Everything You Need to Know About COMLEX’s New Question Styles

Preparing for the COMLEX Level 1 is hard and the stakes are high. There are recent changes to the style of questions on this exam, and as part of our mission to help you perform to your highest level, we’d like to share the latest trends to clearly articulate what you can expect on exam day.

Item Types for COMLEX

The NBOME currently maintains three common item types. Items are presented within COMBANK to mirror the style of questions tested by the NBOME, and are listed as follows: single answer items, multi-step cases and matching items.

Single answer item types typically make up 60-70 percent of the entire examination. Each question is independent of the next and has at least five answer choices.

After reaching the halfway point in each section of your exam, you will encounter multi-step cases. This item type has a set of questions that revolve around a single case scenario.

Lastly, matching items show up at the end of each 50-item block. There is a list of headings in each matching section to choose from. Keep in mind that all questions on both COMLEX and the USMLE revolve around clinical vignettes.

These types of exam item-types may seem straightforward enough and you may even be encountering them in your courses today. However, there are reports of notable changes to the style of questions on COMLEX that you need to be aware of in order to properly prepare for the exam.

New Question Styles for COMLEX

New Style #1: Longer Stems

The first change to the question style is the length. In past years, the questions had a reputation for being short in length. Now, COMLEX questions have longer stems — more lab values, more history, and in some questions, there can be one or more paragraphs of information in the stem.

Below is an example of how we adjusted an item within our question bank to align with this new, evolved style. Notice how the inclusion of the additional information was a distractor and can lead you in the wrong direction if you’re not careful.

New Style #2: More OMM Content

An additional reported change to the COMLEX question style is the focus on a deeper integration of OMM concepts and topics. This change goes beyond typical questions on Chapman’s points, counterstrain and viscerosomatic reflexes.

Furthermore, osteopathic principles are incorporated into all aspects of COMLEX Level 1 and you should expect to see them incorporated in 25-30 percent of all test items in two forms: “pure” OMM items and “integrated” items.

Pure OMM items are a subset of items dedicated to evaluating your knowledge of Osteopathic concepts, philosophy and medical practice. These questions will look very familiar to what you may encounter on your OMM exams in the classroom.

Integrated OMM items are tougher. These additional items are incorporated throughout the examination (in the question stem or in the answer choices) and contain both Osteopathic-specific and Osteopathic non-specific answer choices. Below is an example of an OMM question that includes an Osteopathic-specific answer choice.

New Style #3: Higher Order Thinking

The last notable change to the COMLEX question style is the requirement for higher order thinking. Higher order questions require both comprehension and application to problem solve in new situations by applying acquired knowledge, facts, techniques, and rules in different, or novel ways.

This type of question style is especially important to recognize and prepare for given the change to include additional information in question stems. To answer this question style correctly, you will need to think through all of the information given and deduce it to only what’s needed to answer the question before inferring and solving it.

Use TrueLearn To Prepare For COMLEX

Our mission is to advocate for you as an osteopathic medical student and help you perform at your highest potential on exams like the COMLEX Level 1. That is why we aim to make you aware of any changes, continuously update our dedicated question bank to mirror those changes and ultimately help you be prepared for success on exam day.

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