COMLEX Level 1: Complete Guide (2023)

December 22, 2023
6 min read


Reviewed by:

Jonathan Preminger

Former Admissions Committee Member, Hofstra-Northwell School of Medicine

Reviewed: 10/30/23

Are you an osteopathic medical student with the COMLEX exams in view? If so, read along to learn all you need about the COMLEX Level 1 exam.

Student studying for exam

Getting into med school is a great achievement, but to continue on the path towards becoming an osteopathic physician in the United States, you’ll need to tackle another crucial milestone: the COMLEX exam

Short for Comprehensive Osteopathic Medical Licensing Examination of the United States, the COMLEX-USA is the pinnacle of your DO (Doctor of Osteopathic Medicine) degree journey and licensure process.

Administered by the National Board of Osteopathic Medical Examiners (NBOME), the COMLEX is a nationally standardized exam structured in three levels, each vital for licensure in osteopathic medicine. While conquering the COMLEX may seem daunting, with adequate preparation, success is within reach.

Passing the COMLEX is not only a requirement for obtaining a DO degree from osteopathic medical colleges in the United States but also a critical step towards entering residency or graduate medical education training programs.

If you’ve been apprehensive about the COMLEX, don’t worry; we’ve got you covered! In this comprehensive guide, we’ll break down everything you need to know about the first level of the COMLEX exam.

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What Is on the COMLEX Level 1?

Students who have just completed their second year of osteopathic medical school, or are about to, are eligible to take the first level of the COMLEX exam. Level 1 assesses foundational biomedical sciences and osteopathic principles and practice. 

The COMLEX Level 1 is a computer-based exam that assesses a student's foundational knowledge and understanding of various medical disciplines, including:

  • Anatomy
  • Behavioral health
  • Biochemistry
  • Microbiology
  • Osteopathic principles and practices
  • Pathology
  • Pharmacology
  • Physiology

Generally, COMLEX exams aim to assess your competitiveness level in applications to residency programs

The Level 1 specifically tests students’ knowledge on clinical problem-solving, foundational biomedical sciences and health promotion knowledge. The questions will focus on medical knowledge, patient care, principles and practice, communication skills, professionalism, and ethics. 

Student reading from notebook

How Many Questions Are on COMLEX Level 1?

So, how many questions on the COMLEX Level 1? In total, the exam consists of 352 multiple-choice questions. But don’t worry, you aren’t required to answer these questions all at once! 

The 352 questions are divided into two four-hour test sessions. Some questions have audio and visual components such as symptom images, heart sounds, or other relevant patient presentations. 

The NBOME categorizes COMLEX exams according to dimensions. While one dimension contains competency related questions, the other includes clinical presentations.

Dimension 1: Competency Domains 

The questions in Dimension 1 will test your knowledge of the seven competency domains. Below is a table that lists the seven domains of the competency-related questions, each of which makes up a minimum percentage of the dimension’s questions. 

Competency Domain Percentage (%) of Questions in Division 1
Application of Knowledge for Osteopathic Medical Practice 60
Osteopathic Principles, Practice and Manipulative Treatment 11
Osteopathic Patient Care and Procedural Skills 6
Practice-based Learning and Improvement 5
Professionalism in the Practice of Osteopathic Medicine 3
Interpersonal and Communication Skills in the Practice of Osteopathic Medicine 3
System-based Practice in Osteopathic Medicine 2

Source: NBOME Blueprint 

As listed above, each domain tests your foundational knowledge about professional skills and standards in osteopathic medicine. 

Dimension 2: Clinical Presentations 

While you equip yourself with professional knowledge, you must also know how a patient would present their case. Dimension 2 caters for clinical presentations that represent how a particular patient or community would present for osteopathic medical care. 

Dimension 2 has 10 categories, each with a specific minimum percentage of questions: 

Clinical Presentations Percentage (%) of Questions in Division 2
Musculoskeletal System 13
Community Health and Patient Presentations Related to Wellness 12
Respiratory System 10
Nervous System and Mental Health 10
Gastrointestinal System and Nutritional Health 10
Circulatory and Hematological System 10
Genitourinary/Renal Systems and Breast 5
Human Development Reproduction and Sexuality 5
Integumentary System 5
Endocrine System and Metabolism 5

These are the categories of questions you should expect throughout the eight sections. However, the questions are not lined up according to categories. The lineup is unpredictable, so prepare and practice questions from every category. 

Student working on computer

COMLEX Level 1 Exam Format Breakdown

This section outlines the typical schedule for exam day. The COMLEX-USA Level 1 lasts approximately nine hours. The exam starts with a brief tutorial, explaining to the student how to navigate each question and select the right answer. Then, you go through eight hours of exams with designated breaks in between. 

The eight-hour exam period is divided as such:

Section Questions
1 44 4 hours
2 44
10-minute break
3 44
4 44
40-minute break
5 44 4 hours
6 44
10-minute break
7 44
8 44

From the table above, you will see a considerable spacing between each section and the designated breaks. Not to worry, you will have a timer to manage your time. You can decide how many minutes to spend on each question in a section and ensure you stick to it. 

During the exam, you will have a review page for each section. This page helps you crosscheck the questions completed, questions you've marked for later, and questions without an answer.

After you mark a section complete, you cannot return to change any answers within that section. So, carefully answer as many questions as possible before moving to the next section. The examiners will give a time warning before the end of each section. This warning is a prompt for you to confirm you have answered as many questions as you can. 

Designated Breaks

During your COMLEX exam, you have the luxury of a pooled 60-minute break time. You have a 10-minute break after the first two sections, a 40-minute lunch break after another two sections, and a last 10 minutes after the next two sections. Ensure you take breaks within the allotted period.

Your break time will not be deducted from your total exam time as long as it is within the allotted 60-minute period. While some students try to take the exam at a stretch without taking breaks, we don't advise that. Any unused time will not increase your total exam time. 

Other students take so many breaks that they exceed the allotted time. The excess time will be removed from your total exam time. Candidates with special issues have access to additional breaks.

When to Take the COMLEX Level 1 Exam

You become eligible to register for the first COMLEX exam after your first year in Osteopathic Medical school. You must create a profile with the NBOME. 

Afterward, you can confirm your eligibility for Level 1 COMLEX before proceeding to register. Your College largely determines your exact exam date. Generally, students take the exam between April and June.

Student writing down notes

COMLEX Level 1 Registration

To register for the COMLEX exam, you'll first need to fill out an application. This will include providing personal information, educational background, and payment details. You’ll then need to complete the following steps:

  1. Pay the Exam Fee: Pay the exam fee using a credit card or other accepted payment methods. Make sure to check the current fee schedule on the NBOME website.
  2. Schedule Your Exam: After payment is confirmed, you can schedule your COMLEX exam. The scheduling process will typically involve selecting a test date and location that is convenient for you.
  3. Confirmation: After a successful registration and exam schedule, you'll receive a confirmation email. The email contains important details about your test date, location, and what to bring on exam day. Ensure you keep this day close to heart. You're now set to begin exam preparations. 

It's important to note that available dates and seats are limited, so it’s best to plan and complete these steps well in advance of your desired exam date.

Tips to Prepare for the COMLEX Level 1

Preparing for the Level 1 exam is a crucial step for medical students pursuing a career in osteopathic medicine. Here are some effective study strategies, valuable tips, and techniques to help you prepare thoroughly and confidently for the first level of COMLEX. 

Set a Goal

Before registering for your COMLEX exams, it's crucial to set a clear target score. Having a specific goal in mind can help you stay focused and motivated throughout your preparation. 

Consider displaying your target score prominently, perhaps on your wall, and sharing it with trusted friends who can provide support and encouragement as you work towards your goal.

Also, remember to aim high. Challenge yourself to prepare rigorously and strive for excellence. Scores exceeding 600 reflect exceptional performance, and it's entirely possible to aim for such high achievement. 

Create a Study Schedule

Now that you have set an exam date, you must manage your time effectively. To start, it’s essential to create a well-structured study schedule that covers all topics on the exam. Be sure to identify your weak areas and allocate more study time to those specific subjects. 

Next, consider the dimensions of questions and their expected percentages (you can use a percentage calculator for this). Prioritize your study schedule accordingly, dedicating appropriate time to categories like the Integumentary system, which may have a lower chance of appearing on the exam.

By adhering to a disciplined study schedule, you can avoid the pitfalls of last-minute cramming due to anxiety. Attempting to absorb all the material in a rush the day before your COMLEX exam can be detrimental. 

Instead, start studying early, as early as your first year in college if possible, to ensure a comprehensive understanding of the content. This approach will not only reduce stress but also increase your chances of success on the exam.

Learn the Exam Format

Learning the exam format is an essential preliminary step in preparing for the COMLEX. It involves gaining a comprehensive understanding of the structure, question types, time constraints, and overall expectations of the examination.

Familiarizing yourself with the format allows you to strategize your study approach effectively, allocate time efficiently during the test, and build confidence in tackling various question categories. 

Accessing resources like the WelCOM and COMSAE self-assessments, provided by the the NBOME, can be invaluable in comprehending the exam format and enhancing overall readiness for this critical assessment.

two male students studying together

Practice Multiple Times

To master the COMLEX exam, it's crucial to engage in repetitive practice. Seek and utilize resources that suit your studying style best. For those who benefit from one-on-one guidance, consider seeking private COMLEX tutoring. Reputable tutors and organizations are available to provide valuable assistance in your preparation journey.

If you lean towards comprehensive study guides and enjoy delving into a broad range of materials, make them a part of your study routine. On the other hand, if you find value in working through past questions, do so diligently. 

However, it's advisable to diversify your approach by exploring multiple study methods to ensure a well-rounded preparation for the exam.

Looking for a place to start? Give our free COMLEX Level 1 Practice Questions Quiz a try!

Create Time for Rest

In the midst of your intensive study sessions, it's essential to maintain both your mental and physical well-being. Some students become so engrossed in their studies that they experience heightened anxiety leading up to the exam, while others may even encounter mental blocks during the test itself.

These experiences can significantly impact your test scores, regardless of how well-prepared you may be. It's crucial to open up and talk about any concerns or anxieties with friends, family members, or a counselor who can provide valuable support and guidance.

Taking breaks and engaging in activities you enjoy can also help alleviate stress and maintain a healthy balance. Remember that your study approach may differ from that of your friends, and that's perfectly okay. Choose study methods that work best for you and adapt them to your unique learning style. 

Lastly, consider seeking advice from seniors who have successfully navigated the COMLEX exams. Their insights and experiences can provide valuable guidance as you prepare for this important milestone.

Plan Ahead

Plan your exam day from the biggest to the most mundane thing. You can keep a list to help you with planning. For instance, pick your dress beforehand. Ensure you know your exam center before the day of the exam. Also, get all the documents you need ready and complete.

You will spend roughly nine hours, so you will need energy to keep up. Ensure you prepare food, fruits, or snacks during your lunch break. Then, pack them in your bags to avoid missing out on anything.

Do not forget these items for the D-day:

  • Current government ID with your picture and signature. 
  • Medical face mask
  • Ear plugs: Your testing center may provide a noise-canceling headphone
  • Food, water, and medication: Note that you cannot take these items into the testing room; you will have a storage locker for these items

You want to get familiar with your test center, so arrive at least 30 minutes ahead. Take that time to get to know the examination room, rooms for designated breaks, and the restroom. Take the next few minutes to stay calm and ready to begin.

FAQs: COMLEX Level 1

To address any concerns you may still have, here are our answers to frequently asked questions about the COMLEX exam. 

1. What Is the COMLEX Level 1?

The COMLEX Level 1 is a standardized medical licensing exam for osteopathic medical students in the United States. It assesses foundational knowledge in various medical subjects and is typically taken after the second year of medical school. Passing it is essential for progressing in medical education and becoming a licensed osteopathic physician.

2. What Is a Good COMLEX Level 1 Score?

Typically, a score above the national average (around 520) is considered good, with 600+ being outstanding, while the passing score is 400. A good Level 1 score depends on your goals and desired residency program competitiveness. 

3. What Percentage of People Pass the COMLEX Level 1?

The pass rate for the first level of the COMLEX exam can fluctuate, but historically, it has been around 90% or higher.

4. How Do I Find a COMLEX Testing Center Near Me?

To find a testing center near you, visit the NBOME website, search for the test center locator tool, and enter your location. You can use the generated list of COMLEX testing centers to find one that’s most convenient for you.

5. Is COMLEX Easier Than USMLE?

COMLEX and USMLE are distinct licensing exams for physicians, and opinions on their difficulty levels vary. Some individuals perceive COMLEX as more challenging, while others find USMLE to be tougher. One common reason for considering COMLEX harder is its higher number of questions compared to USMLE.

6. How Many Times Can You Take COMLEX Level 1?

If you fail an attempt, you can typically take the exam up to four times within 12 months. There are specific eligibility and waiting period requirements between attempts. Do well to check with NBOME over time.

Final Thoughts

Many students say that COMLEX Level 1 is quite challenging. After reading this guide, we're certain that your fears have been dispelled, at least a bit. If not, review this guide, taking note of the dimensions, exam format, and preparation tips. 

Finally, the first level of COMLEX is one in a series of exams. See it as the first preparation for several licensing exams to come. Practice towards scoring as highly as possible, and give your best. Once you can successfully scale through Level 1, all other exams before residency will get easier.

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