COMLEX-USA Level 1: What Osteopathic Students Need to Know

If you are an osteopathic (DO) medical student, COMLEX-USA Level 1 is one of the first major milestones of your training. It is the osteopathic profession's own licensing exam — and while it overlaps heavily with the basic science that USMLE Step 1 tests, it has a distinct emphasis and structure of its own. This guide covers what COMLEX-USA Level 1 is, what it tests, and how to prepare efficiently.

What Is COMLEX-USA?

COMLEX-USA (the Comprehensive Osteopathic Medical Licensing Examination) is administered by the National Board of Osteopathic Medical Examiners (NBOME). It is a three-level national licensing examination that, in the NBOME's words, "assesses osteopathic medical knowledge, knowledge fluency, clinical skills, and other competencies essential for practice as an osteopathic generalist physician."

The three levels are taken progressively through training: Level 1 typically during the second year of medical school, Level 2-CE in the third or fourth year, and Level 3 during residency. Level 1 is the foundational science checkpoint.

What COMLEX-USA Level 1 Tests

The defining feature of Level 1 is that it integrates foundational biomedical sciences with osteopathic principles and practice — it is not simply a basic-science exam with a few osteopathic questions bolted on.

The NBOME structures the exam around competency domains. The largest is the application of osteopathic medical knowledge, which makes up around 60% of the exam, with the majority of that focused on foundational biomedical sciences. But osteopathic principles and practice (OPP/OMM) is a guaranteed and substantial component — a minimum of roughly 12% — alongside smaller domains covering patient care and procedural skills, practice-based learning, communication, professionalism, and systems-based practice.

Content is also organized around clinical presentations spanning the major body systems: wellness, development and reproduction, endocrine, nervous system and mental health, musculoskeletal, genitourinary, gastrointestinal, circulatory and hematologic, respiratory, and integumentary.

The practical takeaway: you need the same foundational science as any medical licensing exam, plus genuine command of osteopathic principles — anatomy, the musculoskeletal system, and osteopathic manipulative treatment are not afterthoughts here.

COMLEX-USA Level 1 Is Pass/Fail

Like USMLE Step 1, COMLEX-USA Level 1 is reported as pass/fail — there is no numeric three-digit score. Candidates who pass receive a Formative Performance Profile that compares their overall performance, and their performance in individual content areas, against other first-time test-takers who passed.

The pass/fail model changes how you should think about preparation. The goal is not to squeeze out a maximal score for residency applications; it is to pass comfortably and, just as importantly, to build the durable knowledge Level 2 and your clinical years will demand. Studying to barely clear the line tends to backfire later.

Because exam structure, scheduling (including a new break structure the NBOME has noted taking effect in 2026), and policies are updated regularly, always confirm the current details on the official NBOME COMLEX-USA Level 1 page.

COMLEX vs. USMLE: Should DO Students Take Both?

Many osteopathic students also sit USMLE Step 1 to broaden their residency options, since some programs are more familiar with USMLE scoring. That is a personal strategic decision based on your specialty goals and the programs you are targeting — and worth discussing with your school's advising office.

The encouraging news for your study plan: the two exams share a large foundational-science core, so most of your preparation counts for both. The main additional work for COMLEX is the osteopathic content — OPP, OMM, and the osteopathic framing of clinical problems — which USMLE does not test.

An Evidence-Based Level 1 Study Plan

However you sequence your exams, the science of how to study is the same, and it is well established.

Make practice questions your engine. Larsen and colleagues (2008), writing specifically about medical education, showed that repeated testing produces better long-term retention than repeated study — particularly when questions require recall and are followed by feedback. Build your prep around doing and reviewing questions, not around passively reading review books.

Space your studying out. Cepeda and colleagues (2006) synthesized hundreds of experiments confirming that distributed practice beats cramming, with the advantage growing the further away the exam. Start early, study a consistent amount most days, and let material cycle back rather than saving everything for a frantic dedicated period.

Do not neglect osteopathic content. Because OPP/OMM is a guaranteed portion of the exam and is not covered by generic USMLE resources, fold it into your spaced practice from the beginning rather than treating it as a last-minute add-on.

Target your weak areas. The Formative Performance Profile exists because knowing your relative weaknesses lets you study more efficiently. Apply the same logic throughout your prep: concentrate your limited time on the content areas where your accuracy is lowest, not the ones you have already mastered.

Prepare for Level 1 Efficiently

CliniQuiz supports curriculum-aware, evidence-based prep — vignette practice questions, flashcards, and an AI tutor that tracks your weak areas so your study time targets exactly what you need, foundational science and osteopathic content alike.

Try a free practice session to see how it fits your schedule, or create your free account and let a tool that knows your weak areas guide your COMLEX preparation.