Effect of COMLEX-USA Level 1 pass/fail score reporting on student stress, test preparation, and performance

The Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) is a three-level national standardized licensure examination designed for the practice of osteopathic medicine. Following several years of analysis and considering input from across the continuum of osteopathic medical education, training, and licensure, the National Board of Osteopathic Medical Examiners (NBOME) transitioned COMLEX-USA Level 1 (Level 1) score reporting from a numeric score with a pass/fail result to a pass/fail result only beginning with the 2022-2023 testing cycle in May 2022.

The purpose of this study is to investigate the differences in student Level 1 self-reported stress levels, test preparation, and performance following the transition to pass/fail score reporting.

The study utilized data from Level 1, including end-of-examination survey responses from first-time test takers in the 2023-2024 administration and examination performance data from first-time test takers across the 2021-2022, 2022-2023, and 2023-2024 administrations. The analysis examined changes in three key outcomes: self-reported stress during examination preparation, perceived examination preparation, and performance on Level 1 examination.

After Level 1 transitioned to pass/fail score reporting, 60 % of students responding to the 2023-2024 end-of-examination survey reported reduced stress in Level 1 examination preparation, and 75 % of respondents reported no change in preparation time. In the first testing cycle after the transition, declines were observed in several performance indicators, including pass rate and the mean, standard deviation, and maximum of z-scores (converted from Level 1 numeric scores). In the subsequent cycle, the pass rate rebounded and the mean z-score stabilized, while both the standard deviation and maximum z-score continued to decline.

The COMLEX-USA series is designed as a licensure examination to assess competencies essential for the practice of osteopathic medicine. Passage of Level 1 indicates that a student has demonstrated competence in the foundational biomedical sciences, osteopathic principles, and related physician competency domains to enter supervised patient care settings. The transition in score reporting for Level 1 preserves that purpose. This study provides preliminary insights into the perceived differences in students' stress level, examination preparation, and examination performance patterns following the change of score reporting. Further study will be conducted as these students transition through their osteopathic education.