Strategies for Success: COMLEX Level 1 Preparation Tips

The Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 1 is an important milestone for all osteopathic medical students. With the relatively recent transition to a pass/fail grading system, the focus has shifted from achieving a high numerical score to ensuring a solid understanding of fundamental medical concepts and passing comfortably. However, performing well on Level 1 lays the foundation for success in Level 2 and in your clinical practice. 

In this guide, we will cover effective strategies for studying, recommended study materials, time management techniques, and ways to reduce stress while preparing for the exam.

Understanding the COMLEX Level 1 Exam Format

COMLEX Level 1 is a computer-based examination that assesses foundational biomedical sciences and their clinical applications through the lens of osteopathic principles. The exam consists of:

• 352 multiple-choice questions (MCQs) divided into two 4-hour sessions within a single day.
• Single-best-answer format, with many most questions presenting clinical vignettes to  test your knowledge.
• Osteopathic Manipulative Medicine (OMM)-specific content integrated into the exam.
• Scheduled breaks, including a 40-minute lunch break and optional breaks between test sections.

Below is a schedule of the format from the National Board of Osteopathic Medical Examiners (NBOME):

When Should You Start Studying for COMLEX Level 1?

Most students will dedicate six to eight weeks of uninterrupted studying before their exam date, though preparation should start during preclinical years to build a strong foundation in the basic sciences. A gradual approach throughout the first two years of medical school, followed by an intensive dedicated study period, is ideal. However, we have seen students complete their “dedicated period” in as short as four weeks now that the test has transitioned to a pass/fail system. There is no ideal amount of time for all students, this is a highly individualized process.

How Many Hours Should You Study for COMLEX Level 1?

The total number of study hours varies greatly based on individual learning styles and baseline knowledge, but students typically spend 8-12 hours per day during their dedicated period. If we imagine that students are studying for 6-8 weeks, this translates to approximately 350 to 650 hours total.

The amount of time also depends on if you plan to take the United States Medical Licensing Examination (USMLE) Step 1. Many D.O. students will often take this examination as well as to provide a direct comparator between their M.D. counterparts.

Study Schedules: How to Plan Your COMLEX Prep

A well-structured study schedule is essential for maximizing efficiency. Consider the following approach:

Phase 1: Early Preparation (Preclinical Years)

• Focus on coursework: Perform well in medical school courses, as they provide the foundation for COMLEX. During this time, some students will begin using Level 1 and Step 1 examination review material (more on this below).
• Use question banks early: It is never to early to start answering board-style questions. This will not only reinforce concepts you learn in the classroom, but it will also familiarize yourself with the exam style.
• Start Osteopathic Manipulative Medicine (OMM) review: Regular exposure to OMM principles helps integrate osteopathic concepts into clinical thinking.

Phase 2: Dedicated Study Period (4-8 Weeks Before the Exam)

• Before dedicated: We recommend taking a full-length practice exam to identify how close you are to passing, and your strengths and weaknesses. This will help you then structure your dedicated period.
• Week 1-2: Significant content review using high-yield resources (First Aid, Boards & Beyond, Sketchy, Pathoma, Anki). Continue using question banks (like you were during Phase 1).
• Week 3-4: Heavy question bank usage (UWorld, AMBOSS, TrueLearn) with continued content reinforcement.
• Week 5-6: Full-length practice exams, review of weaknesses, and rapid OMM review.
• Final Week: Light review, practice questions, and relaxation before the exam.

High-Yield Study Materials for COMLEX Level 1

Question Banks

• UWorld – Generally considered the gold standard for clinical vignettes and solidifying medical knowledge.
• AMBOSS – Very similar to UWorld but has significantly more content available to help reinforce challenging content.
• TrueLearn – COMLEX-specific questions with a focus on OMM. Most D.O. students will get this question bank because of its OMM focus. While both UWorld and Amboss now offer OMM questions too, TrueLearn has been doing so for a longer time.

Review Books and Video Resources

• First Aid for the USMLE Step 1 – Comprehensive yet concise review – this is the go-to textbook for both Level 1 and Step 1. We recommend this textbook for most students
• Pathoma – Essential for pathology mastery. This consists of a video series and a short textbook that highlights the most high yield pathology consents.
• Sketchy – Videos that present visual guides for microbiology, pharmacology, and pathology. However, in our experience, the most high yield videos are those for microbiology and pharmacology – we prefer Pathoma for the pathology review.

• Boards & Beyond – An excellent resource providing for in-depth explanations through videos of basic sciences and it’s own question bank. This resource will function more as a dedicated curriculum to work through rather than a supplement to the aforementioned question banks.
• Osmosis – Engaging, high-yield videos for quick reviews. This can be used throughout your preclinical years as well.

Anki (Spaced Repetition Software)

• Pre-made decks (e.g., AnKing, Zanki) – Reinforce concepts efficiently with spaced repetition. It is easy to become overwhelmed with the number of Anki cards you have to get through. Read our blog about how to use Anki efficiently and effectively.

Tutors: Do You Need Them?

A tutor can provide personalized support for students who need extra guidance, structure, motivation and accountability. They can help clarify complex topics, teach and reinforce test-taking strategies, and create a tailored study plan to optimize your likelihood of success on test day.

• Who Should Consider a Tutor?
  • Students who struggle with standardized tests and need additional test-taking strategies.
  • Those who have difficulty managing their study schedule and staying on track.
  • Students who failed or underperformed on their preclinical examinations or practice exams.
  • Individuals seeking one-on-one support to reinforce weak subjects or topics.
• Maximizing the Value of a Tutor
  • Come prepared with specific questions and problem areas to address. Think about your strengths and weaknesses before you meet with your tutor.
  • Use tutoring sessions to refine test-taking techniques rather than just reviewing content.
  • Save the content review for the most challenging topics; try and teach yourself the easier material.
  • Implement strategies learned during tutoring in your independent study sessions.
  • Set measurable goals with your tutor to track progress effectively.

Time Management Strategies for Efficient Studying

1. Prioritize Weak Areas: Focus more time on topics where you struggle. Take a practice test early to identify what your strengths and weakness are and how close you are to passing.
2. Use both active and passive learning: Active learning primarily consists of question banks whereas passive learning involves flashcards, videos, and textbooks. A blend of the two will keep you engaged and not become bored with just one approach to learning material.
3. Practice Exams: Take full-length practice exams (NBOME practice tests, UWorld self-assessments) to gauge progress. Complete these early and frequently.
4. Time Your Blocks: As it gets closer to test day, begin simulating real testing conditions by practicing 40-50-question timed blocks.
5. Consider using the Pomodoro Technique: This technique involves shorter bursts of activity, interspaced with short breaks. For example, early on in your dedicated period, it is not necessary to complete 40 question timed blocks back to back (you may get burnt out doing this). Try and complete 15-20 question blocks, and then take a 10 minute break to maintain focus.

Stress-Reduction Techniques

1. Exercise Regularly: Physical activity boosts cognitive function and reduces stress. Do not sacrifice your physical and mental health during your dedicated period!
2. Mindfulness & Meditation: Apps like Headspace or Calm help with relaxation.
3. Maintain a Sleep Schedule: Aim for at least 7-8 hours of sleep per night.
4. Take Breaks: Engage in hobbies or social activities to avoid burnout.
5. Stay Connected: Talk to peers, your tutor, family, or mentors for support and motivation.

How Hard Is It to Pass COMLEX Level 1?

The pass rate for first-time test takers is generally over 90%, but passing requires disciplined studying, strong foundational knowledge, and familiarity with OMM concepts. You can see the pass rates in our blog here.

Final Thoughts: Setting Yourself Up for Level 2 Success

Succeeding in COMLEX Level 1 not only ensures progression in medical school but also sets the foundation for Level 2 and your clinical expertise. Many of the skills developed in Level 1 prep, like critical thinking, time management, and question analysis, will carry over to Level 2. By following a structured study plan, using high-yield resources, and managing stress effectively, you WILL confidently pass COMLEX Level 1 and pave the way for success as a future doctor.