Every osteopathic medical student eventually wants to know their chances of passing COMLEX-USA. Whether you’re an OMS-II preparing for COMLEX-USA Level 1 or an OMS-III preparing for COMLEX-USA Level 2-CE, understanding the COMLEX Level 1 pass rate and COMLEX Level 2 pass rate can help you put your own exam preparation into perspective.
The pass rates are useful benchmarks, but they do not determine an individual student’s outcome. Your preparation, knowledge, test-taking skills, and readiness on exam day all play a role in your performance.
This guide brings together the most current data reported by the National Board of Osteopathic Medical Examiners (NBOME), explains how COMLEX-USA Level 1 and Level 2-CE are structured and scored in 2026, and outlines study strategies that can help you prepare effectively for exam day.
What Is COMLEX-USA?
COMLEX-USA (the Comprehensive Osteopathic Medical Licensing Examination of the United States) is the three-level national standardized licensure examination series for osteopathic physicians, administered by the National Board of Osteopathic Medical Examiners (NBOME). It is accepted for physician licensure in all 50 states and is also used as a graduation and residency-training requirement in osteopathic medical education.
The series has three levels:
- COMLEX-USA Level 1 — Typically taken during the second year of osteopathic medical school, it assesses foundational biomedical sciences and osteopathic medical knowledge in the context of clinical problem-solving.
- COMLEX-USA Level 2-CE (Cognitive Evaluation) — Taken during the third or fourth year, it assesses the application of clinical and foundational biomedical sciences knowledge to patient care and clinical decision-making.
- COMLEX-USA Level 3 — Taken during residency after passing Levels 1 and 2-CE and graduating from an accredited college of osteopathic medicine, it assesses competencies required for the unsupervised practice of osteopathic medicine.
COMLEX Level 1 & Level 2 Pass Rates
National First-Time Pass Rates
Unlike the USMLE, COMLEX-USA does not use a predetermined percentage of candidates who must pass. The NBOME uses a criterion-referenced passing standard, meaning candidates are evaluated against an established level of competence rather than ranked against other test takers. As a result, the percentage of candidates who pass can vary from one testing cycle to another.
The most recent NBOME-reported data show the following first-time pass rates for COMLEX-USA Level 1 and Level 2-CE:
| Testing Cycle | COMLEX-USA Level 1 First-Time Pass Rate | COMLEX-USA Level 2-CE First-Time Pass Rate |
|---|---|---|
| 2024–25 | 90.3% | 91.3% |
| 2023–24 | 93.0% | 92.5% |
| 2022–23 | 90.6% | 94.5% |
Note: The testing periods differ slightly between the two exams. Level 1 data shown above covers May 2024–April 2025, while Level 2-CE covers June 2024–April 2025 for the 2024–25 cycle. The same cycle-specific date ranges apply to the earlier years.
A few points stand out from the latest data:
- Level 1: The first-time pass rate was 90.3% in 2024–25, down from 93.0% in 2023–24 but slightly above the 90.6% reported for 2022–23.
- Level 2-CE: The first-time pass rate was 91.3% in 2024–25, compared with 92.5% in 2023–24 and 94.5% in 2022–23.
- Pass rates are not predetermined. A change in the percentage of first-time test takers who pass does not necessarily mean the exam became harder or easier. Candidate preparation, the characteristics of the testing population, and other factors can contribute to year-to-year changes.
- The number of first-time test takers has also increased. For Level 1, the number rose from 8,798 in 2022–23 to 9,381 in 2024–25. For Level 2-CE, it increased from 7,816 to 8,924 over the same period.
- Passing standards are criterion-based. The NBOME establishes passing standards through a formal standard-setting process rather than setting a target percentage of candidates who should pass.
Why the Numbers Move Around
A roughly 1-in-10 failure rate on either exam is a meaningful number when you’re the one testing. A few factors explain most of the year-to-year movement:
- Pass/fail transitions change behavior. Level 1 became pass/fail-only starting with the 2022–23 cycle. Program directors and students alike have had to recalibrate how much weight to put on preparation once the outcome is binary.
- Cohort size and composition shift. As more COMs open and matriculant numbers grow, the first-time test-taker pool changes year to year, which can move the aggregate pass rate even without a change in individual student readiness.
- Standard-setting reviews. When the NBOME resets the passing standard, cohorts tested just before and after a reset can show noticeably different results.
- A failed attempt has lasting visibility. Because a failed attempt remains on a candidate’s record and is factored into screening by the majority of residency program directors, schools have strong incentive to gate students who aren’t ready — which is part of why COM-level pass rates tend to run higher than certain national cycles.
COMLEX-USA Exam Format
Level 1 format and Level 2-CE format currently share the same basic testing structure—320 questions across eight sections over two 4-hour sessions—but assess different stages of medical training.
COMLEX Level 1 Format
- One-day, computer-based exam administered at Pearson VUE test centers
- 320 questions, delivered across eight sections of 40 questions each (this reflects the format effective May 2026; the exam previously used 352 questions in eight sections of 44)
- Two four-hour testing sessions, roughly eight hours of total seated time
- A 60-minute total break allowance that can be used across scheduled break opportunities
- Content follows the COMLEX-USA Blueprint, integrating foundational biomedical sciences (anatomy, physiology, pathology, pharmacology, microbiology, biochemistry) with osteopathic principles and practice (OPP) and osteopathic manipulative treatment (OMT), all delivered through clinical vignettes rather than pure recall questions
- Most students sit for Level 1 near the end of their OMS-II year
COMLEX Level 2-CE Format
- One-day, computer-based examination with an eight-hour testing period, divided into two separately timed 4-hour sessions
- 320 questions across eight sections of 40 questions each, reduced from 352 questions across eight sections of 44, beginning with the June 2026 testing cycle
- Tests the application of clinical and foundational biomedical sciences knowledge, osteopathic principles and practice, and other physician competencies in the context of clinical and patient presentations
- Assesses competency domains including osteopathic patient care, communication skills, professionalism and ethics, systems-based practice, and practice-based learning and improvement
- Students must pass Level 1 and complete the second year of study at an accredited college of osteopathic medicine to be eligible for Level 2-CE.
- Level 2-CE is generally taken during the clinical-education portion of osteopathic medical school, commonly in OMS-III or OMS-IV.
COMLEX-USA Scoring Systems
This is one of the most misunderstood parts of COMLEX-USA, largely because Level 1 and Level 2-CE are now scored differently from one another.
COMLEX Level 1: Pass/Fail Only
Since May 2022 (aligned with the start of the 2022–23 testing cycle), COMLEX-USA Level 1 no longer reports a three-digit numeric score. Candidates receive only a “Pass” or “Fail” result. The passing standard corresponds to a standard score of 400. However, Level 1 candidates no longer receive a three-digit score; their official result is reported only as Pass or Fail.
Alongside the pass/fail result, Level 1 candidates receive a Formative Performance Profile, which compares their overall performance and performance in individual content areas against other first-time test-takers who passed — useful diagnostic information, even though it isn’t a numeric score you can report to residency programs.
COMLEX Level 2-CE: Numeric Score Plus Pass/Fail
Level 2-CE reports both a Pass/Fail result and a three-digit standard score. The passing standard is 400. Unlike Level 1, which transitioned to Pass/Fail reporting in 2022, Level 2-CE continues to provide a numeric score that allows applicants and residency programs to distinguish levels of exam performance.
Because Level 1 is now reported only as Pass/Fail, Level 2-CE has become an important quantitative measure of COMLEX-USA performance in residency applications. However, the importance assigned to the score varies by specialty and residency program, so it should be considered alongside the broader application rather than as a standalone measure of competitiveness.
How Scoring Works Under the Hood
For both exams, your raw score (number of items answered correctly) is converted to a model-based standard score that accounts for the psychometric properties of that specific exam form — this is why passing standards stay consistent even though the exact questions change from administration to administration. Scores are typically released four to six weeks after the end of a testing window, posted to the NBOME Portal. Percentile conversions become available later in the cycle, once full cohort data is in, via the NBOME’s Percentile Score Converter.
Study Tips for COMLEX Level 1 & Level 2
Build Your Foundation Around the Blueprint
The single most reliable study tip for both exams is the same: know the COMLEX-USA Blueprint. It defines exactly how content is weighted across competency domains and clinical presentations, and every legitimate prep resource — from qbanks to review courses — is built to mirror it. Don’t guess at what’s high-yield; the blueprint tells you.
Use a Strong Question Bank as Your Core Tool
Retrieval practice — actively recalling information through practice questions rather than passively re-reading — is consistently the highest-yield study activity for exams like this. Popular resources include:
- UWorld — offers COMLEX-style question banks with detailed rationales
- COMBANK — built specifically around the COMLEX blueprint
- COMSAE (Phases 1 and 2) — the NBOME’s own self-assessment tool, directly predictive of real exam performance and the best gauge of readiness before test day
For additional exam-preparation guidance, Gold USMLE Review offers resources designed to help medical students strengthen their knowledge and prepare for medical licensing exams.
Whichever qbank you choose, work through missed questions methodically, track your performance by content area, and revisit weak domains rather than moving on once you’ve “seen” a topic once.
Don’t Skip Osteopathic Content
OPP and OMM questions are a smaller slice of the exam than the foundational biomedical sciences, but they’re a guaranteed, predictable slice — and one that non-DO-specific resources won’t cover well. Dedicated OMM review resources and blueprint-aligned practice questions are worth the time relative to their share of the exam.
Time Your Prep to the Exam You’re Taking
- For Level 1: Most students run a dedicated study period in the weeks leading into their OMS-II to OMS-III transition, building from coursework review into intensive qbank work, using COMSAE Phase 1 checkpoints to track trends.
- For Level 2-CE: Preparation should build continuously through your core rotations rather than starting cold afterward — clinical exposure to internal medicine, family medicine, surgery, and the other tested disciplines directly reinforces exam content. A focused four-to-eight-week dedicated block after rotations, combining daily clinical vignette questions with continued OMM review, tends to work well.
Treat Readiness Data Honestly
If your COMSAE trend is below your target and test day is approaching, that’s information worth acting on — not a reason to panic, but a reason to have an honest conversation with your school’s academic support team about whether an additional few weeks of preparation makes sense. A failed attempt has lasting visibility on residency applications, so the calculus almost always favors testing when you’re truly ready rather than testing on the original date at all costs.
Don’t Study in Isolation from the Data
Understanding the exam format changes, the scoring system you’re actually being measured against, and the historical pass-rate trend isn’t just background reading — it shapes how much cushion you should build into your prep. A pass/fail exam like Level 1 rewards a “get comfortably over the bar” mindset; a scored exam like Level 2-CE rewards continued push for a stronger three-digit result once you’re confident you’ll pass, since that number now carries real weight in your residency application.
Final Thoughts
COMLEX Level 1 and Level 2-CE pass rates have generally remained in the 90% range, while both exams have shifted to 320 questions across eight sections. The best preparation remains consistent: follow the blueprint, practice with a strong question bank, use COMSAE to assess readiness, and allow enough study time. For the latest pass-rate data, check the NBOME’s official COMLEX-USA Examination Performance Data.
