COMLEX Level 1

It is the first examination in the COMLEX-USA series. NBOME states that passing Level 1 indicates you have demonstrated competence in the foundational biomedical sciences and osteopathic principles and related physician competency domains required to enter supervised patient care settings and to continue lifelong learning.

It is aimed at osteopathic medical students who have completed the foundational biomedical science portion of the curriculum. Eligibility rules, timing relative to your college's promotion requirements, and scheduling are governed by NBOME's Bulletin of Information and your COM, so confirm before booking.

Level 1 reports a pass or fail rather than a numeric score. You also receive a Formative Performance Profile that compares both your total examination performance and your performance in individual content areas to other first-time test-takers who passed the examination, which is useful for spotting weak domains.

Usually within two to six weeks from the end date of a COMLEX-USA testing window for Level 1, you receive an email indicating that your score is available. Plan post-exam deadlines conservatively, because release follows the window end date rather than your individual test day.

In Dimension 1, application of knowledge for osteopathic medical practice is listed at a minimum of 60%, well above osteopathic principles, practice and manipulative treatment at 12% and osteopathic patient care at 6%. In Dimension 2, the musculoskeletal system is highest at 13%, followed by community health and wellness at 12%.

Start with the Blueprint so your plan maps to the published domains and clinical presentations rather than rumor. Then build basic-science blocks that feed clinical reasoning, and protect regular time for osteopathic principles and manipulative treatment, which is easy to defer and is a distinct, separately weighted domain.

The Level 1 page does not publish the item count or duration. NBOME announced that 2026 and 2027 enhancements include changes in the number of items for Level 1 and Level 2-CE, but the page does not state the revised count. Check the Bulletin of Information and Test Specifications.

Yes. A new break structure for COMLEX-USA Level 1 and Level 2-CE has been released for those testing after May 7, 2026, providing more flexibility for test takers. Anyone scheduling around that date should read the current Bulletin of Information rather than relying on older test-day routines.

The Level 1 page does not publish a retake policy or attempt limits, so any number you have heard is unverified. Consult the Bulletin of Information and your college of osteopathic medicine, which may impose its own remediation and waiting-period requirements before you can sit again.

Two stand out: treating Level 1 as pure basic-science recall when NBOME describes it as integrated with clinical problem-solving, and skipping osteopathic principles and manipulative treatment because it feels less examinable. A third is ignoring the Formative Performance Profile's content-area breakdown when preparing for a subsequent attempt.