NBOME COMLEX-USA Level 2-CE Practice Test

Level 2-CE (Cognitive Evaluation) is a computer-based, written examination testing clinical knowledge and decision-making. Level 2-PE (Performance Evaluation) was a hands-on, practical skills exam assessing clinical and osteopathic manipulative treatment (OMT) skills; however, the NBOME has suspended the Level 2-PE requirement as of 2021. The clinical skills competency is now assessed through alternative pathways as determined by your medical school and for residency eligibility.

The Level 2-CE is scored on a three-digit scale. The passing standard is set by the NBOME and is subject to periodic review. You must achieve a score at or above the minimum passing score, which is determined through a rigorous standard-setting process. The score report also includes a performance profile showing your strength in various clinical discipline areas. It is essential to check the NBOME website for the most current passing score information.

The typical timeline is to take Level 2-CE after completing core clinical rotations (e.g., Internal Medicine, Surgery, Pediatrics, OB/GYN, Psychiatry, and Family Medicine) in your third or early fourth year of osteopathic medical school. This timing ensures you have been exposed to the breadth of clinical material tested. It must be completed sufficiently early so that scores are available for residency applications, which open in the fall of your fourth year.

For osteopathic applicants seeking ACGME-accredited residency programs, the COMLEX-USA series is fully recognized. While some program directors in highly competitive specialties may be more familiar with USMLE scoring, the vast majority of residency programs accept and evaluate COMLEX scores. Many programs use conversion tools to understand COMLEX scores in context. The most important factor is achieving a strong, competitive score on the exam you take. Always check individual program requirements.

Osteopathic Principles and Practice (OPP) is integrated throughout the exam, not isolated to separate questions. Preparation must include reviewing OMM techniques, somatic dysfunction diagnosis (including TART criteria), viscerosomatic reflexes, and the application of OMT within the management of common clinical conditions presented in the vignettes. Utilize OMM-specific review texts, question banks, and ensure you can apply osteopathic concepts to general medical scenarios, such as managing low back pain, respiratory infections, or pediatric conditions.