Clinical Decision-Making (CDM) cases have been a core component of the COMLEX-USA Level 3 exam since 2018. These cases are designed to evaluate how well you apply clinical knowledge in real-world patient management scenarios which is an essential skill for osteopathic physicians preparing to practice independently.
CDM cases emphasize clinical judgment rather than memorization. They assess your ability to gather relevant patient information, interpret findings, and determine appropriate next steps in care. This focus is especially important on Level 3, which serves as the final pathway to licensure for osteopathic physicians practicing in an unsupervised setting as outlined in the NBOME’s overview of CDM cases for COMLEX Level 3.
What Skills do CDM Cases Assess?
CDM cases are built to evaluate clinical judgment at key decision points in patient care. You’ll be asked to demonstrate your ability to:
- Gather and prioritize relevant clinical data
- Interpret findings to develop a working diagnosis
- Select appropriate management, treatment, and follow-up steps
This structure mirrors how physicians make decisions in real clinical, settings, reinforcing applied knowledge over recall.
How CDM Cases Are Structured on COMLEX-USA Level 3
On the current COMLEX Level 3 exam, CDM cases are presented across two dedicated sections, with 13 cases per section, for a total of 26 cases.
Each case is based on a clinical scenario and typically includes multiple related questions. These questions may appear in either a short-answer format or an extended multiple-choice format, where more than one response may be appropriate.
Navigating CDM Cases on Exam Day
Comlex CDM cases follow a sequential format. As you progress through a case, you must submit your responses before moving forward, and previously submitted answers cannot be changed. This design reflects real-world clinical practice, where each decision influences subsequent care.
Unlike traditional multiple-choice sections, CDM cases cannot be marked for later review. This makes it especially important to read carefully, commit to each decision, and manage your time thoughtfully.
Preparing for CDM Cases With COMQUEST
To support Level 3 preparation, COMQUEST includes physician-authored CDM cases as part of its COMLEX Level 3 subscription, allowing students to practice both traditional questions and CDM-style scenarios within a single study resource.
Each CDM case includes detailed explanations that reinforce clinical reasoning, highlight effective decision-making strategies, and help clarify why certain choices are preferred over others.
Final Tips for CDM Success
Starting early and practicing consistently with both question formats can help build confidence and familiarity ahead of exam day. Regular exposure to CDM-style cases allows you to refine your approach to complex patient scenarios and strengthen the skills Level 3 is designed to assess.
Continue checking back for additional guidance and strategies to help you navigate CDM cases and other important Level 3 topics throughout residency.