COMLEX Level 1 currently has 352 questions, split across eight sections of 44 questions each. Starting in May 2026, the exam will be shortened to 320 questions, with each of the eight sections containing 40 questions instead.
How the Exam Is Structured
The 352 questions are divided into two sessions, each containing four sections. Session A covers sections 1 through 4, and Session B covers sections 5 through 8. Every section has the same number of questions, so you face a consistent pace throughout the day. Once the May 2026 changes take effect, the same two-session, eight-section structure stays in place, just with 40 questions per section instead of 44.
The entire exam day lasts approximately nine hours, including a brief tutorial at the start and designated breaks. You receive a pool of 60 minutes of total break time, which you can spread across three scheduled breaks under the current format. After the May 2026 update, you’ll be able to use those same 60 minutes across seven scheduled breaks, giving you more flexibility to rest between sections.
What the Questions Cover
Every question on COMLEX Level 1 maps to two dimensions outlined in the NBOME’s official blueprint. The first dimension is competency domains, which determines the skill being tested. The second is clinical presentations, which determines the body system or health topic involved.
The competency domain breakdown looks like this:
- Application of Knowledge for Osteopathic Medical Practice: 60% of questions. Within this domain, about 75% focus on foundational biomedical sciences, making basic science knowledge the single largest slice of the exam.
- Osteopathic Principles, Practice, and Manipulative Treatment (OPP/OMT): 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%
On the clinical presentation side, the musculoskeletal system carries the heaviest weight at 13%, followed by the nervous system and mental health, gastrointestinal system, circulatory and hematologic systems, and respiratory system, each at 10%. Community health and wellness topics account for 12%. Smaller shares go to endocrine, genitourinary, integumentary, and reproductive health topics at 5% each.
How Scoring Works
COMLEX Level 1 is scored on a pass/fail basis with no numeric score reported. After you take the exam, you’ll receive a Formative Performance Profile that compares your overall performance and your performance in individual content areas against other first-time test-takers who passed. This profile highlights relative strengths and weaknesses, but the NBOME explicitly cautions against using it in residency applications or clinical rotation decisions. It exists purely as a study and self-assessment tool.
Scores are generally released within two to six weeks from the end of a testing window. You’ll get an email notification when your results are available, and you can access them through the NBOME Portal. Your school’s dean’s office also has access to your results.
Planning Your Study Time
Knowing the question count and blueprint percentages helps you allocate study time more effectively. With 60% of the exam testing applied biomedical knowledge (and most of that rooted in foundational sciences), your heaviest preparation should focus on biochemistry, microbiology, pathology, pharmacology, and physiology. OPP/OMT at 12% is a meaningful chunk, roughly 42 questions on the current exam, so it deserves dedicated review rather than last-minute cramming.
On test day, pacing matters. With 44 questions per section right now (or 40 per section starting May 2026), you’ll want to practice answering at a steady clip during your preparation so that no single section eats into time you can’t recover. The 60-minute break pool is yours to manage, so consider how you’ll split it to stay sharp across all eight sections.