Don’t let the COMSAE frustrate you. It’s meant to help!
According to the NBOME, the COMSAE is not meant to be used to predict your COMLEX score but most osteopathic medical students use it for just that. It really depends on how far apart you take the COMSAE from the COMLEX. If you score average on the COMSAE Phase 1 in January and your COMLEX Level 1 date is in July, you can be fairly confident that you’ll score well above average if you plan to study for the next six months. Scoring average on the COMSAE a couple of weeks before your COMLEX is scheduled is considered high-risk. In summary, it’s a good way to gauge your base of knowledge – but not so much to predict your actual score.
How is it structured?
COMSAE Phase 1
Currently, the COMSAE Phase 1 consists of 176 questions which are divided into four sections of 44 questions each. Each question follows a single-best-answer, multiple-choice format with some items including images or visual exhibits.
COMSAE Phase 2
Starting in February 2026, the COMSAE Phase 2 will consist of 160 questions (changed from the previous 176 question amount). Like Phase 1, all COMSAE Phase 2 questions follow a single-best-answer, multiple-choice format with select items supported by images or visual exhibits.
COMSAE Phase 3
COMSAE Phase 3 inludes 200 questions, organized into four testing blocks. Questions are primarily single-best-answer and may be supported by multimedia elements such as images, video clips, or audio to reflect real clinical scenarios.
While the exam is designed to approximate the structure of COMLEX-USA Level 3, Phase 3 focuses solely on traditional question-based assessment and does not include interactive case simulations or avatar-based decision-making.
When purchased directly through the NBOME, COMSAEs cost $60 and can be taken in either timed or untimed mode. If your medical school administers the exam, it is typically delivered in timed mode, with total testing time aligned to the current exam format.
How do I study for the COMSAE?
The COMSAE is meant to replicate the COMLEX in terms of structure and presentation. Therefore, the best way to prepare for it is using COMLEX resources. This includes COMLEX question banks, study books, and taking practice COMSAEs. If you’re using a question bank, make sure to take practice tests that consist of all Dimension I and Dimension II categories rather than focused tests. This is so that the practice test most accurately represents the COMSAE.
Online resources
COMQUEST offers a practice COMSAE for Level 1 and Level 2-CE that align with the structure and rigor of the COMLEX. Results include percentile performance and score guidance informed by aggregated COMQUEST user data.
These practice assessments are available to students with an active subscription to the corresponding COMLEX question bank and are offered for a nominal additional fee.
If you have any questions, let us know. We’re around 7 days a week to answer your questions.