The Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) is a three-part examination used for licensing osteopathic physicians. The relationship between performance on this examination and prior student academic performance has been unclear. This study explores the relationship between COMLEX-USA level 2 scores and student academic performance at Oklahoma State University College of Osteopathic Medicine (OSU-COM). All first-time examination candidates from OSU-COM had a formal, weeklong board review in March 2000, and all passed the examination. Predictions about COMLEX-USA scores generated by the academic dean's office at OSU-COM underestimated student examination performance; results suggest a significant correlation between level 2 performance with (1) level 1 performance (.751); (2) grade point average (GPA) in basic science (.659); (3) total GPA (.672); and (4) Medical College Admission Test (MCAT) scores (.406). The correlation of level 2 scores to clinical GPA (.269) was lower but still significant. Results of this study suggest that performance on COMLEX-USA level 2 is strongly correlated with prior student academic performance in this population.