COMLEX Blueprints for Level 1, Level 2 CE, and Level 3 – to Include in Your Study Strategy
The journey to becoming a Doctor of Osteopathic Medicine is a long one, filled with many exams, each marking an important milestone in your education. The three most important of these come in the form of the Comprehensive Osteopathic Medical Licensing Examination (COMLEX).
As you prepare to take each, it’s useful to know what they have in common and how they differ.
COMLEX Blueprint Similarities
Osteopathic Emphasis
It goes without saying that the primary focus of the COMLEX exams is to ensure that DO students understand and can apply osteopathic principles and practices. This emphasis sets the COMLEX apart from other medical licensing exams. Expect questions that assess your knowledge of osteopathic manipulative treatment (OMT), osteopathic philosophy, and the holistic approach to patient care.
Two Distinct Dimensions
The questions on each of the three exams fall into two categories, or dimensions. The first dimension is Competency Domains, and the second dimension is Clinical Presentations. All three exams integrate the following elements:
- Osteopathic philosophy of whole-person health care
- Underlying structure-function relationships
- Interdependence of body systems
- Self-healing and self-regulatory mechanisms
- Osteopathic approach to patient care including osteopathic manipulative medicine and osteopathic manipulative treatment
What differs between the three is the minimum percentage of total content they represent.
Level 1 Subject Breakdown
This test is designed to assess an osteopathic medical student’s foundation of medical knowledge and their understanding of osteopathic principles before they transition to the clinical years of medical school. COMLEX Level 1 contains 352 multiple-choice questions. There are eight blocks with 44 questions each and three scheduled breaks.
| Competency Domains | Minimum % |
| 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 Medicine | 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% |
| Clinical Presentations | Minimum % |
| Community Health and Patient Presentations Related to Wellness | 12% |
| Human Development, Reproductions, and Sexuality | 5% |
| Endocrine System and Metabolism | 5% |
| Nervous System and Mental Health | 10% |
| Musculoskeletal System | 13% |
| Genitourinary/Renal System and Breasts | 5% |
| Gastrointestinal System and Nutritional Health | 10% |
| Circulatory and Hematological Systems | 10% |
| Respiratory System | 10% |
| Integumentary System | 5% |
Level 2 Subject Breakdown
This test is designed to assess the clinical knowledge and skills of the osteopathic medical student. Like Level 1, Level 2 contains 352 multiple-choice questions. There are also eight blocks with 44 questions each and three scheduled breaks.
| Competency Domain | Minimum % |
| 1: Osteopathic Principles, Practice, and Manipulative Treatment | 10% |
| 2: Osteopathic Patient Care and Procedural Skills | 30% |
| 3: Application of Knowledge for Osteopathic Medical Practice | 26% |
| 3.1: Foundational Biomedical Sciences Knowledge Base | 25% |
| 4: Practice Based Learning and Improvement in Osteopathic Medicine | 7% |
| 5: Interpersonal and Communication Skills in the Practice of Osteopathic Medicine | 5% |
| 6: Professionalism in the Practice of Osteopathic Medicine | 7% |
| 7: Systems-Based Practice in Osteopathic Medicine | 5% |
| Clinical Presentations | Minimum % |
| Community Health and Patient Presentations Related to Wellness | 12% |
| Human Development, Reproduction, and Sexuality | 5% |
| Endocrine System and Metabolism | 5% |
| Nervous System and Mental Health | 10% |
| Musculoskeletal System | 13% |
| Genitourinary/Renal System and Breasts | 5% |
| Gastrointestinal System and Nutritional Health | 10% |
| Circulatory and Hematological Systems | 10% |
| Respiratory System | 10% |
| Integumentary System | 5% |
Level 3 Subject Breakdown
Level 3 has many differences from the previous two exams. The exam is broken down into four separate sections of 3.5 hours each, given over a two-day period. And there are two types of questions: single best answer multiple-choice questions and clinical decision-making (CDM) cases. Each CDM case typically contains 2-4 questions. The exam consists of a total of 420 multiple-choice questions (taken on day one) and 26 CDM cases (taken on day two).
Serving as the final step in the COMLEX series, Level 3 assesses the candidate’s ability to effectively deliver osteopathic medical care.
| Competency Domains | Minimum % |
| 1: Osteopathic Principles, Practice, and Manipulative Treatment | 10% |
| 2: Osteopathic Patient Care and Procedural Skills | 40% |
| 3: Application of Knowledge for Osteopathic Medical Practice | 17% |
| 3.1: Foundational Biomedical Sciences Knowledge Base | 10% |
| 4: Practice Based Learning and Improvement in Osteopathic Medical Practice | 8% |
| 5: Interpersonal and Communication Skills in the Practice of Osteopathic Medicine | 3% |
| 6: Professionalism in the Practice of Osteopathic Medicine | 6% |
| 7: Systems-Based Practice in Osteopathic Medicine | 6% |
| Clinical Presentations | Minimum % |
| 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% |
The COMLEX exams are a challenging but necessary part of your path to becoming a Doctor of Osteopathic Medicine. By understanding the content breakdown and expectations for each level, you can better navigate your way to success!
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