A COMLEX fail is recoverable, and NBOME's rules for what comes next are clear. The two levels need different plans: Level 1 is pass or fail and usually comes in second year, while Level 2-CE gives a three-digit score and usually comes in fourth year, close to residency applications. Go straight to the part for your level.
How many people fail COMLEX?
More than you might think from the way people talk about it. In the latest NBOME data, about one first-time taker in ten did not pass Level 1, and about one in thirteen did not pass Level 2-CE (NBOME performance data):
| Level | First-time takers | Passed | Testing cycle |
|---|---|---|---|
| Level 1 | 9,678 | 90.2% | 2025-2026 (May to March) |
| Level 2-CE | 9,096 | 92.5% | 2025-2026 (June to May) |
| Level 3 | 8,596 | 97.1% | 2025 (January to December) |
In numbers, that is roughly 950 first-time takers at Level 1 and roughly 680 at Level 2-CE in a single cycle. A fail is a setback you share with hundreds of classmates nationally, and NBOME’s rules leave room to fix it.
Part 1: Failed COMLEX Level 1
1. Read the Formative Performance Profile
Because Level 1 reports pass or fail, you will not get a number. What you do get is the Formative Performance Profile, which compares your total performance and your performance in individual content areas with first-time test takers who passed (NBOME, scoring and reporting). That comparison is the most useful document you have for planning the retake.
Look for areas well below the passing group and check whether they are concentrated in a few disciplines or spread across many. Concentrated gaps call for targeted review; widespread gaps usually point to how you are answering questions rather than what you know.
2. Know your attempts
NBOME allows four scored attempts at each level, and no more than four attempts at a level within 12 months, including incomplete or voided attempts (NBOME Bulletin 2026-2027). A fifth attempt is possible only at the explicit request of a medical licensing agency. After one fail you have room to plan properly; it is worth using it rather than rushing back.
3. Talk to your college
Your college of osteopathic medicine will have its own policies on retake timing and on starting rotations after a Level 1 fail. Speak to your dean's office or advisor early so the retake date fits those rules.
4. Diagnose why it happened
- Content: the profile shows a few clearly weak areas that match your practice misses.
- Application: you recognise topics in review but miss the vignettes built on them.
- OMM: NBOME sets osteopathic principles, practice and manipulative treatment at a minimum of 12% of Level 1; students who left it to the end often lose points here.
- Stamina and timing: eight hours of testing in two four-hour sessions exposes pacing problems that short practice blocks hide.
More than one of these is common. The retake plan should address each one you find, not just the content gaps.
5. Rebuild foundations through questions
Level 1 tests foundational biomedical science applied to patients: NBOME sets application of knowledge at a minimum of 60% of the exam (NBOME, Level 1). Re-reading notes rarely fixes that. We rebuild through vignette-style questions, reviewing each miss for the reasoning, and go back to content only where the misses point.
6. Put OMM in every week
Because OMM runs through the blueprint, we schedule it weekly from the start of the retake plan rather than as a final block. Short, regular practice with OMM questions keeps it from becoming the area that costs the pass.
7. Choose the date from your practice results
Pick the retake window when practice results are consistently passing under test conditions, with a margin. If they are not there a few weeks out, moving the window is usually wiser than spending an attempt.
“Sean and Alex are the best tutors I have ever worked with. Not only did they help me come up with a study method that actually worked for me after multiple failed attempts at Level 1, but they made themselves accessible every day for any questions I had or any life difficulties…”
— Olivia S
8. Plan the rest of your training around the retake
A Level 1 retake often overlaps with the start of clinical work. Agree the timing with your college, protect study time on your schedule, and keep the plan realistic. If you are also taking USMLE Step 1, decide with your advisor whether to sit both or focus on COMLEX first.
Part 2: Failed COMLEX Level 2-CE
9. Compare your score with 400
NBOME lists the Level 2-CE passing score as 400. Your report gives a three-digit standard score, a pass/fail designation and a graphical performance profile (NBOME, scoring and reporting). NBOME converts the number of questions you answer correctly into a model-based standard score, and every scored question counts equally.
A score close to 400 usually means the knowledge is mostly there and consistency or timing needs work. A score far below calls for a broader rebuild across several content areas.
“When I first began preparing for my COMLEX Level 2 retake, I was overwhelmed, defeated, and unsure of how to move forward. After failing my initial attempt with a 361, I knew I needed a different approach.”
— Matthew D.
10. Use the performance profile
The graphical profile shows where you were strongest and weakest. Line it up with your question bank data from the same period. If both point at the same areas, you have found most of the lost points; if they disagree, look harder at timing and how you read the stem.
11. Know the rules for a retake
NBOME allows four scored attempts per level and no more than four attempts at a level within 12 months, counting incomplete or voided attempts. Once you pass, you cannot retake to raise the score (NBOME Bulletin 2026-2027).
If you have failed Level 2-CE twice
Two fails leave two scored attempts at Level 2-CE, and NBOME’s cap of four attempts in 12 months is rarely the limit that matters by then (NBOME Bulletin 2026-2027). Two other limits matter more. Some state licensing boards set their own attempt limits, so check the state where you plan to be licensed; our attempt-limit guide covers how those rules work. And your college may have its own policy on a third attempt, so speak to the dean’s office before you book.
A third attempt needs a different plan, not just a later date. Go back through both score reports and both performance profiles side by side: the areas that were weak twice are the core of the plan, and a score that barely moved between attempts usually points to how you work the questions rather than what you know. Book the date only once timed, full-length practice results have been clearly passing for several weeks.
12. Weight the plan the way the exam is weighted
Level 2-CE puts more weight on patient care than Level 1: NBOME sets osteopathic patient care and procedural skills at a minimum of 30% and osteopathic principles, practice and manipulative treatment at a minimum of 10% (NBOME, Level 2-CE). A retake plan that is all content review misses that shift toward clinical decisions.
13. Build the plan around your rotations
- Light rotations: longer blocks of timed clinical questions and full reviews.
- Heavy rotations: one short block a day so the habit survives long shifts.
- Weekends: targeted review of the weakest areas from your profile.
- Every few weeks: a practice exam under test conditions to check the trend.
14. Practise the full day
Level 2-CE is 320 questions in two four-hour sessions on one day. Stamina is part of the test. Build up to full-length practice so the second session feels as controlled as the first.
For a scored checkpoint, NBOME’s COMSAE Phase 2 form is 160 questions in four hours, set to the same per-question pace as Level 2-CE. Our COMSAE guide explains the forms, and the Level 2-CE format and blueprint page sets out how the exam is built.
15. Think about residency timing
A retake date affects when programs can see a passing result. Talk to your advisor about application deadlines and how a retake fits them, and set the date with both the calendar and your practice data in view. Scores generally arrive within two to six weeks, so build that into the timeline.
16. If you are also taking Step 2 CK
Many DO students sit both. If you failed Level 2-CE and still plan to take Step 2 CK, decide with your advisor which comes first. The content overlaps, but the scales and passing standards differ: 400 on COMLEX, 218 on USMLE. See Level 2-CE vs Step 2 CK.
“Extremely motivating! Sean was extremely motivating and dedicated to me as I prepared for COMLEX 2. He did a fantastic job tailoring his sessions with my schedule and timeline.”
— Hailey, 6 lessons with Sean
Level 1 and Level 2-CE retakes compared
| Level 1 | Level 2-CE | |
|---|---|---|
| Result | Pass/fail | Three-digit score, passes at 400 |
| Report to plan from | Formative Performance Profile | Score plus graphical performance profile |
| Main focus of the retake | Foundational science applied to vignettes; OMM weekly | Clinical decisions and patient care; OMM weekly |
| Usual timing pressure | Start of rotations | Residency applications |
| Attempts | Four scored per level | Four scored per level |
A 10-week retake timeline
| Weeks | Level 1 retake | Level 2-CE retake |
|---|---|---|
| 1 | Read the Formative Performance Profile; baseline practice test | Compare score with 400; baseline practice test |
| 2-4 | Vignette questions daily in the weakest disciplines; OMM weekly | Timed clinical blocks around rotations; OMM weekly |
| 5 | Second practice test; adjust the plan | Second practice test; adjust the plan |
| 6-8 | Mixed timed blocks; build to full-length days | Mixed timed blocks; one full-length day a week |
| 9 | Final practice test; keep or move the date | Final practice test; keep or move the date |
| 10 | Light review, sleep, logistics | Light review, sleep, logistics |
This is our default plan; we stretch it when rotations are heavy and shorten it when the score report shows only a few gaps. NBOME testing windows and score-release times affect the dates, so check them on the NBOME site before you book.
How we help with a COMLEX retake
We tutor COMLEX retakes one-on-one by live video (Zoom or Google Meet) for $349 per 50-minute session, starting from your score report and practice data. See Level 1 tutoring, Level 2-CE tutoring, attempt limits, or book a free intro consult.