In recent years, DO residency applicants have become much more focused on their COMLEX Level 2 score percentile. And it’s easy to see why. Prior to 2022, COMLEX Level 1 was seen as a pivotal exam for osteopathic medical students. However, since the National Board of Osteopathic Medical Examiners (NBOME) transitioned to a pass/fail system for COMLEX Level 1 years ago, the stakes have shifted to COMLEX Level 2. Now, simply passing Level 2 isn’t enough on its own—your COMLEX level 2 score percentile matters as well!
As a result, understanding what your COMLEX Level 2 percentile is and how it fits into the bigger picture of the application process is critical for navigating an increasingly competitive residency Match cycle. In this post, we’ll break down what your COMLEX Level 2 percentile really means, how to interpret it, and how to use your score (even if it’s lower than you expected) during residency application season.
We’ll begin by answering the question that makes your Level 2 percentile rank an issue to begin with: why was the switch to pass/fail made for COMLEX Level 1?
Why Did COMLEX Level 1 Go Pass/Fail?
In 2022, the NBOME transitioned COMLEX-USA Level 1 from a numeric score to a pass/fail scoring system. The decision was preempted by a shifting movement in medical education to reduce the emphasis placed on standardized test scores, particularly during the preclinical years (USMLE Step 1 went to pass/fail that same year). Educators believed the overemphasis on these exams scores were leading students to prioritize board prep over foundational learning or clinical reasoning.
And so, COMLEX Level 1 transitioned to pass/fail with the goal to reduce exam stress and anxiety for students in the early years of training, which would ideally allow them to focus on their preclinical courses and preparation for clinical rotations. It was also intended to promote a broader focus on applicants as a whole, rather than solely honing in on Level 1 scores, and encourage interest in research and clinical performance as well as other holistic aspects of a student’s profile.
While these changes were well-intentioned, they also brought other consequences. Without a numerical Level 1 score, many residency programs began placing more weight on COMLEX Level 2 as one of the few remaining standardized, comparable metrics. As a result, the pressure to perform well on board exams didn’t disappear—it simply shifted further down the medical school timeline for allopathic and osteopathic students alike.
Outcomes of the Pass/Fail Shift
With Level 1 no longer providing a numeric indicator of performance, residency programs needed an alternative benchmark. That benchmark became COMLEX Level 2, aka the COMLEX Level 2 Cognitive Evaluation (or Level 2-CE).
According to the NOBME, scoring well on Level 2 indicates to programs you’ve demonstrated competence in the clinical sciences and related physician competency domains. Based on your exam performance, they’re confident you’re ready to enter into supervised graduate medical education settings and to continue lifelong learning.
As a result:
- COMLEX Level 2 is now the primary standardized metric used to differentiate DO students academically.
- Program directors report using COMLEX Level 2 percentile scores more prominently in screening applicants, especially when students have not taken the USMLE.
- The change increases pressure on DO students to perform well during their clinical rotations and excel on shelf exams as well as the main event, COMLEX Level 2.
In some ways, this shift is positive. COMLEX Level 2 better reflects a student’s clinical knowledge and decision-making ability. However many DO students feel even more pressure to excel numerically since other parts of their application (e.g., school prestige, research) may not carry as much weight.
Additionally, some ACGME programs remain unfamiliar with how to interpret COMLEX scores. This lack of standardization means DO applicants must often advocate for themselves or choose whether to also take the USMLE Step 2 CK to be more competitive. (More on that later.)
Understanding COMLEX Level 2 Scores
COMLEX Level 2 is an exam designed to assess your ability to apply medical knowledge and clinical skills in real-world scenarios. Unlike Level 1, which focuses heavily on basic sciences, Level 2 emphasizes clinical decision-making, diagnostic reasoning, and patient management.
This is a computer-based test given on one day in which you have eight hours to answer 352 questions based on the competency domains and clinical presentations for osteopathic medical practice. Test questions are single-best answer, multiple-choice format and may include audio-visual elements. For more on competencies assessed and topics tested, check out the blueprint for the exam.
The COMLEX Level 2 Percentile System
Scores for the COMLEX Level 2 and other standardized tests are reported as percentiles, which are scores below which a certain percentage of scores is a data set fall. For example, if a score is at the 50th percentile, it means 50% of all the scores in the data set are at or below that score. If a score is at the 99th percentile, 99% of scores are at or below that score.
Interpretation of COMLEX Level 2 Scores
Scores for Level 2 are released approximately four to six weeks after the examination administration date. The minimum passing three-digit standard score is 400 for Level 2 for 2025-2026, which is around the 10th percentile based on the 2024-2025 exam cycle. Your COMLEX Level 2 score is a scaled score, not a percentage of questions correct. The NBOME uses a complex equating process to adjust for differences in test difficulty across versions.
Because percentiles aren’t published in real-time, the NBOME periodically releases score distributions to help students interpret their performance.
Here’s a a list of scores, their COMLEX Level 2 percentile estimates, and how they can be broadly interpreted:
| Score | COMLEX Level 2 Percentile Estimate | General Interpretation |
| 650+ | ~90th percentile | Exceptional; competitive for most specialties, including dermatology, plastics, ortho, ENT |
| 600–649 | ~75th–89th percentile | Strong; competitive for most specialties and programs, chance for the elite programs |
| 550–599 | ~60th–74th percentile | Above average; makes you a decent candidate for mid-tier programs |
| 500–549 | ~40th–59th percentile | Close to average; passable for less competitive specialties |
| 450–499 | ~20th–39th percentile | Just above passing; okay for fringe programs |
| 400-449 | ~10-19th percentile | Barely passed. Red flag for majority of programs |
Source: NBOME
Below 400 is considered failing and you must retake prior to application season.
How to Use Your Score Strategically
Let’s say you scored a 560. That places you comfortably above the mean and likely within the 65th to 70th percentile. That COMLEX Level 2 score percentile may open doors to:
- Mid-tier residency programs
- A decent selection of primary care and some of the less competitive surgical subspecialties
- Some competitive programs, if paired with strong clinical grades and letters of recommendation from electives you performed well in
If you scored below 500, you may want to:
- Apply broadly, and strongly consider community and rural-based programs.
- Emphasize other strengths, such as outstanding clinical evaluations, strong personal statements, or a unique background during your interviews.
- Consider doing audition rotations to demonstrate ability in-person, especially to the programs above that you have a good shot at.
If you scored above 620, you’re in a strong position to:
- Apply to competitive specialties (orthopedic surgery, dermatology, radiology).
- Be considered for prestigious academic programs or urban centers for primary care and subspecialty programs alike
- Be careful to not ease off the gas pedal, you still need strong clinical performances and letters. A strong COMLEX Level 2 CE score is a boon, don’t waste it by performing suboptimally on other aspects of your application.
What is a “Good” COMLEX Level 2 Score Percentile?
Ultimately, a “good” score is contextual. It depends on:
- Your specialty of interest
- The geographic competitiveness of where you’re applying (California and the Northeast tend to be more competitive, bigger cities and academic centers as well.)
- Whether you’re applying to AOA-only or ACGME programs
- The strength of the rest of your applications
I realize that’s a bit of a cop out answer so use the chart above to gauge your score. I’d say anything in the top quartile (75% above) is a good score, so in this case, approximately 600+. However, let me disprove my own statement with a few examples:
- Student A wants to match into pediatrics in the Midwest. A Level 2 score of 505 may be sufficient, especially with decent letters and clinical performances.
- Student B is applying to dermatology in New York. A Level 2 score of 605 (a whole 100 points higher than student A) may be required, and even then this student will have a tough time matching into his/her top choice, despite having research, leadership, and AOA endorsement because competitive specialties are just that competitive.
If your goal is a competitive specialty, aim for the top quartile. For primary care fields, a score above the 500 mark is reasonable when supported by other strengths in the application.
Should DO Students Take the USMLE Step 2 CK?
For DO students, the decision to take the USMLE Step 2 CK in addition to COMLEX Level 2 depends on a variety of factors such as the competitiveness of their desired specialty. While COMLEX is sufficient for licensing and many programs are comfortable evaluating DO applicants using it alone, some residency programs—especially in competitive specialties or certain geographic regions (East and West Coast, big metro areas)—may still lean towards or even require a USMLE score for direct comparison with MD candidates.
However, taking Step 2 CK means extra time, money, and preparation. It’s not always necessary, particularly for students targeting primary care or programs with a track record of accepting COMLEX alone.
Consider Step 2 CK if:
- You’re applying to ACGME programs in competitive specialties, such as ENT, derm, ortho, and other surgical subspecialities.
- You want to improve your chances in regions where COMLEX is less familiar. Data from the National Resident Matching Program (NRMP) shows that DO students who take the USMLE tend to match into their preferred specialties at higher rates than those who take only the COMLEX.
- You want to directly compare yourself numerically to MD applicants for academic or large metro programs, which may not always be “DO friendly.”
Perhaps skip Step 2 CK if:
- You’re applying primarily to DO-friendly residencies. These include programs that actively recruit DOs and already have a higher percentage of DO residents.
- Your COMLEX Level 2 score is already strong (e.g., >550).
- You have robust clinical evaluations, strong letters of recommendation, and a clear path to your specialty match.
Discuss whether you should take Step 2 CK with your school’s academic advisors or specialty mentors. Also consider whether you have time to prepare adequately—a subpar Step 2 CK score can hurt more than help.
Common Pitfalls and Misinterpretations of COMLEX Level 2
Pitfall #1: “I passed, so I’m fine.”
A passing score is essential, but for competitive programs, simply passing may not be enough. Some programs have “silent cutoffs” around 500–550, even if they don’t publish them.
Pitfall #2: You overemphasize the raw score and ignore the percentile.
While a 510 might seem good, if that year’s average is 520, you’re below the mean. Use the chart above and interpret your score in the context of that year’s percentiles.
Pitfall #3: You ignore specialty specific expectations.
Family medicine may not demand high scores, but competitive subspecialties will expect strong Level 2 performance. Always research the expectations for your target programs. For instance, it took an average score of above 610 to match into diagnostic radiology (DR) in the past cycle. Keep in mind that you can match into DR with a lower score, but you’re less likely to do so, and that scoring above a 610 doesn’t guarantee a spot.
What If I Don’t Get the Score I Wanted?
First, take a breath. Board scores are important, and your COMLEX Level 2 score percentile does matter, but they aren’t the only things programs look at. Many applicants match each year with average or below-average scores.
Here’s what you can do:
- Meet with your dean or advisor to review your entire application.
- Be strategic with your program ranking.
- Pursue audition rotations to make a strong impression in person and get a strong LOR.
- Strengthen other aspects of your application (research, volunteering, and leadership).
- Focus on writing an outstanding personal statement.
- Note that you cannot retake COMLEX for a better score if you pass.
- Consider taking USMLE Step 2. That said, the decision should be strategic. Step 2 CK requires extra preparation, so you should only attempt it if you have enough time to prepare thoroughly so that your USMLE score will strengthen—not weaken—your application.
- If your score is near the pass/fail threshold, consider whether delaying your application cycle by a year or completing a research or transitional year could help you become a stronger candidate.
If you’re looking for more one-on-one support while prepping for COMLEX Level 2, we can help! Schedule a free consultation with a Blueprint tutor to get personalized guidance to identify any areas of weakness, create a study plan, and help you pass the exam with flying colors. 🚀🤩
The Big Picture
Your COMLEX Level 2 score is an important metric, but it’s not your identity. Residency programs care about the kind of physician you’ll be—not just how many questions you got right.
Here’s what else matters to program directors:
- How well you performed during clinical rotations
- Your ability to work in teams and communicate with patients
- Your understanding and application of osteopathic principles
- How you reflect on your journey in your personal statement
- What your mentors and attendings say about you in letters
- How well you interact during interviews
In a Level 1 pass/fail world, it’s tempting to see Level 2 as a do-or-die moment. And to think your COMLEX Level 2 percentile score will make-or-break you as a candidate. But remember: becoming a DO means embracing a whole-person philosophy of medicine. Don’t lose sight of that when staring at a three-digit score.
From us here at Blueprint, best of luck on your COMLEX Level 2 exam and the rest of your medical journey!
And for more (free!) resources to help you through med school, check out these other posts on the blog:
