The authors present data on examination format and examinee demographics, performance, and survey results for the Comprehensive Osteopathic Medical Licensing Examination-USA Level 2-Performance Evaluation (COMLEX-USA Level 2-PE) from the first five testing cycles (2004-2005 to 2008-2009). First-time examinees in the 2004-2005 testing cycle had a pass rate of 96.1%, compared with a pass rate of 94.7% for first-time examinees in the 2008-2009 testing cycle. Pass rates were fairly consistent across all testing cycles. Based on postexamination survey results from all testing cycles, the majority of examinees reported that the cases in COMLEX-USA Level 2-PE represented appropriate challenges for fourth-year osteopathic medical students. The majority of examinees also reported that comprehensive standardized patient-based examinations and exercises were administered through their colleges of osteopathic medicine. In addition, survey results indicated overall satisfaction among examinees with the administration of COMLEX-USA Level 2-PE.