COMLEX-USA Level 1 Osteopathic Medical Licensing Practice Test

While both exams cover similar foundational biomedical sciences, COMLEX-USA Level 1 is distinct in its significant integration of Osteopathic Principles and Practice (OPP). This includes specific questions on osteopathic manipulative treatment (OMT), somatic dysfunction, and a patient-centered, holistic approach to diagnosis and management. The question style and emphasis on clinical application within an osteopathic framework also differ. Many DO students take both exams, but COMLEX-USA is the primary licensing requirement for osteopathic physicians.

COMLEX-USA Level 1 uses a three-digit standard score, with a current passing score set by the NBOME (typically around 400-410, but confirm the exact figure on the NBOME website as it can be adjusted). The score is based on a statistical equating process, not a simple percentage of correct answers. You will receive a pass/fail result and your numerical score, which is reported to residency programs.

The standard timeline is after completing your second year of osteopathic medical school, before beginning core clinical rotations. Your specific test date should be determined in consultation with your academic advisors, allowing for a dedicated period of focused study (typically 6-8 weeks) following the completion of your preclinical coursework.

Effective preparation involves integrating OPP throughout your study, not treating it as a separate subject. Focus on understanding the principles of somatic dysfunction (TART), indications/contraindications for OMT, and how OMT integrates into treatment plans for common conditions. Use OPP-specific question banks and review texts, and consistently apply osteopathic concepts when reviewing system-based pathology and clinical presentations.

The exam is administered in two 3-hour and 20-minute sessions over one day, for a total testing time of 6 hours and 40 minutes. It consists of 352 multiple-choice questions, primarily presented as clinical case vignettes. The format includes single-best-answer items, two-step sequential questions, and items associated with multimedia (e.g., images, audio).