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COMLEX-USA Level 1
About COMLEX-USA Level 1
COMLEX-USA Level 1 is the first examination in the COMLEX-USA series. Passing COMLEX-USA Level 1 indicates that you have demonstrated competence in the foundational biomedical sciences and osteopathic principles and related physician competency domains for osteopathic medical care of patients as required to enter supervised patient care settings and to continue lifelong learning.
Examination Description
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. Specific content information can be found in the COMLEX-USA Blueprint.
Familiarizing yourself with the Blueprint will help you anticipate the type of content you will encounter during your Level 1 examination.
Test Specifications
Competency domains assessed include osteopathic principles and practice, osteopathic patient care, application of osteopathic medical knowledge, communication skills, professionalism, practice-based learning, and systems-based practice. Competency assessment occurs in the context of clinical and patient presentations and systems-based practice as required for entry into the supervised practice of general osteopathic medicine and for readiness for lifelong learning and practice-based learning and improvement.
Dimension 1 of the COMLEX-USA blueprint consists of seven competency domains. These include foundational abilities, representing the required elements and outcomes that define knowledge, skills, experience, attitudes, values, behaviors, and the established professional standards an osteopathic physician should possess.
| Dimension 1 Competency Domains | Minimum % Level 1 |
|---|---|
| 1 Osteopathic Principles, Practice, and Manipulative Treatment | 12% |
| 2 Osteopathic Patient Care and Procedural Skills | 6% |
| 3 Application of Knowledge for Osteopathic Medical Practice | 60% |
| 3.1 Foundational Biomedical Sciences Knowledge Base | 75% |
| 4 Practice-Based Learning and Improvement in Osteopathic Medical Practice | 4% |
| 5 Interpersonal and Communication Skills in the Practice of Osteopathic Medicine | 3% |
| 6 Professionalism in the Practice of Osteopathic Medicine | 3% |
| 7 Systems-Based Practice in Osteopathic Medicine | 2% |
Dimension 2 consists of ten clinical presentations, which represent the manner in which a particular patient, group of patients, or community present for osteopathic medical care.
| Dimension 2: Clinical Presentations | Minimum % Level 1 |
|---|---|
| 1 Community Health and Patient Presentations Related to Wellness | 12% |
| 2 Human Development, Reproduction, and Sexuality | 5% |
| 3 Endocrine System and Metabolism | 5% |
| 4 Nervous System and Mental Health | 10% |
| 5 Musculoskeletal System | 13% |
| 6 Genitourinary/Renal System and Breasts | 5% |
| 7 Gastrointestinal System and Nutritional Health | 10% |
| 8 Circulatory and Hematologic Systems | 10% |
| 9 Respiratory System | 10% |
| 10 Integumentary System | 5% |
New Break Structure
A new break structure for COMLEX-USA Level 1 and Level 2-CE has been released for those who are testing after May 7, 2026, providing more flexibility for test takers.
COMLEX-USA Level 1 Enhancements
News
Enhancements to COMLEX-USA Exams in 2026, 2027
Enhancements include changes in number of items for COMLEX-USA Level 1 and 2-CE, and a one-day format for COMLEX-USA Level 3.
You Passed! What’s Next?
Usually, within two to six weeks from the end date of a COMLEX-USA testing window for Level 1, you will receive an email indicating that your score is available. Because COMLEX-USA Level 1 reports a “pass” or “fail” versus a numeric score, you will also receive a Formative Performance Profile that compares both total examination performance and performance in individual content areas to the performance of other first-time test-takers who passed the examination.
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