As previously announced, COMLEX-USA Level 1 (Level 1) reporting will transition from a three-digit numeric score to “Pass” or “Fail” outcomes for Level 1 beginning on or after May 10, 2022.
To receive a three-digit numeric score, candidates must take their Level 1 before May 10, 2022.
Dates for Level 1 Transition to Pass/Fail Only:
| Level 1 | Test before May 10, 2022 | Test on or after May 10, 2022 |
| Score Release | Numeric score AND pass/fail | Pass/fail only |
| Transcripts | Numeric score AND pass/fail | Pass/fail only |
Level 1 Candidate Score Report
All candidates will receive their performance information as it relates to the national mean performance of those who have taken COMLEX-USA Level 1 for the first time. This feedback (Low/Average/High) identifies areas of strength and weakness and may be useful to guide a study plan for failing candidates. The minimum blueprint percentage allocated to the competency domains and clinical presentations will also be presented. Discipline scores will no longer be included in either candidate or school reports
View a Sample Formative Performance Profile
December 17, 2020
PHILADELPHIA, Pa. – The Board of Directors is pleased to announce that the NBOME will change from reporting three-digit numeric scores to reporting only “Pass” or “Fail” for COMLEX-USA Level 1examinations administered effective May 1, 2022, aligning with the start of the 2022-2023 testing cycle. This decision was made after several years of analysis and considering input from across the education, training, and licensure continuum.
The NBOME recognizes that this score reporting modification for COMLEX-USA Level 1 (pass/fail only) will create new questions for osteopathic medical students, faculty and deans, state licensing board members, the GME community, and other stakeholders. More information and further specifics will be made available by July 2021 on the particulars and logistics of the new score reporting construct for candidates, and that for schools and other secondary users. Input was considered from stakeholder groups across the continuum, including the licensure community, osteopathic medical students and residents, those involved in undergraduate and graduate medical education, accreditation authorities, and numerous other professional organizations across the profession. Ultimately, the NBOME Board took this action in support of wellness across the continuum and in the interest of its mission to protect the public.
Frequently Asked Questions
Changes will go into effect for any administrations taken on or after May 10, 2022.
Yes. COMs will still get up-to-date student performance on COMLEX-USA Level 1 with pass/fail (P/F) and performance profiles by clicking “View Score Report” on their dean’s page.
The NBOME cautions against use of these performance profiles for purposes other than providing candidates with an understanding of their relative strengths and weaknesses in the COMLEX-USA blueprint.
No. Beginning May 10, 2022 administrations, the Level 1 discipline scores will no longer be available for the candidate score reports, Dean’s Page, and aggregate school report. Only performance as it relates to the blueprint competency domains and clinical presentations as seen in the candidate score report will be available to COM deans. This information will be accessible under the “View Score Report” on the Dean’s Page.
COM deans will be able to view how many of their students have taken the exam for the first time, and performance pass rates for their students who are first-time test-takers as compared to the national pass rate for first-time test-takers. They will see performance as it relates to the blueprint competency domains and clinical presentations as seen in the candidate score report.
Yes, an annual report of school performance will be available to deans in September 2023.
Program directors will only see a pass or fail result in ERAS for candidates who take Level 1 after that date. The minimum passing score of 400 will also be shown in the ERAS transcript, but no numerical scores for candidates will be reported for candidates who test on or after May 10, 2022.
We will continue updating this document with answers to additional questions as we receive them. If your question is not answered here, please email clientservices@nbome.org.
Because the COMLEX-USA Level 1 examination is highly integrative, students should review all content areas, especially if they are retaking the examination. The COMLEX-USA Level 1 Test Specifications are a good place to start.
The NBOME offers self-assessment tools that osteopathic medical students may use prior to sitting for the COMLEX-USA Level 1 examination: COMSAE and WelCOM. These tools are used to gauge students’ knowledge base and abilities, reinforce medical knowledge, and determine which content areas they are most adequately prepared for.
The COMSAE Phase 1 score report provides performance by discipline, competency domain, and clinical presentation, which may be helpful for students as they prepare to take COMLEX-USA Level 1. Please see this article for additional information on the role of COMSAE Phase 1 in COMLEX-USA Level 1 preparation
WelCOM provides additional learning resources to prepare students for both COMSAE Phase 1 and COMLEX-USA Level 1. After responding to each WelCOM question, candidates are shown the correct answer, the rationale for why that answer is correct, and are provided additional references for further study.
While there had been considerable discussion and consideration of reporting only pass or fail rather than numeric scores for COMLEX-USA examinations with NBOME’s testing committees and Board of Directors since the first COMLEX-USA redesign in 1995, the concept of the elimination of numeric scores from COMLEX-USA Level 1 garnered considerable attention and analysis by NBOME’s Blue Ribbon Panel for Enhancing COMLEX-USA, which was commissioned in 2009 and published an initial report in March 2012.
At the time, with the secondary use of licensing examination scores by Program Directors and the beginning of discussions regarding a potential transition to a Single Accreditation System for Graduate Medical Education, the decision was to continue to report numeric scores. NBOME continued to engage the medical licensure, regulatory, assessment and education communities on this topic, including inviting input from osteopathic medical students and residents. NBOME has presented on this topic at national meetings including those within the licensure community, but many expressed concerns about change. Students, residents and their advisors in particular cautioned against the unintended consequences of discontinuing reporting of COMLEX-USA Level 1 numeric scores, primarily related to concerns about application for residency programs.
While other concerns were cited, the principal apprehension was that DO candidates with a COMLEX-USA score that reported as pass/fail only would not be able to be compared to applicants from MD-granting schools and international medical graduates who applied producing numeric scores. Upon USMLE’s announcement earlier in 2020 that they would discontinue reporting “Step 1” numeric scores beginning in 2022, this concern was mitigated, and stakeholder input changed.
This December 2020 decision was ultimately made after several years of analysis and considering input from across the education, training, and licensure continuum, and in the interest of wellness across the continuum and supporting NBOME’s mission of protecting the public through assessment. The comprehensive analysis included research, surveys of individuals, and solicitation of stakeholder position statements, including those from organizations representing the medical licensure community, undergraduate and graduate medical education, accreditation authorities, and students and residents.
Our COMLEX-USA test cycles align with the cohorts of students who take the examination and their anticipated graduation year and are established with input from colleges of osteopathic medicine and other stakeholders. This change to the score reporting for COMLEX-USA Level 1 examinations needs to align with the test cycle change, therefore we will make this change in May 2022 (a time when the Class of 2024 begins to take this examination).
To make this change earlier would compromise both the psychometric integrity of the examination results of the 2021-2022 test cycle, and would potentially result in half of a graduating cohort having numeric scores, and half having only Pass/Fail results. In addition, this provides stakeholders appropriate notice to prepare for the transition. USMLE has reported that their “Step 1” exam, which is often compared to COMLEX-USA Level 1, will make the change to Pass/Fail reporting as early as January 2022, which is the start of their test cycle.
Historically, students at some MD-granting schools and international graduates take Step 1 of USMLE earlier in the calendar year than DO students begin taking COMLEX-USA Level 1, who do not start taking Level 1 until May.
It is anticipated that comprehensive score reports provided to candidates and available to schools for COMLEX-USA Level 1 examinations taken on or after May 1, 2022 will still include individual candidate performance profiles as they currently do. These demonstrate individual areas of strength and weakness within the examination blueprint for the benefit of continuous professional development, and, when relevant, to use as part of remediation and to enhance potential for success.
These reports will likely continue to be generated for candidates and available to COM deans in their secure NBOME Portal accounts. However, it is anticipated that this information will NOT be reported in examination transcripts provided for residency program applications in ERAS or to state medical and osteopathic medical licensing boards. Particulars and logistics of the new score reporting construct for candidates as well and schools and other secondary users will be made available by July 2021.
No. If you take/took your COMLEX-USA Level 1 examination on or prior to April 30, 2022, NBOME will continue to report numeric scores AND pass/fail result. Your numeric score will remain on your COMLEX-USA transcript and will be reported in ERAS and to state licensing boards as such. It will not change or update with this transition. Reports for Level 1 examinations starting May 1, 2022 will no longer report numeric scores.