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COMLEX Level 3 is a two-day exam of 420 multiple-choice questions and 26 clinical decision-making (CDM) cases for test dates through December 19, 2026. From January 13, 2027 it becomes a one-day exam of 240 questions and 16 CDM cases in four 2-hour sessions (NBOME examination format).
Which version you sit depends only on your test date. This page sets the two side by side, walks through each session, and covers scoring, results and how to practise for the format you will actually get.
Exam format at a glance
| Topic | Official rule | Source |
|---|---|---|
| Length | Through December 19, 2026: two days within a 14-day window, four 3.5-hour sessions. From January 13, 2027: one day, four 2-hour sessions. | NBOME: COMLEX-USA examination format |
| Questions | Through December 19, 2026: 420 multiple-choice questions and 26 clinical decision-making (CDM) cases. From January 13, 2027: 240 multiple-choice questions and 16 CDM cases. Each CDM case has two to four questions. | NBOME: COMLEX-USA examination format |
| Scoring | A three-digit standard score with a pass or fail designation, plus a performance profile. | NBOME: scoring and reporting |
| Passing score | 350. Standard implemented January 2024; next review scheduled for November 2026. | NBOME: scoring and reporting |
| Eligibility | Passed Level 1 and Level 2-CE, graduated from an accredited COM, residency program director attestation of good standing, and the COM dean's clinical skills attestation. NBOME recommends six months of graduate medical education first. | NBOME Bulletin of Information 2026-2027 |
| Fee | $950. | NBOME: frequently asked questions |
| Results | Eight to 10 weeks from the end date of the Level 3 testing window. | NBOME: scoring and reporting |
What changes on January 13, 2027
| Through December 19, 2026 | From January 13, 2027 | |
|---|---|---|
| Days | Two, within a 14-day window | One |
| Sessions | Four of 3.5 hours, two per day | Four of 2 hours |
| Multiple-choice questions | 420, in sections of 70 | 240, in sections of 40 |
| CDM cases | 26, in two sections of 13 | 16, in two sections of 8 |
| Where the CDM cases sit | Day 2 morning | The last session of the day |
| Breaks | 60 minutes pooled per day | Optional between sections, from a 60-minute pool |
All rows from the NBOME format page (NBOME examination format). The question types stay the same: single-best-answer questions plus CDM cases. What changes is the length and the number of sittings. The passing standard is set separately and is 350 today (NBOME scoring).
Pick the date first, then prepare for that version. A resident who books for early December gets two days and 140-question sessions; one who books for February gets one long day that ends with the CDM cases.
The two-day exam, session by session
Day 1 is all multiple choice: a 3.5-hour morning session with two sections of 70 questions, then a 3.5-hour afternoon session with two more. Day 2 opens with the CDM cases, two sections of 13, and finishes with two final sections of 70 multiple-choice questions in the afternoon (NBOME format). You have 60 minutes of pooled break time each day (NBOME format).
The pace works out to roughly 90 seconds per multiple-choice question: 140 questions in each 3.5-hour session. Day 2 asks you to switch modes, from case management in the morning back to single-best-answer questions after lunch, and that switch is where tired residents lose time.
The one-day exam from 2027
The new format runs four 2-hour sessions. Sessions A, B and C each hold two sections of 40 multiple-choice questions, still about 90 seconds a question. A 10-minute CDM tutorial comes before session D, which holds two sections of 8 CDM cases. Breaks between sections are optional and come out of a 60-minute pool (NBOME format).
Two consequences matter for practice. The CDM cases now arrive at the end of a long day, so you should rehearse them when you are already tired, not fresh. And the day is shorter in total than the old two days combined, but there is no overnight reset between the question sessions and the cases.
What CDM cases ask you to do
Each CDM case gives a clinical scenario and then two to four questions about the decisions an independent osteopathic physician makes: what history, exam or test to get, what the findings mean, and how to treat, counsel and follow up (NBOME format). Answers can be extended multiple choice, where more than one option may be required, or short answer.
Two details catch people out. The CDM sections have no review screen (NBOME format), so decide and move on rather than planning to come back. And the official practice exam, COMSAE Phase 3, has no CDM cases (NBOME COMSAE); use NBOME's sample questions for the case format and practise the select-all-that-apply habit on your question bank's multi-answer items.
Scoring, results and retakes
Level 3 reports one three-digit standard score with a pass or fail designation, plus a performance profile by area (NBOME scoring). Both days of the current format feed that single result. The passing score is 350; NBOME's next scheduled review of that standard is November 2026 (NBOME scoring).
Results come eight to 10 weeks after the end of the testing window (NBOME), longer than for Levels 1 and 2-CE, so leave room before any contract or licensing deadline. In 2025, 97.1% of first-time takers passed (NBOME performance data). If you do not, NBOME allows four scored attempts per level (NBOME Bulletin); our failed COMLEX guide covers the next steps.
Level 3 tutoring around residency
Dr. Sean Moazezi, DO teaches Level 3 and sat every COMLEX level himself. Sessions run by live video (Zoom or Google Meet) around your rotations, including evenings. We work live questions and CDM-style cases while you talk through your reasoning, so a habit such as ordering every test or hesitating on a management step shows up and gets fixed. Bring your test date and your call schedule to the first session; whether you sit the two-day or the one-day format changes the plan.