Comprehensive Osteopathic Medical Licensing Examination (COMLEX)
Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) is a series of three osteopathic medical licensing examinations. Legally, and professionally, there is no difference between osteopathic physicians (DOs) and Medical Doctors (MDs). DOs are entitled to practice in every available branch of medicine, and when it comes to internships, residencies, and job opportunities, they are in competition with MDs. The medical training of DO’s is essentially the same as that of MD’s - the main difference being that DO’s undertake extra coursework in osteopathic manipulative medicine (OMM). OMM is a form of therapy that requires hands-on treatment of muscles, tendons, and joints - brings together elements of massage and other hands-on methods of relieving pain and improving function. One other educational difference is that DO schools typically require that students spend more time rotating in primary care specialties such as internal medicine, family medicine, pediatrics, and obstetrics/gynecology during the third and fourth years than do some MD schools. In basic terms, DO schools tend to cater to the would-be generalist medical practitioner, and provide a strong grounding toward that end. MD schools, on the other hand, will prepare students more with later specialization in mind. That is not to say that DOs cannot specialize. Many do, and they can be found specialized in every available area of medical practice.
While MDs take the USMLE, anyone who goes the DO route will be required to take the osteopathic equivalent - the COMLEX-USA. It helps with career planning to know if the residency programs in the specialty of your interest recognize the COMLEX as USMLE equivalent or encourage DO’s take the USMLE too.
Strongly competitive MD residency programs have been known to encourage osteopathic applicants to take the USMLE as a way of standardizing the applications they receive and facilitating a direct comparison of board scores. That is the only drawback, and COMLEX-USA is the most common pathway by which osteopathic physicians apply for license. There are three levels to the COMPLEX-USA, the last of which will usually be tackled during internship.
Level ONE
Taken after the second year of medical school, this takes place in one day and consists of two, four-hour exam sessions. Level one covers basic medical sciences, including: Anatomy, Behavioral science, Biochemistry, Osteopathic principles, Microbiology, Pharmacology, Pathology, Physiology.
Level TWO
Taken during the final year of medical school, level 2 consists of two parts: 2-CE and 2-PE. Level 2-CE requires demonstrable knowledge of clinical concepts and medical decision making. It's a problem-based, symptoms-based, integration of the following clinical disciplines: Emergency medicine, Family medicine, Internal medicine, Obstetrics/gynecology, Osteopathic principles, Pediatrics, Psychiatry, Surgery.
Level 2-PE is assessed in a one-day, seven-hour exam. This uses actors trained to present clinical symptoms in order to test the candidates' clinical skills. Candidates must demonstrate proficiency in:
- History taking and physical examination skills
- Integrated differential diagnosis and clinical problem solving
- Written communication and synthesis of clinical findings (SOAP note format)
- Osteopathic principles and/or osteopathic manipulative treatment
Level THREE
The final exam, level three, is taken during an internship. The assessment covers clinical disciplines, including: Emergency medicine, Family medicine, Internal medicine, Obstetrics/gynecology, Osteopathic principles, Pediatrics, Psychiatry, Surgery.