How Long is COMLEX Level 1 & How Many Questions are On the Exam?

The Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 1 is a critical milestone for osteopathic medical students. It serves as one of the standardized examinations that students will need to overcome prior to clinical training and residency applications. This high-stakes exam assesses a student’s foundational medical knowledge and ability to apply osteopathic principles in patient care.

One of the most frequently asked questions about COMLEX Level 1 is its duration and question format. In this comprehensive guide, we will break down the structure, timing, and number of questions on the exam to help students prepare effectively.

Background to COMLEX Level 1

COMLEX is administered by the National Board of Osteopathic Medical Examiners (NBOME). It consists of multiple levels, with Level 1 being the first major step in the licensing process. Students who are new to the licensing process may also benefit from learning more about what the COMLEX exams are and how each level fits into osteopathic medical training. Per the NBOME, “COMLEX-USA Level 1 integrates foundational biomedical sciences with other areas of osteopathic medical knowledge relevant to clinical problem-solving and the promotion of health maintenance”.

COMLEX Level 1 transitioned to a pass/fail scoring system in 2022. This change was made to reduce stress on students and shift focus from numerical scores to overall competency. While this eliminates score-based competition, the rigorous nature of the exam remains unchanged.

To find all of the most up to date information on the COMLEX, we recommend visiting the NBOME website on the COMLEX examinations.

How Long is the COMLEX Level 1 Exam?

The total testing time for COMLEX Level 1 is approximately 8 hours, divided into two 4-hour sessions, which are further subdivided with scheduled breaks in between. The exam is administered in a single day and follows a strict schedule:

Breakdown of Testing Time

Students must complete each session within the allotted time, and any remaining time does not carry over to the next session. The two 10-minute breaks (between sections 2 and 3, and 6 and 7) and the 40-minute lunch break (between sections 4 and 5) provide an opportunity to rest and refresh, which is crucial for maintaining focus and stamina throughout the day.

How Many Questions are on COMLEX Level 1?

The COMLEX Level 1 exam consists of 352 multiple-choice questions (MCQs), distributed evenly across eight sections, each containing 44 questions. Each section is timed separately, requiring students to pace themselves effectively to answer all questions within the given time constraints.

Question Format

The questions on COMLEX Level 1 are single-best answer, multiple-choice format and may include audio-visual elements. Each question presents a clinical vignette or scenario, followed by a question and possible answer choices. Questions can be answered, reviewed, and changed one section at a time. The exam does not time individual sections. However, once you advance to a new section, you can no longer return to the previous one.

 The exam tests:

• Basic biomedical sciences (anatomy, physiology, biochemistry, pharmacology, microbiology, pathology, and genetics)
• Osteopathic principles and manipulative medicine (OMM)
• Clinical decision-making and patient management

Time Management per Question

Since each section has 44 questions to be completed in 1 hour, students have approximately 1 minute and 22 seconds per question. Efficient time management helps students answer every question within the allotted time.

What kind of questions can I expect to answer?

The specific breakdown for each COMLEX exam can be found in the figure below and at the following website. Specifically, COMLEX has a Blueprint regarding the concepts that students are expected to master, and these concepts are broken down into two dimensions. Dimension 1 refers to competency domains while Dimension 2 refers to Clinical Presentations. Students should review the COMLEX Level 1 exam blueprint to understand how it organizes and weights these topics.

What to Expect on Exam Day?

Understanding the exam structure and timing is only part of the preparation process. On the day of the exam, students should arrive at the testing center early to allow enough time for check-in procedures, including identification verification, fingerprint scanning, and security screening.

Tips for Exam Day Success

• Arrive early: Plan to arrive at least 30-60 minutes before your scheduled exam time to complete check-in procedures. Often times the staff at the testing center will allow you to begin your exam early.
• Dress comfortably: Testing centers have varying temperatures, so wear layers to stay comfortable that you can remove on breaks if it gets too hot.
• Bring necessary identification: You must bring a government-issued photo ID.
• Use your breaks wisely: Eat a light meal during lunch and stay hydrated to maintain energy levels (always bring more food than you think you will need)
• Stay calm and focused: If you encounter a difficult question, make an educated guess and move forward to save time.

How to Prepare for the Length and Question Volume?

The sheer length and number of questions on COMLEX Level 1 can be daunting, but effective preparation strategies can help students build endurance and confidence.

1. Take Full-Length Practice Exams

Simulating the actual test by taking full-length practice exams under timed conditions is one of the best ways to prepare. This helps students develop stamina and improve time management. Along with taking full-length assessments, review the best COMLEX Level 1 study resources to determine which tools may be most helpful during each stage of your preparation.

2. Follow a Study Schedule

A structured study plan that includes reviewing high-yield topics, taking practice questions, and scheduling rest days can optimize learning and retention. Students who need help organizing their preparation can use EMP’s free COMLEX Level 1 10-week study calendar as a starting point.

3. Use Question Banks

Resources like UWorld, TrueLearn, and COMBANK offer question banks designed to mimic the COMLEX exam format. These are valuable tools for reinforcing concepts and improving test-taking strategies. Before selecting a question bank, read our detailed TrueLearn review for COMLEX preparation to understand its features, strengths, and limitations.

4. Focus on OMM

Osteopathic principles and manipulative medicine (OMM) are unique to the COMLEX exam. Many students find this section challenging because medical school courses often place less emphasis on OMM than on the basic biomedical sciences. Therefore, dedicating sufficient time to OMM review is crucial. If this is one of your weaker areas, learn how to study for OMM questions more effectively.

5. Build Stamina with Timed Study Sessions

Studying in timed blocks, similar to the exam’s structure, can help condition students for long periods of focused work.

6. Ask for Help!

Studying with friends and classmates is a great way to get support during these challenging times. Tutors are also available to help you craft an individualized study plan. Students who need more individualized support may benefit from working with a COMLEX Level 1 tutor to develop a personalized schedule, address knowledge gaps, and strengthen their test-taking strategy.

Conclusion

COMLEX Level 1 is a demanding exam that requires both knowledge and endurance. Understanding its structure—8 hours in total, divided into eight 1-hour testing sections, with 352 multiple-choice questions—is essential for effective preparation. By practicing with timed exams, using question banks, and maintaining a structured study schedule, you can improve their performance and increase their confidence on exam day. Do not be afraid to ask for help – tutors can be a wonderful resource to improve your scores.

With adequate preparation and the right mindset, you can successfully navigate COMLEX Level 1 and move forward in your medical careers with a strong foundation in osteopathic medicine.