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I began working with Sean 9 weeks before COMLEX Level 1. At the time, my practice scores were low, I had zero confidence, and my test-taking strategy was honestly terrible.
Dylan M.
COMLEX Level 1 is a one-day exam with 8 hours of testing: two 4-hour sessions of four 40-question sections each, 320 questions in all (NBOME Bulletin 2026-2027). Add 60 minutes of pooled break time and a 16-minute tutorial, and the full day runs past nine hours before check-in.
If you have seen 352 questions quoted elsewhere, that was the old count: NBOME cut Level 1 to 320 from the spring 2026 test cycle and kept the eight hours (NBOME news). Below are the sessions, the time you get per question, what the blueprint covers, how the exam is scored and how it compares with USMLE Step 1.
Exam format at a glance
| Topic | Official rule | Source |
|---|---|---|
| Length | One day: 8 hours of testing in two separately timed 4-hour sessions (A and B) of four sections each, plus 60 minutes of pooled break time and a 16-minute pre-exam information and tutorial. | NBOME: COMLEX-USA Bulletin of Information 2026-2027 |
| Questions | 320 single-best-answer multiple-choice questions, in 8 sections of 40. Some include images, video or audio clips. | NBOME: COMLEX-USA examination format |
| Scoring | Pass/fail only, reported instead of a numeric score, with a Formative Performance Profile comparing you with first-time takers who passed. | NBOME: scoring and reporting |
| Passing standard | Pass/fail. The current standard was last reviewed in January 2024, took effect in May 2024 and is next reviewed in January 2028. | NBOME: scoring and reporting |
| Eligibility | Completion of the first year at an accredited college of osteopathic medicine, plus a good academic and professional standing attestation from your dean. | NBOME: COMLEX-USA Bulletin of Information 2026-2027 |
| Fee | $745. Rescheduling and cancellation fees rise as test day gets closer, starting at $0; a no-show costs $400. | NBOME: frequently asked questions |
| Results | Generally within two to six weeks from the end of the testing window you sat in. | NBOME: scoring and reporting |
The Level 1 exam day, session by session
NBOME lays the day out as two separately timed sessions (NBOME examination format):
| Part | What it contains | Time |
|---|---|---|
| Pre-exam | Information and tutorial | 16 minutes |
| Session A | Sections 1-4, 40 questions each (160) | 4 hours of testing |
| Session B | Sections 5-8, 40 questions each (160) | 4 hours of testing |
| Breaks | Pooled across the day | 60 minutes |
Break time is pooled, so you choose how to spend it between sections. NBOME has also released a new break structure for Level 1 and Level 2-CE for those testing after May 7, 2026 (NBOME Level 1); read the current Bulletin before test day so your plan matches the rules on your date. Some questions include images, video or audio clips, so practise with media-based items rather than text alone.
How much time you get per question
Each 4-hour session holds 160 questions, so you average 90 seconds a question, or one hour per 40-question section. That is our arithmetic from NBOME's published session times (NBOME Bulletin); NBOME itself does not state a per-question figure.
Ninety seconds is generous for a one-line recall question and tight for a long clinical vignette with a lab table. The practical habit is to check your pace at the 20-question mark of every section: if you are past 30 minutes, start committing faster. Practise in timed 40-question blocks, the same size as the real sections, so the pace becomes automatic.
What Level 1 tests: the COMLEX blueprint
NBOME builds Level 1 on two dimensions of the COMLEX-USA blueprint and publishes a minimum share for each part (NBOME Level 1).
| Dimension 1: competency domain | Minimum share |
|---|---|
| Application of Knowledge for Osteopathic Medical Practice | 60% (foundational biomedical sciences 75% of this) |
| Osteopathic Principles, Practice and Manipulative Treatment | 12% |
| Osteopathic Patient Care and Procedural Skills | 6% |
| Practice-Based Learning and Improvement | 4% |
| Interpersonal and Communication Skills | 3% |
| Professionalism | 3% |
| Systems-Based Practice | 2% |
| Dimension 2: clinical presentation | Minimum share |
|---|---|
| Musculoskeletal system | 13% |
| Community health and wellness | 12% |
| Nervous system and mental health | 10% |
| Gastrointestinal system and nutritional health | 10% |
| Circulatory and hematologic systems | 10% |
| Respiratory system | 10% |
| Human development, reproduction and sexuality | 5% |
| Endocrine system and metabolism | 5% |
| Genitourinary/renal system and breasts | 5% |
| Integumentary system | 5% |
Two things follow. Osteopathic principles and OMM are at least 12% of the exam, roughly one question in eight, so they need daily time rather than a last-week cram. And musculoskeletal is the single largest clinical presentation, which is where OMM and anatomy questions meet.
How Level 1 is scored and when results come
Level 1 reports pass or fail only, with no numeric score. With the result you get a Formative Performance Profile that compares your performance, overall and by content area, with first-time takers who passed (NBOME scoring and reporting). The current passing standard took effect in May 2024 and is next reviewed in January 2028 (NBOME).
Results usually arrive two to six weeks after the end of the testing window you sat in, not after your own test date (NBOME). For the 2025-2026 cycle, 90.2% of 9,678 first-time takers passed (NBOME performance data).
COMLEX Level 1 vs USMLE Step 1
Many DO students take both. The format differences matter on test day:
| Feature | COMLEX Level 1 | USMLE Step 1 |
|---|---|---|
| Testing time | 8 hours, two 4-hour sessions | 8 hours, one session |
| Questions | 320, in sections of 40 | About 280, in 30-minute blocks of up to 20 (from May 14, 2026) |
| Breaks | 60 minutes pooled | At least 55 minutes |
| Score | Pass/fail | Pass/fail |
| Osteopathic content | At least 12% (OPP and OMM) | Not tested |
Level 1 has about 40 more questions in the same eight hours, in longer sections (USMLE Step 1). Both are now pass/fail (USMLE scoring). If you are sitting both, see our COMLEX Level 1 tutoring page for how we fold OMM into a shared plan.
Practice tests that match the format
NBOME's own practice exam for Level 1 is COMSAE Phase 1: three student forms at $60 each, 176 questions in four sections of 44, with up to four hours in timed mode (NBOME COMSAE format). A COMSAE is shorter than the real exam, so it checks readiness and style rather than full-day stamina.
To rehearse the day itself, string question-bank blocks into two 4-hour sessions of four 40-question blocks, with your planned breaks. Do it at least once in the last two weeks, at the same start time as your appointment.
Preparing for Level 1 with a tutor
Level 1 tutoring with us is led by Dr. Sean Moazezi, DO, who sat the COMLEX exams he teaches, and Chelsi Flippo, MD. Sessions work live questions in 40-question timed blocks, with OMM built into each week, and the schedule is built around your COMSAE results and your test date. Keep the limits in mind as you choose that date: four scored attempts per level, and no more than four in any 12 months (NBOME Bulletin).