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Changes to COMLEX-USA Level 3 and New Responsibilities for Program Directors


COMPLEX-USA Level 3 Process

The COMLEX-USA Level 3 is part of a three-level national standardized licensure examination. It is the final exam in the series and is designed to be given to osteopathic postgraduate candidates.

On September 10, 2018, COMLEX-USA Level 3 begins administration as a two-day examination with residents completing both days within a 14-day time period. Candidates began registering for the two-day examination on March 16, 2018.


To be eligible for COMLEX-USA Level 3, the candidate must pass both COMLEX-USA Levels 1 and 2, and have graduated from an accredited college of osteopathic medicine. The school must also release the candidate’s graduation status prior to attestation. Though not a requirement, the National Board of Osteopathic Medical Examiners (NBOME) recommends that Level 3 candidates have completed a minimum of six months of residency training prior to testing.

Eligibility will require an attestation from an American Osteopathic Association (AOA)- or Accreditation Council for Graduate Medical Education (ACGME)-accredited graduate medical education program director. Attestation is an important step to ensure residency program directors agree a candidate is ready to take the final examination in the COMLEX-USA series and prepare for licensure. The program director will need to attest that the Level 3 exam candidate is in “good academic and professional standing,” meets the professional requirements of the residency program, and is eligible to continue as a resident in the program.

It is the responsibility of the resident to request attestation before (s)he can schedule to take the Level 3 examination. Once the resident submits a request, the NBOME will send reminder emails to the program director until the attestation is completed. Candidates will be notified immediately by email from the NBOME when the program director completes the attestation. If the program director has not provided an attestation within ten days after a request has been submitted, the NBOME will send the resident a reminder indicating they should follow-up with their residency program director to confirm that they received the email in response to the request. If the program director does not receive the email, the reminder sent to the resident will contain instructions to confirm the program director’s email address in the NBOME system.

Time Frame

Once an attestation is provided to an intern or resident to take the Level 3 examination, it does not expire. The intern or resident has up to six attempts to complete Level 3 with a maximum of four attempts in any 12-month period. This applies to interns in transitional rotating internships with TRI program directors able to provide an attestation for an intern.

Residency program directors will receive the scores approximately 8-10 weeks from the date of the examination, after the initial two-day Level 3 score release. More information about specific score release dates for the two day Level 3 examination will be available on the NBOME website this fall.

Helpful Resources

According to the NBOME, nearly 4,000 attestations have been completed and 2,000 candidates are scheduled to take Level 3 between September 2018 and February 2019. Learn more at https://www.nbome.org/exams-assessments/comlex-usa/enhancing-comlex-usa/residency-programs/.