

Pass/fail COMLEX: Considerations and outlook from a student’s perspective

More to Match: Should I choose a back-up specialty?

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