Preparing for the COMLEX Level 1 is one of the biggest milestones in the journey of becoming a physician of osteopathic medicine. For many students, this exam represents the culmination of two years of intensive didactic medical school coursework, and it serves as the foundation for residency applications and future board exams. Often, physicians refer to COMLEX Level 1 as the hardest examination they take throughout their entire medical career given the intense focus on basic science. Because of the high stakes, it is easy to feel overwhelmed by the sheer amount of material, the need to balance clinical context with foundational science, and the pressure to perform at their best.

While some students succeed with studying independently, others find that a structured and personalized tutoring approach provides the clarity, accountability, and strategy needed to maximize performance.

This article will explore the details of COMLEX Level 1—its structure, costs, and scoring—as well as study timelines, resources, predictors of success, and ultimately, how tutoring can significantly enhance preparation and outcomes.

For students interested in professional guidance, we at EliteMedicalPrep offer personalized COMLEX tutoring designed to maximize your efficiency, knowledge retention, and confidence.

Background of the COMLEX Level 1

Before we talk about strategies and tutoring, it’s important to understand the exam itself.

What is the COMLEX Level 1?

The Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) Level 1 is a test administered by the National Board of Osteopathic Medical Examiners (NBOME). It is designed to assess whether a student has the foundational biomedical knowledge and osteopathic skills necessary to practice medicine safely and effectively. Passing this exam is required for progression to clinical clerkships in many DO schools and, most importantly, is necessary for medical licensure in the United States.

Exam Format

• Length: One-day computer-based exam
• Questions: Approximately 352 test items
• Structure: 8 blocks of 44 questions each
• Time: Each block allows 60 minutes, with a total testing time of around 8 hours plus time for breaks

The questions are multiple-choice, often structured as clinical vignettes that test not only factual recall but also critical reasoning, application of knowledge, and integration of osteopathic principles and practices (OPP).

Exam Content

COMLEX Level 1 covers:

• Basic Medical Sciences: Anatomy, physiology, biochemistry, microbiology, pathology, pharmacology
• Clinical Sciences: Patient presentations, diagnosis, and management in a pre-clinical context
• Osteopathic Principles: OMM/OMT knowledge, osteopathic philosophy, somatic dysfunction

More specifically, there are two major dimensions:

• Competency Domains – This dimension assesses seven core competency areas, each representing foundational abilities required for osteopathic medical practice:

• Osteopathic Principles, Practice, and Manipulative Treatment – 12%

• Osteopathic Patient Care and Procedural Skills – 6%

• Application of Knowledge for Osteopathic Medical Practice – 60%

• Practice-Based Learning and Improvement in Osteopathic Medical Practice – 4%

• Interpersonal and Communication Skills in the Practice of Osteopathic Medicine – 3%

• Professionalism in the Practice of Osteopathic Medicine – 3%

• Systems-Based Practice in Osteopathic Medicine – 2%

• Clinical Presentations – This dimension focuses on ten clinical presentations, representing common patient scenarios encountered in osteopathic medical practice:

• Community Health and Patient Presentations Related to Wellness – 12%

• Human Development, Reproduction, and Sexuality – 5%

• Endocrine System and Metabolism – 5%

• Nervous System and Mental Health – 10%

• Musculoskeletal System – 13%

• Genitourinary/Renal System and Breasts – 5%

• Gastrointestinal System and Nutritional Health – 10%

• Circulatory and Hematologic Systems – 10%

• Respiratory System – 10%

• Integumentary System – 5%

The exam is designed to ensure that DO students have a comparable foundation to MD students taking the USMLE Step 1, while also incorporating osteopathic-specific content.

Cost

As of 2025, the fee to register for COMLEX Level 1 is $715. Additional fees apply for rescheduling, cancellations, or late registration. While this is a significant expense, the true “cost” of the exam lies in the time, effort, and emotional investment required to prepare effectively.

Scoring

COMLEX Level 1 transitioned to a Pass/Fail scoring system in May 2022. This change was designed to reduce stress and shift the focus from numerical performance to overall competency – this is in line with the changes to make STEP 1 pass fail. However, despite the pass/fail nature, residency program directors still place emphasis on whether a student passed on the first attempt – often, a failure on the first attempt can limit residency opportunities. Additionally, strong performance on Level 1 often predicts future success on Level 2 CE and in residency training.

How Long Should You Study for COMLEX Level 1?

The ideal study timeline varies depending on your baseline knowledge, study habits, and the resources available.

• Traditional Dedicated Period: Most students study for 6–8 weeks in a dedicated fashion after completing second-year coursework.
• Longitudinal Approach: Many programs integrate board prep into the curriculum, allowing students to begin reviewing 6–12 months in advance, gradually increasing intensity.
• Daily Hours: During the dedicated study period, students typically study 8–12 hours per day, balancing question banks, review resources, and practice exams – this is like a full-time job!

Factors to Consider

1. Academic Standing: Students with strong pre-clinical performance may need less time, while those who struggled in coursework may need more.
2. Test-Taking Skills: Familiarity with standardized test-taking strategies can shorten prep time.
3. Personal Circumstances: Work, family, or health issues may extend the timeline – do not neglect personal events and commitments.

The key is consistency. Spreading study out over time (rather than cramming) helps with retention and reduces burnout.

Best Resources for COMLEX Level 1

With so many resources available, choosing the right ones can feel overwhelming. Here are the most widely recommended options:

1. COMBANK (TrueLearn)

Specifically designed for COMLEX, this question bank mirrors the style and content of the exam, including OMM questions. It provides detailed answer explanations and analytics to track progress. This is a fundamental resource that every DO student should have.

2. UWorld

Originally geared towards the USMLE exainations, UWorld remains the gold standard for test-style questions in basic sciences and clinical reasoning. While it does not have the depth and bready of osteopathic-specific content, it’s an invaluable resource that has been around for many years. Some students will get both COMBANK and UWorld, while other will simply use one or the other.

3. First Aid for the USMLE Step 1

Though not COMLEX-specific, First Aid is a staple for consolidating basic science knowledge in high-yield topics. Many DO students pair it with OMM-specific supplements. This is, undoubtedly, the best review textbook for both COMLEX Level 1 and USMLE Step 1.

4. Anki Decks

Popular spaced-repetition flashcards (like AnKing) help reinforce memory, particularly for pharmacology and microbiology.

5. NBOME Practice Exams (COMSAEs)

These practice exams mimic COMLEX content and provide performance feedback. They can be anxiety-inducing, but they are one of the best predictors of readiness. Students should aim to complete as many of these (if not all of them) as possible.

6. Sketchy / Pathoma

Excellent for conceptual learning and visual memory reinforcement, particularly early in the study process. These two resources are bedrocks for pathology, microbiology, and pharmacology.

7. Tutoring

A tutor can provide highly individualized teaching and structure to your dedicated study period. For guidance on integrating these resources effectively, EliteMedicalPrep provides expert COMLEX tutoring that ensures your study plan is focused, comprehensive, and tailored to your needs.

How to Do Well on COMLEX Level 1

Develop a Study Schedule

• Plan daily blocks of Qbank practice, review, and intermittent OMM focus. Your question bank will be where you spend the majority of your time (in addition to content review)
• Balance weaker areas with reinforcement of strong topics.
• Build in breaks and exercise to avoid burnout – make sure to get outside!

Active Learning > Passive Learning

• Do questions daily—do not just read notes.
• Use spaced repetition for long-term retention – for high yield topics, it is NOT enough to just look at them once and assume you full understand the topic.
• Teach concepts to peers or tutors to reinforce mastery.

Practice Exams

• Take at least 2–3 COMSAEs during preparation, but again, if you can take all of them – that is the best!
• Simulate testing conditions to build stamina.
• Review incorrect answers thoroughly.

Test-Taking Strategies

• Manage time: Do not get bogged down on one question, this will make it harder for you to get subsequent questions correct
• Use elimination: Narrow choices before guessing, rule in/out to the best of your ability
• Recognize COMLEX quirks: Vignettes often highlight OMM relevance or osteopathic philosophy.

Best Predictor of Success for Level 1

The best predictors of success include:

1. Performance in Pre-Clinical Courses: Students with strong grades tend to do well – this is not too surprising. However, if you did poorly in your pre-clinical coursework, this does NOT mean you cannot succeed on Level 1!
2. Question Bank Performance: Consistently scoring >65–70% on COMBANK or UWorld questions correlates with strongly passing.
3. Practice Exam Scores: COMSAE scores are one of, if not the most, reliable predictors.
4. Consistency: Daily practice over months outperforms cramming.
5. Engagement with OMM: Neglecting OMM can hurt, since it’s a uniquely weighted part of COMLEX. Try and integrate this throughout your entire dedicated study period.

Ultimately, success is less about raw intelligence and more about structured, disciplined preparation.

How Tutoring Can Help with COMLEX Level 1

Here is where the discussion becomes highly practical and individualized. Tutoring is not about replacing but rather supplementing self-study by enhancing efficiency, confidence, and outcomes.

1. Personalized Study Plans

Tutors tailor schedules to individual needs. While generic study plans exist, tutors adjust for:

• Your personal Strengths and weaknesses
• Preferred learning style (visual, auditory, kinesthetic)
• Time available before the exam
• Mental health and burnout concerns

This individualization ensures no wasted effort. Additionally, they have experience they have worked with students before and they themselves have learned what works and what does not work.

2. Accountability and Structure

One of the biggest challenges of dedicated study is procrastination and burnout. Regular tutoring sessions provide:

• Accountability to stay on track
• Structured review of key topics
• Real-time and honest feedback on progress

It is hard to cut corners when you have someone else right there alongside you making sure you are maximizing your efforts.

3. Breaking Down Complex Topics

Medical school material can feel overwhelming. Tutors:

• Simplify difficult concepts (biochemistry pathways, neuroanatomy, microbiology)
• Use analogies and clinical scenarios to reinforce memory
• Highlight “high-yield and testable” content vs. “low-yield and nice to know” details

Your tutor should be able to teach you any material you do not fully understand, but also provide expert insight into how much time you should spend on each topic!

4. OMM Expertise

Many students neglect OMM until the last minute. While many students are able to teach this material to themselves, tutors with osteopathic backgrounds can:

• Provide targeted OMM review
• Teach high-yield material
• Walk through biomechanics questions and common traps

5. Test-Taking Strategies

Tutors, above all, do not just teach content—they teach the art of the exam – this is the most valuable part of tutoring! They will teach you how to work through a test question, a skill most students do not practice. This includes

• Timing strategies to avoid fatigue
• Question dissection: identifying key clues in vignettes
• Eliminating distractors effectively
• Developing a calm, confident exam-day mindset

6. Performance Tracking

Tutors help analyze question bank data and identify trends:

• Are you consistently missing pharmacology mechanism questions?
• Are you struggling with interpreting lab values?
• Are you weak in OMM biomechanics?

This guided analysis makes study more efficient and allows you to spend your time where it is of highest yield.

7. Confidence Building

Much of COMLEX anxiety stems from self-doubt – this is a normal part of becoming a medical professional. Having an experienced mentor to validate your approach, reassure you, and celebrate progress can significantly improve mental resilience. You do not need to go through medical school alone, having a tutor serves as a guide who has travelled this journey before.

8. Remediation for At-Risk Students

Students who struggled in coursework or failed a COMSAE may feel lost. Tutors specialize in turning things around by:

• Diagnosing root causes of struggles
• Resetting study approaches
• Preventing a spiral of anxiety and poor performance

It should NOT be seen as a sign of weakness if you reach out for help. It is quite the opposite – you recognize that you need help, and that is the first step towards becoming stronger. Nobody has become a physician alone, if you are not asking for help, you will not maximize your success!

9. Bridging COMLEX and USMLE Prep

Many DO students also take the USMLE Step 1 (although, this is now changing given many systemic changes with residency applications between the ACGME and AOA). Tutors familiar with both exams can help integrate study plans so that preparation overlaps efficiently, while ensuring OMM content is not neglected.

Final Thoughts

COMLEX Level 1 is more than just an exam—it’s a pivotal step in becoming a competent osteopathic physician. While the move to pass/fail has changed the stakes, the need to pass on the first attempt remains critical. Success requires not just hard work but smart, structured, and strategic preparation.

Tutoring provides an edge by offering:

• Personalization
• Accountability
• Test-taking mastery
• OMM expertise
• Confidence and resilience

For students feeling overwhelmed or uncertain, investing in tutoring can be one of the most impactful decisions during medical school. EliteMedicalPrep can provide expert guidance tailored to your needs, transforming preparation from a solitary grind into a guided journey that maximizes both performance and peace of mind.