There are two separate national board examination pathways to obtain state licensure as a physician in the U.S. Osteopathic medical students take the COMLEX, and allopathic medical students take the USMLE. Although these examinations are similar in timing and structure, the osteopathic COMLEX examination is unique in testing osteopathic philosophy, evaluation and treatment.

Des Moines University doctor of osteopathic medicine students must pass COMLEX Part 1 at the end of the second year of osteopathic medical school in order to begin the third year clinical rotations. The pass rate for DMU students taking Part 1 of COMLEX for the first time in June of 2008 was 96%; the national average was 90%.

COMLEX Part 2 is taken by all COM students during their fourth year and is divided into the COMLEX CE (cognitive exam) and COMLEX PE (performance exam). Osteopathic medicine students must complete and pass both components of COMLEX Part 2 prior to graduation from Des Moines University. The pass rate for DMU students taking Part 2 of COMLEX for the first time in October of 2007 was 96%; the national average was 92%.

COMLEX Part 3 is taken during the first year of post-graduate or residency training.

Some osteopathic medicine students choose to take the USMLE examination, however it is not required by DMU or necessary to obtain a license to practice osteopathic medicine in the U.S.