This is where you demonstrate that you can apply knowledge from the classroom and clinical experiences to patient care. For dual USMLE takers, this is also a chance to bridge the gap between COMLEX and Step 2 CK preparation.
In this guide, I’ll walk you through the exam format, best study resources, OMM-specific preparation, and how to build a study plan that maximizes efficiency and results. By the end, third and fourth year DO students, as well as dual USMLE takers, will have a clear roadmap to take on the COMLEX Level 2 exam with confidence.
COMLEX Level 2-CE is a one-day, computer‑based exam administered by the National Board of Osteopathic Medical Examiners (NBOME). It is split into two, four‑hour sessions for a total of eight hours of testing time.
The exam currently consists of 352 multiple‑choice, single‑best‑answer questions, but that number will drop to 320 questions starting in summer 2026. Total exam time will remain the same.
The exam content is organized according to the COMLEX-USA blueprint, which defines the following competency domains:
These competencies are assessed across the major clinical science disciplines: internal medicine, family medicine, pediatrics, obstetrics and gynecology (OB/GYN), psychiatry, surgery, emergency medicine, and osteopathic principles and practice.
All candidates receive 60 minutes of pooled break time to use during scheduled break periods. This usually consists of two 10-minute breaks after two blocks, and then a 40-minute break after the fourth block.
Choosing the right resources is essential for effective study prep. Overloading on study materials can reduce efficiency, so focus on quality over quantity. Aim for two to three primary resources plus targeted supplements.
A strong question bank is the cornerstone of COMLEX Level 2 prep. This is what will help you practice clinical reasoning, apply osteopathic principles, and get familiar with the style of questions you’ll see on exam day. Here are my top options:
Many students also use rotation-specific UWorld questions to prepare for COMAT shelf exams during their third year.
Most students aim to complete the majority of a primary question bank at least once before exam day, then cycle back through incorrect questions. Students often set personal daily question goals that scale with their schedule. What matters most is consistency, high-quality review, and spaced repetition. Spaced repetition is essential to make sure that everything that you are learning during your study period is accessible and retrievable on exam day.
Content review for COMLEX Level 2 should be targeted. The goal isn’t to relearn every detail of medicine, but to strengthen clinical decision-making and address gaps revealed by practice questions. For most students, the two most practical resources for content review are:
For dual USMLE takers, integrate Step 2 CK resources to cover overlapping topics efficiently. Some students also supplement review with podcasts like Divine Intervention, especially for reinforcing clinical reasoning during commutes or lighter study days.
For COMLEX Level 2, OMM is integrated throughout the exam. Most students find that clinical integration beats isolated memorization. Focus on common presentations where OMM is most frequently tested, and use OMM review to reinforce clinical decision-making rather than trying to memorize every technique.
Question banks are a great starting point for OMM prep. COMBANK and COMQUEST include dedicated OMM questions that you should complete at least once. While OMM questions make up a smaller portion of the exam, consistent practice ensures you don’t get caught off guard.
Beyond question banks, here are a few resources I like:
Practice exams are an essential part of your preparation because they help you build stamina, refine pacing, and simulate the structure and thought process of the real exam. The most authentic practice exams come from the NBOME’s own self-assessment tools.
The Comprehensive Osteopathic Medical Self-Assessment Exam (COMSAE) Phase 2 series is designed to align with COMLEX Level 2. Taking a timed COMSAE early in your study period gives you a baseline for your study prep. Repeating one later can help you track progress, but it’s important to note that each COMSAE costs $60.
Many students supplement with commercial practice exams that simulate exam conditions and offer additional scoring feedback. COMQUEST practice exams are widely used because they provide full-length, timed formats shaped around COMLEX-style questions.
Successful COMLEX Level 2-CE exam prep balances clinical responsibilities with consistent, question-driven learning. Most students follow a three- to four-month timeline, adjusting the intensity of their studies based on their rotations and whether they are also preparing for USMLE Step 2 CK.
I tell my students that instead of separating studying into rigid phases, they should think of their plan as gradually shifting emphasis as exam day approaches.
Students who want a more personalized timeline often work with our tutors to align COMLEX prep with rotations, shelf exams, and dual USMLE goals. Our tutors have the material mastered and are trained in high-yield clinical reasoning, osteopathic principles, and exam strategy.
The first phase focuses on building momentum and identifying gaps. Begin incorporating daily question blocks while reviewing high-yield systems during clinical rotations. This is the time to establish routines, refresh core concepts, and reconnect OMM principles with real patient scenarios you’re seeing.
As you move deeper into preparation, practice questions should dominate your study time. Use them to refine clinical reasoning, improve timing, and recognize recurring patterns in diagnoses and management. Content review during this phase should be targeted. Focus on flagged or missed questions rather than broad reading. Our tutors can provide personalized assistance with an approach to questions and test-taking strategies.
In the final weeks, shift toward confidence-building. Revisit weak areas, reinforce OMM integration, and complete full-length practice exams to simulate test-day conditions. The goal here isn’t to learn new material, but to close content gaps, sharpen decision-making, and walk into the exam feeling as prepared as possible.
Being aware of these pointers can help you stay on track and enter test day with confidence:
COMLEX Level 2 and USMLE Step 2 CK both assess clinical knowledge, reasoning, and decision-making, but they serve different purposes and emphasize different skills.
COMLEX is required for DO students and integrates osteopathic principles and practice (OMM) throughout. USMLE is taken by MD students and focuses on biomedical and clinical science.
Some DO students take both exams to boost competitiveness, especially for residency programs that are more familiar with USMLE scores. This approach works but requires careful planning and extra effort.
For most students, a strong COMLEX prep plan is enough for a successful residency match. Those considering both exams should base the decision on specialty goals, program expectations, and their personal readiness. Use overlapping content strategically while ensuring osteopathic principles receive adequate attention.
COMLEX Level 2 is challenging, but most medical students who complete their core clerkships and follow a structured study plan pass on their first attempt. In 2024-2025, roughly 90% of first-time test-takers passed Level 2-CE.
The official passing score for COMLEX Level 2-CE is 400, as set by the NBOME. Each question contributes equally to your score, and your raw score is converted to a standardized score to determine pass/fail. This is different than Level 1, where you only get a pass/fail designation.
A score of 600 on COMLEX Level 2 typically places a student well above average, often around the 75th-85th percentile, though exact percentiles vary by testing year.
Anki can be a valuable supplement for COMLEX Level 2 preparation as a form of spaced repetition. It works best for reinforcing concepts you’ve already seen in practice questions or clinical scenarios. Many students prefer creating their own cards based on missed questions rather than relying on premade decks.
COMSAE Phase 2 scores can give you a general sense of where you stand, but they are not perfect predictors of your actual exam score. COMSAEs work best when interpreted alongside other measures of performance like clinical assessments and question bank results.
If you want more structure, accountability, and targeted guidance during your COMLEX Level 2 prep, working with an experienced tutor can make a meaningful difference.
Dr. Ramirez is an integrated vascular surgery resident at UCSF who is passionate about teaching and tutoring for several board exams. He has served on the University of California, San Francisco School of Medicine admissions committee and is committed to being a leader in medical education.