Let’s debunk three persistent myths.
Myth 1: "Form 108 is harder than the real COMLEX." Reality: No. The difficulty is identical. However, you have less adrenaline and less pressure during a COMSAE, so it feels harder. The real COMLEX is harder because of the length, not the question complexity.
Myth 2: "If you fail 108, you will fail Level 1." Reality: False. Many successful DOs failed their first COMSAE. It is a diagnostic tool. It tells you what to study, not that you are hopeless.
Myth 3: "Form 108 has repeats from older forms." Reality: The NBOME actively rewrites questions. Do not try to find "brain dumps" or "recalls." This is a violation of the NBOME honor code and can get you dismissed from medical school permanently. Trust your knowledge, not cheating.
If you are a student at a College of Osteopathic Medicine (COM), you have likely heard the whispered warnings and anxious chatter in group chats: “Have you taken Form 108 yet?” or “How predictive is COMSAE 108, really?”
As the landscape of osteopathic board preparation shifts, COMSAE Form 108 has emerged as one of the most talked-about, feared, and relied-upon assessments in the lead-up to the COMLEX-USA Level 1. Released by the NBOME (National Board of Osteopathic Medical Examiners) as part of their Phase 2 overhaul, Form 108 is not just another practice test—it is often considered the gold standard for predicting your real COMLEX score.
In this long-form guide, we will dissect everything you need to know about COMSAE Form 108: what it tests, how it compares to other forms (106, 107, 109, 110), its predictive value, common pitfalls, and a strategic study plan to conquer it.
Q: Is COMSAE 108 harder than COMLEX? A: Subjectively, yes. Many students find it harder because it has no experimental questions. Objectively, the topics are identical.
Q: Can I take COMSAE 108 at home? A: Depends on your school. Some allow remote proctoring; others require in-person.
Q: How many times can I take COMSAE 108? A: Once. NBOME does not allow retakes of the same form. If you need another assessment, buy Form 109.
Q: Do schools see my COMSAE 108 score? A: Yes. If your school paid for it, they receive the score report automatically. If you bought it independently, you can choose to share it.
Q: What is the passing score for COMSAE 108? A: There is no official "pass" for a practice exam, but most COMLEX-gated schools require >450 to sit for Level 1.
The COMSAE Form 108 is a critical self-assessment tool used by osteopathic medical students to gauge their readiness for the COMLEX-USA examinations. Specifically, Form 108 (often noted as 108b) is frequently utilized as a Phase 2 practice exam for the COMLEX Level 2-CE, though it has historically been used in Phase 1 as well. Purpose and Structure
The primary goal of COMSAE Form 108 is to help candidates understand their level of knowledge in fundamental clinical sciences and osteopathic principles.
Format: The exam consists of 176 single-best-answer multiple-choice questions.
Sections: It is typically divided into four sections of 44 questions each.
Content Alignment: The form aligns with the NBOME's COMLEX-USA blueprint, covering seven competency domains and ten clinical presentation categories. Key Topics Covered in Form 108
Student reports and study guides like those on Docsity highlight several high-yield areas tested in Form 108:
Clinical Skills & Diagnostics: Apgar scale, management of GERD with progressive dysphagia (endoscopic biopsy), and diagnosing pulmonary embolism via CT. comsae form 108
Osteopathic Principles (OPP): Still technique positioning (position of ease), Chapman points of the chest, and musculoskeletal physical exam findings like supraspinatus tears (Drop Arm test).
Pharmacology & Infectious Disease: Kawasaki criteria, management of MRSA with vancomycin allergies, and tick-borne illnesses requiring doxycycline.
Internal Medicine & Ethics: Solitary pulmonary nodules, screening guidelines based on age, and legal/ethics topics. Scoring and Interpretation
COMSAE scores are reported as a standard score, which students use to estimate their potential performance on the real exam.
COMSAE Form 108 is a Comprehensive Osteopathic Medical Self-Assessment Examination (COMSAE) primarily used by students preparing for the COMLEX-USA Level 2-CE (Phase 2) [1, 5, 20]. It is designed by the NBOME to gauge a candidate's readiness and knowledge base before the official licensure exam [6, 17]. Core Content Areas
Form 108 follows the standard Phase 2 blueprint, which focuses on clinical presentations and competency domains [3, 9]. Key topic distributions typically include:
Musculoskeletal System (13%): High emphasis on OMM and orthopedic injuries [3, 14].
Community Health & Wellness (12%): Ethics, health promotion, and patient safety [3]. Major Systems (10% each):
Gastrointestinal System (e.g., chronic GERD, dysphagia) [2, 3].
Respiratory System (e.g., NRDS diagnosis, pulmonary embolism findings) [3, 8]. Circulatory and Hematologic Systems [3].
Nervous System and Mental Health (e.g., antipsychotic medications, delirium) [3, 8].
Specialty Areas (5% each): Endocrine, Genitourinary/Renal, and Human Development/Sexuality [3]. Exam Style & Characteristics
Students often compare Form 108 to other assessment tools like COMSAE Form 111 or TrueLearn [13, 21]. Notable characteristics include:
Question Format: Features short, "one-liner" or few-sentence stems, which can be significantly shorter than actual COMLEX Level 2 stems [20, 22].
Difficulty: Often described by students on Reddit r/comlex as having high repetition of Osteopathic Principles and Practice (OPP) questions [13, 20].
Answer Keys: Unlike older forms, the NBOME now launches answer keys for student-purchased COMSAE forms to aid in self-review [12]. Scoring Interpretation
The NBOME grading scale for COMSAE results is categorized as follows [18]: High Performance: Scores higher than 649. Average Performance: Scores between 400 and 649. Low Performance: Scores lower than 400.
The fluorescent lights of the library hummed with a frequency that seemed to vibrate directly against Dr. Evans' skull. It was 2:00 AM. The air smelled of stale coffee and desperation. Let’s debunk three persistent myths
Evans stared at the screen. The text at the top read: COMSAE Form 108.
Legend among the medical students held that Form 108 was not merely a practice exam. It was a rite of passage, a psychological gauntlet designed by the NBOME not to test knowledge, but to test the limits of the human spirit. It was the "Ghost in the Machine," the form that seemed to know exactly which obscure metabolic disorder you had skipped, or which renal physiology concept you had only half-understood.
Evans clicked "Begin."
Question 1: A 34-year-old male presents with a feeling of impending doom...
"Classic," Evans muttered, rubbing his eyes. "Start with the panic attack, then hit me with the pheochromocytoma."
But the question didn't ask for the diagnosis. It asked for the specific enzymatic defect associated with a genetic precursor to the condition, located on a chromosome number that Evans was suddenly unsure existed.
He marked it and moved on.
Question 47: The room seemed to get colder. Evans was deep in the "Zone of 108." This was the section where the vignettes stopped making sense. A patient had a rash, but also a heart murmur, and had recently returned from a trip to a specific river in Egypt. The answer choices weren't bacteria or viruses; they were vectors. Snail? Mosquito? Sandfly? Tse-tse fly?
Evans knew the answer was Schistosomiasis. He knew it was the snail. But Form 108 was tricky. It offered Biomphalaria or Oncomelania. Did it matter? In Form 108, everything mattered.
He selected Biomphalaria and immediately felt a phantom sensation of a wrong answer, a ghostly tug of regret.
Time Remaining: 1:45:00
He was falling behind. The clock was the true antagonist of the story. He sped through a block of musculoskeletal questions, his brain auto-piloting through rotator cuff muscles and ankle ligaments. Then, he hit the wall.
Question 84: A graphic of a complex cardiac cycle is shown. Point Y indicates...
The graph looked like a seismograph reading of an earthquake. It wasn't a standard Wiggers diagram. The lines were jagged, distorted. Evans stared at it. The silence of the library pressed in on him. He looked at the options: A) Mitral valve opening B) Aortic valve closure C) Rapid ventricular filling D) The exact moment the patient realized they forgot to pay their taxes
"Option D looks tempting," Evans whispered to the empty room.
He was hallucinating. That was the effect of Form 108. It stripped away your confidence until you were a raw nerve, guessing between 'C' and 'D' not because you knew the answer, but because 'C' looked friendlier.
Time Remaining: 0:15:00
The final block. Evans was sweating. His heart rate mimicked the tachycardia of the patient in Question 112. He had five questions left. He was clicking blind, trusting his "gut"—a gut that had been wrong about so many practice questions before. If you are a student at a College
Question 148: A mother brings in her child...
He didn't even read the stem. He saw the buzzwords. "Blue sclera." "Multiple fractures." He clicked Osteogenesis Imperfecta. He didn't check the type. He didn't check if it was Type I or Type II. He just wanted to finish.
End of Exam.
The screen faded to black for a moment. Evans sat back, the adrenaline crash hitting him hard. The screen flickered back to life.
REPORT.
The loading bar was agonizingly slow. When the numbers finally appeared, Evans didn't scream. He didn't cry. He just stared.
Predicted Score: 475.
It was the threshold. The bare minimum. The 'P' in a world of 'F's.
He had survived Form 108. He had entered the valley of shadow and doubt and emerged, barely, on the other side. He closed his laptop. The sun was beginning to peek through the library blinds. He stood up, knees cracking, and walked out into the morning light, a survivor of the ghost story that haunts every medical student's dreams.
If you are a second-year osteopathic medical student (OMS-II), the acronym "COMSAE" likely carries a heavy weight of anxiety. Among the battery of practice exams administered by the NBOME (National Board of Osteopathic Medical Examiners), COMSAE Form 108 has become a hot topic in student forums, study groups, and academic coaching sessions.
But what exactly is Form 108? How does it compare to Forms 107, 109, and 110? And most importantly, if you have this form coming up, how should you prepare?
In this comprehensive guide, we will break down the anatomy of COMSAE Form 108, analyze its difficulty, discuss its predictive value for Level 1, and provide a strategic roadmap to conquer it.
Unlike the real COMLEX, COMSAE 108 does not have experimental questions removed from the scoring. That means it may feel harder than the real exam because every question counts. Many students report scoring 20-30 points higher on the actual COMLEX than on Form 108.
Case Study: Student A scored 465 on COMSAE 108 (failing threshold at her school). She delayed COMLEX by 3 weeks, hammered OMM and biostats, and scored 510 on the real exam.
To succeed on Form 108, you cannot rely on brute memorization of First Aid. The NBOME has specifically designed this form to test clinical reasoning and osteopathic principles in tandem.
COMSAE 108 is scaled similarly to the real COMLEX:
Critical Warning: Many schools require a 450 to pass. If you score below 450 on Form 108, you may face academic remediation or a delay in your board eligibility.
When to take it: Ideally 3–4 weeks before your COMLEX Level 1 date, after completing one pass of a Q-bank (e.g., TrueLearn, Combank) and reviewing OMT.
Score interpretation:
Post-exam review: NBOME provides a breakdown by system and competency. Do not just look at the score—analyze every OMM question you missed. Students often lose points on simple viscerosomatic reflex tables.