Navigating the COMLEX Level 1 Exam Blueprint

The early summer can only mean one thing for second-year osteopathic medical students – COMLEX Level 1 season is here. Whether you’re taking the COMLEX Level 1 exam in the coming weeks or you’re a curious first-year student looking to get ahead of the curve, we’ve got some quick pearls you might expect as the exam nears.

It’s common knowledge that residencies heavily weigh COMLEX and USMLE scores during the interview process. In the most recent survey published by the National Resident Matching Program (NRMP), 94 percent of all program directors interviewed (n = 1,793) identified USMLE Step 1 and COMLEX Level 1 scores as the number one selection criteria for selecting applicants for interview.

The first step in optimizing performance is to familiarize yourself with your opponent. How do you do this?

Familiarize Yourself With The COMLEX Level 1 Blueprint

Well, the first step is to learn as much as possible about the COMLEX exam you are about to take. Most licensure exams are transparent when it comes to their testing blueprint, yet few students actually become familiar with these resources.

Take some time to review the different content categories and the proportion of the exam they represent. After you become familiar with the categories and content, next look at item-types you will be tested on. Ask yourself if these questions are structured differently from the ones you have seen in your courses?

Most Osteopathic colleges employ faculty that are actual test writers for licensure exams. Find out the names of these professors and take time to learn how they structure test items in the classroom. The NBOME’s National Faculty announcements from 2013 should give you an idea of some of the individuals who will be composing and reviewing exam items on COMLEX Level 1, and provide insight into their backgrounds.

Understanding the Blueprint

The NBOME has made the COMLEX Level 1 blueprint available on their website. The blueprint is divided into two dimensions: Patient Presentation and Physician Tasks.

The second dimension is further broken down into six sections, based on the proportion of test items for each examination level. About 70-85 percent of all questions on the COMLEX Level 1 stem from “Scientific Understanding of Health and Diseases Mechanisms.”

This differs from COMLEX Levels 2 CE and 3 where the weight is on “History and Physical Examination” and “Management.” We encourage you to visit the NBOME’s website for more information about the Level 1 blueprint. After viewing the blueprint, take some time to drill into the detailed outline of both dimensions of the exam. It’s time well spent!

COMLEX Level 1 Item Types

Although exam is always evolving, the NBOME currently maintains five approved item-types.

1. & 2. Stand-Alone Items (A-Type And Extended A-Type)

The majority of the items on the COMLEX Level 1 will revolve around case-based scenarios. This item-type represents approximately 60-70 percent of questions on the exam. Each question is independent of the next, which means answering a stand-alone item incorrectly will not impact subsequent items. Stand-alone items typically have five answer choices and are referred to as A-type items. If more than five answer choices are available, the item is considered an extended A-types.

3. Multi-Step Cases (S-Type)

Halfway through your exam, you will find question sets that revolve around a single case scenario. From our experience, there is usually an average of two to three steps for each case, but you may find as many as four questions referring to the same case.

For example, you may be presented with a case and asked to give the diagnosis (first question), an associated physical exam finding (second question) and the mechanism of action of the medication used for treatment (third question).

The tricky part about these questions is that each subsequent answer choice corresponds to one of the diagnoses. So it’s easy to miss two or three questions if you don’t get the diagnoses correct. If you learn to make the correct diagnoses, you will be able to use this format to your advantage.

4. & 5. Matching (B-Type Or X-Type)

Matching questions show up at the end of each question block. Two to five questions in a matching section, places the question in the B-type item category. If more than five headings are present, the item is of the X-type variety and may have between 6-25 headings.

Matching sections are typically reserved for topics that require a broad scope of knowledge. Be mindful that answers may (and sometimes should) be used more than once. This can add an increased degree of difficulty to the item-type.

Incorporating OMM Into Your Game Plan

Although you will find the OMM/OPP category embedded within the “Scientific Understanding of Health and Disease Mechanisms” section of the blueprint, NBOME makes an effort to emphasize that nowhere is it stated what percentage of the exam will include Osteopathic concepts.

The reason of this is that Osteopathic concepts are embedded throughout the exam in different ways. Our estimation is that between 20 – 30 percent of questions on the COMLEX Level 1 will likely incorporate Osteopathic principles. These items can be categorized as either ‘pure’ or ‘integrated’ depending on the nature of the osteopathic concept being tested. It is imperative you not only have an understanding of Osteopathic principles, but also can apply these principles to clinical scenarios.

We recommend you also incorporate OMM into your systems-based studies so you have a thorough understanding of how Osteopathic principles apply to all areas of the exam.

You’re going to be spending hundreds of hours preparing for the COMLEX Level 1 (and maybe even the USMLE Step 1). Being familiar with the exam’s blueprint, question types and study strategies will allow you to optimize your preparation. Remember, before you sit for test day, know your opponent inside and out!