COMAT Clinical was developed at the request of COM Deans for osteopathically distinctive clinical discipline exams that correspond to clinical learning experiences typically provided in COM clerkships, clinical rotations, and courses. Each of the COMAT clinical subjects integrates OPP and OMM content into the discipline blueprint. Released in 2011, COMAT has been used by COMs to demonstrate compliance with COCA accreditation standards regarding curricula, specifically standards 6.4 and 6.6 (OPP in each year of the curriculum).

Format

Each of the COMAT Clinical subject exams consists of 120 items that must be completed within 2 hours and 30 minutes. A 5-minute tutorial is provided before each exam begins. Every examination in the COMAT series has multiple forms, and all are psychometrically equivalent in content covered, level of difficulty, and reliability, allowing COMs to administer a given COMAT subject exam multiple times per year.

Exam Blueprints

Emergency Medicine

Emergency Medicine

Core Knowledge & Elements of Osteopathic Principles in the Discipline of Emergency Medicine

Content Outline and Assessment Objectives

The Emergency Medicine examination is designed for end-of-course or end-of-clinical rotation/clerkship assessment for students enrolled at a college of osteopathic medicine (COM). Individual COMs may also administer the examination at other times in accordance with their curriculum goals and mission. This examination emphasizes core knowledge and elements of osteopathic principles and practice in the discipline of Emergency Medicine that are essential for the predoctoral osteopathic medical student. The exam blueprint below contains the Emergency Medicine topics covered in two dimensions: Dimension 1 – Patient Presentation and Dimension 2 – Physician Tasks.

Dimension 1: Patient Presentation

Topic	%
Abdominal Pain	6–11%
Chest Pain	6–11%
Environmental/Travel Disorders	2–5%
Gastrointestinal Bleeding	3–6%
Genitourinary	4–7%
HEENT (Head, Eyes, Ears, Nose, and Throat) Disorders	4–7%
Mental Status Change/Weakness	6–11%
Musculoskeletal Disorders	6–11%
OB/GYN	4–7%
Poisoning/Overdose/Withdrawal	4–7%
Psychiatric/Behavioral	2–5%
Rashes/Disease of the Skin	2–5%
Resuscitation/Shock	5–8%
Shortness of Breath	6–11%
Special Populations	4–7%
Traumatic Injuries	4–7%

Dimension 2: Physician Tasks

Topic	%
History & Physical Examination	20–28%
Differential Diagnosis & Diagnostic Technologies	15–25%
Management	15–25%
Scientific Understanding of Health & Disease Mechanisms	5–15%
Health Care Delivery Issues	4–8%
Understanding of Procedural Skills (Indications/Performance Description/Contraindications)	10–20%
Health Promotion & Disease Prevention	2–4%

General Learner-Centered Objectives

Based on the general learner-centered objectives outlined in the Emergency Medicine Examination Blueprint, the examinee will be required to demonstrate the ability to apply:

1. Foundational content knowledge to situations and patient presentations encountered in clinical settings and important to Emergency Medicine.
2. Foundational content knowledge and clinical problem-solving ability related to physician tasks critical to Emergency Medicine.
3. Knowledge and clinical problem-solving as related to the Fundamental Osteopathic Medical Competency Domains, including osteopathic principles and practice and osteopathic manipulative treatment (OMT), osteopathic medical knowledge, interpersonal and communication skills, practice-based learning and improvement, systems-based practice, professionalism and patient care.
4. Osteopathic principles and practice in commonly encountered patient care scenarios.

Selected Specific Learner-Centered Objectives for Emergency Medicine

For Emergency Medicine, the examinee will be required to demonstrate the ability to diagnose and manage selected patient presentations and clinical situations involving, but not limited to:

1. Abdominal Pain: Aortic aneurysm, appendicitis, bowel obstruction, cholecystitis/cholelithiasis and diverticulitis
2. Mental Status Change/Weakness: Cerebrovascular disease, hypoglycemia, infection, seizure, syncope and metabolic disorders
3. Chest Pain: Acute coronary syndromes, aortic dissection, pneumothorax and pulmonary embolism
4. Environmental/Travel Disorders: Chemical and thermal burns, envenomations and hypothermia/hyperthermia
5. HEENT Disorders: Infection, headache including migraine and subarachnoid hemorrhage, glaucoma, epistaxis and trauma
6. Gastrointestinal Bleeding: Upper including peptic ulcer disease and variceal, and lower including diverticulosis, hemorrhoids and malignancy
7. Poisoning/Overdose: Anion gap acidosis, decontamination, and overdoses of acetaminophen, carbon monoxide, opioids, salicylates, tricyclic antidepressants and toxic alcohols
8. Psychiatric/Behavioral: Psychosis, depression, substance abuse and suicidal ideation or attempt
9. Resuscitation/Shock: Basic airway management, cardiopulmonary resuscitation, dysrhythmia identification and treatment and first minute of a code, treatment of shock states including anaphylaxis, cardiogenic, hypovolemic and septic
10. Shortness of Breath: Airway obstruction, asthma/COPD, heart failure, pulmonary embolism, and infections including pneumonia, bronchitis, and epiglottitis
11. Traumatic Injuries: Abdomen including bowel, hepatic, and splenic injuries, chest including hemothorax, pneumothorax, and tension pneumothorax, extremities including dislocations, fractures and splinting, head injuries including epi-/subdural hematomas, neck including cervical fractures and spinal cord damage, and pediatric non-accidental trauma/domestic violence
12. OB/GYN: Abortion including complete, incomplete, inevitable and threatened, ectopic pregnancy, placenta previa and placental abruption. Infections including pelvic inflammatory disease and sexual transmitted infections
13. Wound Care: Irrigation, local anesthesia, primary closure and tetanus prophylaxis

Selected Student and Faculty Learning Resources for Emergency Medicine

In addition to the aforementioned objectives, examples of supplementary resources used by the NBOME to inform the development of the Emergency Medicine exam are listed below:

• Society for Academic Emergency Medicine (SAEM) – Emergency Medicine Clerkship Curriculum: An Update and Revision
• American Osteopathic Association (AOA) – Emergency Medicine
• American Osteopathic Association (AOA) and American College of Osteopathic Emergency Physicians – Basic Standards for Residency Training in Emergency Medicine

Practice Questions

The Emergency Medicine Practice Questions are primarily designed to assist the candidate in navigating through the examination, and it is provided to facilitate the actual testing experience. It is not designed to give the candidate a score or provide information about how a candidate might actually perform on the examination. Launch Emergency Medicine Practice Questions

Additional Resources

 

Title	Author	Edition	Year
Tintinalli's Emergency Medicine: A Comprehensive Study Guide	Tintinalli et al.	9th	2019
Rosen's Emergency Medicine: Concepts and Clinical Practice	Walls, Hockberger, & Gausche-Hill	10th	2022
Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care	Roberts et al.	7th	2018
Tintinalli's Emergency Medicine Manual	Cydulka et al.	9th	2019
An Osteopathic Approach to Diagnosis and Treatment	DiGiovanna, Amen, & Burns	4th	2020
Foundations of Osteopathic Medicine	Seffinger	4th	2019

Family Medicine

Family Medicine

Core Knowledge & Elements of Osteopathic Principles in the Discipline of Family Medicine

Content Outline and Assessment Objectives

The Family Medicine examination is designed for end-of-course or end-of-clinical rotation/clerkship assessment for students enrolled at a college of osteopathic medicine (COM). Individual COMs may also administer the examination at other times in accord with their curriculum goals and mission. This examination emphasizes core knowledge and elements of osteopathic principles and practice in the discipline of Family Medicine that are essential for the predoctoral osteopathic medical student.The exam blueprint below contains the Family Medicine topics covered in two dimensions: Dimension 1 – Patient Presentation and Dimension 2 – Physician Tasks.

Dimension 1: Patient Presentation

Topic	%
General	3–10%
Hematology/Oncology & Immune Disorders	5–15%
Genitourinary/Renal & Gynecologic/Reproductive	7-17%
Gastrointestinal	7-17%
Endocrine	5-15%
Musculoskeletal/Dermatology	7-17%
Psychiatry/Neurology	7-17%
Cardiovascular	9-20%
Respiratory	9-20%

*10-20% patients under 18 years old on each form

Dimension 2: Physician Tasks

Topic	%
Health Promotion / Disease Prevention / Health Care Delivery	5–20%
History & Physical/Diagnostic Technologies	40–60%
Management	20–40%
Scientific Understanding of Mechanisms	5–15%

*10-20% patients under 18 years old on each form

General Learner-Centered Objectives

Based on general learner-centered objectives, as outlined in the Family Medicine Examination Blueprint, the examinee will be required to demonstrate the ability to apply:

1. Foundational content knowledge to situations and patient presentations encountered in clinical settings and important to Family Medicine.
2. Foundational content knowledge and clinical problem-solving ability related to particular physician tasks critical to Family Medicine.
3. Knowledge and clinical problem-solving as related to the Fundamental Osteopathic Medical Competency Domains, including osteopathic principles and practice and OMT, osteopathic medical knowledge, interpersonal and communication skills, practice-based learning and improvement, systems-based practice, professionalism and patient care.
4. Osteopathic principles and practice in commonly encountered patient care scenarios.

Selected Specific Learner-Centered Objectives for Family Medicine

For Family Medicine, the examinee will be required to demonstrate the ability to diagnose and manage selected patient presentations and clinical situations involving, but not limited to:

1. General: Patients presenting for routine examinations, patients presenting for routine screening, patients presenting for vaccinations/preventive care and patients presenting with health care delivery concerns
2. Cardiovascular System Disorders & Presentations: Asymptomatic patient with a cardiovascular disorder, symptomatic patient with undifferentiated symptoms related to the cardiovascular system, arrhythmias, coronary artery disease, heart failure, hypertension/hypotension, left ventricular hypertrophy/cardiomyopathies, pericarditis, valvular heart disease, murmurs & congenital heart disease and vascular (venous, arterial, lymph) disorders
3. Endocrine System Disorders & Presentations: Asymptomatic patient with an endocrine disorder, symptomatic patient with undifferentiated symptoms related to the endocrine system, adrenal disease, diabetes-related issues, dyslipidemia, electrolyte & serum mineral disorders, growth/puberty & weight-related presentations, gynecologic & male hypogonadism/gynecomastia, heat/cold intolerance or heat-related conditions, osteoporosis/osteomalacia, pituitary disease and thyroid/parathyroid disease
4. Gastrointestinal System Disorders & Presentations: Asymptomatic patient with a gastrointestinal disorder, symptomatic patient with undifferentiated symptoms related to the gastrointestinal system, anorectal disorders/hernias, gastric disorders, hepatobiliary disorders, mouth/oropharynx/esophageal disorders, nutritional & vitamin deficiencies/nutritional replacement, pancreatic disorders, poisonings/ingestions/foreign bodies and small large bowel disorders
5. Genitourinary/Renal & Gynecologic/Reproductive System Disorders & Presentations: Asymptomatic patient with a GU/GYN/reproductive disorder, symptomatic patient with undifferentiated symptoms related to these systems, abnormal vaginal bleeding/menstrual-related disorders, boy's/men's health, breast disorders, contraceptive management, developmental/sexuality, incontinence, menopause/hormone replacement therapy, ovarian/uterine disorders, pregnancy-related presentations, renal disease/disorders, sexually transmitted infections, urinary tract infections and vulvovaginal & cervical disorders
6. Hematology/Oncology & Immune System Disorders & Presentations: Asymptomatic patient with a hematology/oncology or immune disorder, symptomatic patient with undifferentiated symptoms related to these systems, anemias, bleeding disorders, hypercoagulability disorders/hereditary thrombophilias/proliferative disorders, autoimmune disorders, HIV/AIDS/immune deficiencies, cancers of the blood/lymph systems, endocrine cancers, gastrointestinal cancers, genitourinary cancers, gynecologic cancers, respiratory cancers, skin cancers, bone/muscle cancers, breast cancer and neuro/ophthalmologic cancers
7. Musculoskeletal/Integumentary System Disorders & Presentations: Asymptomatic patient with a musculoskeletal or dermatologic disorder, symptomatic patient with undifferentiated symptoms related to the musculoskeletal or integumentary systems, elbow & lower arm disorders/somatic dysfunction, head & neck disorders/somatic dysfunction, hip & upper leg disorders/somatic dysfunction, lumbar, pelvic & sacral disorders/somatic dysfunction, shoulder & upper arm disorders/somatic dysfunction, thoracic and rib disorders/somatic dysfunction, wrist & hand disorders/somatic dysfunction, ankle/Foot disorders/somatic dysfunction, arthritis/vasculitis/inflammatory conditions, knee & lower leg disorders/somatic dysfunction and soft tissue syndromes Dermatology: Benign & premalignant growths/lesions, hair, nail, sweat gland & keratinization disorders, hypersensitivity/allergic/autoimmune skin disorders, infectious skin disorders, infestations/bites/burns/trauma, inflammatory skin disorders, pigmentation disorders and skin manifestations of systemic disease
8. Psychiatry/Neurology System Disorders & Presentations Asymptomatic patient with a psychiatric or neurologic disorder, symptomatic patient with undifferentiated symptoms related to the psychiatric or neurologic systems, abuse/substance abuse/eating disorders, anxiety disorders, developmental/behavioral & neurologic problems in children/adolescents, mood and adjustment disorders, personality disorders, schizophrenia & other psychotic disorders, sleep-related disorders and somatoform disorders Neurology: Cerebrovascular disease/TIA/CVA/syncope, dementia/delerium, demyelinating/degenerative & neuromuscular conditions, headaches, meningitis/infectious disorders, neuropathies/neuropathic disorders/chronic pain syndromes and seizure disorders
9. Respiratory System Disorders & Presentations Asymptomatic patient with a respiratory disorder, symptomatic patient with undifferentiated symptoms related to the respiratory system, ear disorders, eye disorders, neck/salivary gland disorders, nose/sinus disorders, oral/pharynx disorders, pulmonary infectious disorders, pulmonary obstructive disorders and pulmonary restrictive & occupational disorders, pulmonary vascular disorders & pulmonary edema

Selected Student and Faculty Learning Resources for Family Medicine

In addition to the aforementioned objectives, examples of supplementary resources used by the NBOME to inform the development of the Family Medicine exam are listed below:

• Society of Teachers of Family Medicine (STFM) – National Clerkship Curriculum
• American Association of Colleges of Osteopathic Medicine (AACOM) – Educational Council on Osteopathic Principles (ECOP)
• American Osteopathic Association (AOA) – Family Medicine
• American Osteopathic Association (AOA) and American College of Osteopathic Family Physicians (ACOFP) – Basic Standards for Residency Training in Osteopathic Family Medicine and Manipulative Treatment

Practice Questions

The Family Medicine Practice Questions are primarily designed to assist the candidate in navigating through the examination, and it is provided to facilitate the actual testing experience. It is not designed to give the candidate a score or provide information about how a candidate might actually perform on the examination. Launch Family Medicine Practice Questions

Additional Resources

Title/Site	Author	Edition	Year
Textbook of Family Medicine	Rakel	9th	2016
Current Medical Diagnosis & Treatment	Papadakis & McPhee	61st	2022
DynaMed Plus		Regularly updated
Essential Evidence Plus		Regularly updated
US Preventive Services Task Force		Regularly updated
MedU		Regularly updated
Foundations of Osteopathic Medicine	Seffinger	4th	2019
Somatic Dysfunction in Osteopathic Family Medicine	Nelson	2nd	2015
ACOFP		Regularly updated
An Osteopathic Approach to Diagnosis and Treatment	DiGiovanna, Amen, & Burns	4th	2020

Internal Medicine

Internal Medicine

Core Knowledge & Elements of Osteopathic Principles in the Discipline of Internal Medicine

Content Outline and Assessment Objectives

The Internal Medicine examination is designed for end-of-course or end-of-clinical rotation/clerkship assessment for students enrolled at a college of osteopathic medicine (COM). Individual COMs may also administer the examination at other times in accord with their curriculum goals and mission. This examination emphasizes core knowledge and elements of osteopathic principles and practice in the discipline of Internal Medicine that are essential for the predoctoral osteopathic medical student. The exam blueprint below contains the Internal Medicine topics covered in two dimensions: Dimension 1 – Patient Presentation and Dimension 2 – Physician Tasks.

Dimension 1: Patient Presentation

Topic	%
Allergy/Chemical/Skin/Miscellaneous	7–13%
Cardiovascular	7–13%
Endocrine/Nutrition/Metabolism	7–13%
Gastrointestinal	7–13%
Hematology/Oncology	7–13%
Infectious Diseases	7–13%
Neurology	7–13%
Renal/Hypertension	7–13%
Respiratory	7–13%
Rheumatology/Musculoskeletal	7–13%

Dimension 2: Physician Tasks

Topic	%
Health Promotion/Disease Prevention	5–15%
History/Physical/Diagnosis	35–55%
Management	20–35%
Scientific Mechanisms of Disease	15–25%

General Learner-Centered Objectives

Based on general learner-centered objectives, as outlined in the Internal Medicine Examination Blueprint, the examinee will be required to demonstrate the ability to apply:

1. Foundational content knowledge to situations and patient presentations encountered in clinical settings and important to Internal Medicine.
2. Foundational content knowledge and clinical problem-solving ability related to particular physician tasks critical to Internal Medicine.
3. Knowledge and clinical problem-solving as related to the Fundamental Osteopathic Medical Competency Domains, including osteopathic principles and practice and OMT, osteopathic medical knowledge, interpersonal and communication skills, practice-based learning and improvement, systems-based practice, professionalism and patient care.
4. Osteopathic principles and practice in commonly encountered patient care scenarios.

Selected Specific Learner-Centered Objectives for Internal Medicine

For Internal Medicine, the examinee will be required to demonstrate the ability to diagnose and manage selected patient presentations and clinical situations involving, but not limited to:

1. Allergy/Skin/Miscellaneous: atopic diseases, anaphylaxis, drug allergy, common dermatological conditions and skin lesions and chemical exposure
2. Cardiovascular: acute coronary syndromes, arrhythmias, chronic ischemic disease of the heart, congenital heart disease, hyperlipidemia, peripheral vascular disease, congestive heart failure, aortic dissection, valvular heart disease, pericarditis and endocarditis
3. Endocrine: weight gain/loss, adrenal disorders, diabetes mellitus, parathyroid and thyroid disturbances, pituitary disorders, disorders of the testes and women's health
4. Gastrointestinal: diseases of the upper and lower gastrointestinal tract, liver, gallbladder and pancreas; gastrointestinal disease prevention, gastrointestinal tract cancer and other gastroesophageal issues
5. Hematology/Oncology: coagulation disorders, anemia, solid tumors, hematologic malignancies and screening and disease prevention
6. Infectious diseases: commonly encountered infectious and immunological diseases and host responses, HIV infections, bioterrorism, and infectious disease treatment and prevention/prophylaxis
7. Musculoskeletal: osteoporosis, somatic dysfunction, viscerosomatic relationships, inflammatory and non-inflammatory rheumatic diseases, vasculitis, and disorders of bone and muscle
8. Neurology: brain anatomy/function, stroke, disorders of the spinal cord and peripheral nerves, disorders of cerebral function and central nervous system neoplasms
9. Renal/Hypertension: fluid and electrolyte disorders, acute renal injury, chronic kidney disease, renal calculi, glomerular and tubulointerstitial disorders, obstructive uropathy and arterial hypertension
10. Respiratory: respiratory tract cancer, asthma, chronic obstructive pulmonary disease, pneumonia, pulmonary embolism, critical care medicine and respiratory failure

Selected Student and Faculty Learning Resources for Internal Medicine

In addition to the aforementioned objectives, examples of supplementary resources used by the NBOME to inform the development of the Internal Medicine exam are listed below:

• American Osteopathic Association (AOA) and American College of Osteopathic Internists (ACOI) – Basic Standards for Residency Training in Internal Medicine

Practice Questions

The Internal Medicine Practice Questions are primarily designed to assist the candidate in navigating through the examination, and it is provided to facilitate the actual testing experience. It is not designed to give the candidate a score or provide information about how a candidate might actually perform on the examination. Launch Internal Medicine Practice Questions

Additional Resources

Title	Author	Edition	Year
Cecil Textbook of Medicine	Goldman & Schafer	26th	2019
Harrison’s Principles of Internal Medicine	Jameson, Fauci, Kasper, Hauser, Longo, & Loscalzo	21st	2022
CURRENT Medical Diagnosis & Treatment	Papadakis & McPhee	61st	2022
Resident Readiness: Internal Medicine	Klamen	1st	2013
The Washington Manual of Medical Therapeutics	Crees et al.	37th	2022
The Washington Manual of Outpatient Internal Medicine	De Fer & Sateia	3rd	2022
An Osteopathic Approach to Diagnosis and Treatment	DiGiovanna, Amen, & Burns	4th	2020
Foundations of Osteopathic Medicine	Seffinger	4th	2019

Obstetrics & Gynecology

Obstetrics / Gynecology

Core Knowledge & Elements of Osteopathic Principles in the Discipline of Obstetrics and Gynecology

Content Outline and Assessment Objectives

The Obstetrics/Gynecology examination is designed for end-of-course or end-of-clinical rotation/clerkship assessment for students enrolled at a college of osteopathic medicine (COM). Individual COMs may also administer the examination at other times in accord with their curriculum goals and mission. This examination emphasizes core knowledge and elements of osteopathic principles and practice in the discipline of Obstetrics/Gynecology that are essential for the predoctoral osteopathic medical student. The exam blueprint below contains the Obstetrics/Gynecology topics covered in two dimensions: Dimension 1 – Patient Presentation and Dimension 2 – Physician Tasks.

Dimension 1: Patient Presentation

Topic	%
Abnormal Obstetrics	20–30%
General Gynecology	25–35%
Gynecologic Oncology	5–15%
Normal Obstetrics	15–25%
Reproductive Endocrinology	10–20%

Dimension 2: Physician Tasks

Topic	%
Diagnosis & Management / Pap Smear & DNA testing	35–45%
History & Physical Examination / Communication & Interaction	40–50%
Preventive Care / Health Maintenance	10–15%
Secondary Overarching Topics	1–5%

General Learner-Centered Objectives

Based on general learner-centered objectives, as outlined in the Obstetrics/Gynecology Examination Blueprint, the examinee will be required to demonstrate the ability to apply:

1. Foundational content knowledge to situations and patient presentations encountered in clinical settings and important to Obstetrics/Gynecology.
2. Foundational content knowledge and clinical problem-solving ability related to particular physician tasks critical to Obstetrics/Gynecology.
3. Knowledge and clinical problem-solving as related to the Fundamental Osteopathic Medical Competency Domains, including osteopathic principles and practice and OMT, osteopathic medical knowledge, interpersonal and communication skills, practice-based learning and improvement, systems-based practice, professionalism and patient care.
4. Osteopathic principles and practice in commonly encountered patient care scenarios.

Selected Specific Learner-Centered Objectives for Obstetrics/Gynecology

For Obstetrics and Gynecology, the examinee will be required to demonstrate the ability to diagnose and manage selected patient presentations and clinical situations involving, but not limited to:

1. Abnormal Obstetrics: abnormal labor, spontaneous abortion, ectopic pregnancy and third-trimester bleeding
2. General Gynecology: normal gynecology, family planning, adolescent issues and development, issues of domestic violence and sexual assault, breast diseases, vulvar/vaginal diseases, sexually transmitted infections, urinary tract disorders, screening and preventive care, menstrual cycle and premenstrual syndrome, somatic dysfunction and viscerosomatic relationships
3. Gynecologic Oncology: cervical, uterine and ovarian disease and neoplasm and gestational trophoblastic neoplasia
4. Normal Obstetrics: preconception, antepartum, intrapartum, and postpartum care; history and physical examination; maternal-fetal physiology; preventive care, nutrition and lactation
5. Reproductive Endocrinology: menopause, normal/abnormal uterine bleeding, and infertility

Selected Student and Faculty Learning Resources for Obstetrics/Gynecology

In addition to the aforementioned objectives, examples of supplementary resources used by the NBOME to inform the development of the Obstetrics/Gynecology exam are listed below:

• Association of Professors of Gynecology and Obstetrics (APGO) – Medical Student Educational Objectives for Students

Practice Questions

The Obstetrics and Gynecology Practice Questions are primarily designed to assist the candidate in navigating through the examination, and it is provided to facilitate the actual testing experience. It is not designed to give the candidate a score or provide information about how a candidate might actually perform on the examination. Launch Obstetrics and Gynecology Practice Questions

Additional Resources

Title	Author	Edition	Year
Comprehensive Gynecology	Lobo, Gershenson, & Lentz	8th	2021
Gabbe's Obstetrics: Normal and Problem Pregnancies	Landon et al.	8th	2020
Essentials of Obstetrics and Gynecology	Hacker	6th	2016
An Osteopathic Approach to Diagnosis and Treatment	DiGiovanna, Amen, & Burns	4th	2020
Foundations of Osteopathic Medicine	Seffinger	4th	2019

Osteopathic Principles & Practice

Osteopathic Principles & Practice

Core Knowledge & Elements of Osteopathic Principles

Content Outline and Assessment Objectives

The Osteopathic Principles and Practice examination is designed for end-of-course or end-of-clinical rotation/clerkship assessment for students enrolled at a college of osteopathic medicine (COM). Individual COMs may also administer the examination at other times in accord with their curriculum goals and mission. This examination emphasizes core knowledge and elements of osteopathic principles and practice in the discipline of Osteopathic Principles and Practice that are essential for the predoctoral osteopathic medical student. The exam blueprint below contains Osteopathic Principles and Practice topics related to concept & philosophy, diagnosis, and treatment methods.

Blueprint

Topic	%
Osteopathic Concept & Philosophy Osteopathic Philosophy & Musculoskeletal Structure/Function Vascular, Lymphatic, & Neurologic Structure/Function	11–35%
Osteopathic Diagnosis Chapman's Reflexes, Cranium, Abdomen, Ribs Cervical, Thoracic, & Lumbar Spine; Pelvis and Sacrum; Lower Extremities & Upper Extremities	22–52%
Osteopathic Treatment Methods Articulatory, Facilitated Positional Release, Still Technique, Balance Ligamentous Technique, Functional Technique,  Indirect, Exercise Therapy, Soft Tissue, & Myofascial Release Muscle Energy, HVLA (High-Velocity – Low-Amplitude) Manipulation, Counterstrain, Cranial Somatovisceral (Autonomic-Oriented Techniques), Visceral, Lymphatic	24–56%

General Learner-Centered Objectives

Based on general learner-centered objectives, as outlined in the Osteopathic Principles and Practice Examination Blueprint, the examinee will be required to demonstrate the ability to apply:

1. Foundational content knowledge to situations and patient presentations encountered in clinical settings and important to Osteopathic Principles and Practice.
2. Foundational content knowledge and clinical problem-solving ability related to particular physician tasks critical to Osteopathic Principles and Practice.
3. Knowledge and clinical problem-solving as related to the Fundamental Osteopathic Medical Competency Domains, including osteopathic principles and practice and OMT, osteopathic medical knowledge, interpersonal and communication skills, practice-based learning and improvement, systems-based practice, professionalism and patient care.
4. Osteopathic principles and practice in commonly encountered patient care scenarios.

Selected Specific Learner-Centered Objectives for Osteopathic Principles and Practice

For Osteopathic Principles and Practice, the examinee will be required to demonstrate the ability to diagnose and manage selected patient presentations and clinical situations involving, but not limited to:

1. Osteopathic concept and philosophy: osteopathic tenets, musculoskeletal structure and function, somatic nerve structure, and lymphatic drainage
2. Osteopathic diagnosis: observation, palpation, and range-of-motion testing of the lower/upper extremities, cervical/thoracic/lumbar spine, pelvis/sacrum, head, abdomen, and ribs
3. Osteopathic treatment methods: counterstrain, muscle energy, myofascial release, high velocity low amplitude (HVLA), soft tissue, lymphatic technique, cranial osteopathic manipulative medicine, articulatory techniques, balanced ligamentous tension, ligamentous articular strain, facilitated positional release, Still technique, visceral technique, Chapman reflexes, and trigger points

Throughout these three categories, examinees will be required to demonstrate the ability to:

1. Discuss the basic principles of the osteopathic philosophy and describe the impact on the health care delivery of osteopathic physicians.
2. Discuss the scientific knowledge supporting the utilization of osteopathic principles and practices and osteopathic manipulative treatment (OMT), including the basic science of the mechanisms of OMT and somatic dysfunction, and the current evidence base for the clinical application of OMT.
3. Define the types of physical examination findings consistent with somatic dysfunction.
4. Define and describe the types of somatic dysfunction found within the ten body regions, including the head, cervical, thoracic, rib, lumbar, pelvic, sacral, abdominal, upper extremity and lower extremity body regions.
5. Describe the symptoms and physical findings consistent with viscerosomatic, somatovisceral and somatosomatic reflexes.
6. Define and describe indirect and direct types of OMT, including articulatory, balanced ligamentous tension, counterstrain, cranial osteopathic manipulative medicine, muscle energy, high velocity low amplitude (HVLA), visceral, lymphatic, exercise therapy, soft tissue and myofascial release techniques.
7. Describe the basic principles of treatment of functional technique, facilitated positional release, ligamentous articular strain and Still techniques.
8. Discuss the indications and contraindications of different types of OMT.
9. Discuss the relative value, advantages and disadvantages of different types of OMT.
10. Correctly diagnose somatic dysfunction within the ten body regions, prioritize a differential diagnosis and develop an appropriate care plan.
11. Effectively communicate with patients and their families regarding risks, benefits and alternatives associated with the use of OMT.
12. Maintain the safety and dignity of the patient while administering OMT.
13. Identify viscerosomatic relationships and the role of the musculoskeletal system in health and disease by performing a structural examination and documenting findings reflective of this relationship.
14. Show sensitivity to ethnic diversity as it may impact on the presentation of somatic and/or visceral dysfunctions.

Selected Student and Faculty Learning Resources for Osteopathic Principles and Practice

In addition to the aforementioned objectives, examples of supplementary resources used by the NBOME to inform the development of the Osteopathic Principles and Practice exam are listed below:

• American Association of Colleges of Osteopathic Medicine (AACOM) – Educational Council on Osteopathic Principles (ECOP)

Practice Questions

The Practice Questions for Osteopathic Principles and Practice are primarily designed to assist the candidate in navigating through the examination, and it is provided to facilitate the actual testing experience. It is not designed to give the candidate a score or provide information about how a candidate might actually perform on the examination.

  Launch OPP Practice Questions

Additional Resources

Title	Author/Site	Edition	Year
An Osteopathic Approach to Diagnosis and Treatment	DiGiovanna, Amen, & Burns	4th	2020
Atlas of Osteopathic Techniques	Nicholas	3rd	2015
Foundations of Osteopathic Medicine	Seffinger	4th	2019
Glossary of Osteopathic Terminology	ECOP/AACOM		2017
Greenman's Principles of Manual Medicine	DeStefano	5th	2016
Osteopathic Core Competencies for Medical Students	AACOM		2012
Somatic Dysfunction in Osteopathic Family Medicine	Nelson	2nd	2014

Pediatrics

Pediatrics

Core Knowledge & Elements of Osteopathic Principles in the Discipline of Pediatrics

Content Outline and Assessment Objectives

The Pediatrics examination is designed for end-of-course or end-of-clinical rotation/clerkship assessment for students enrolled at a college of osteopathic medicine (COM). Individual COMs may also administer the examination at other times in accord with their curriculum goals and mission. This examination emphasizes core knowledge and elements of osteopathic principles and practice in the discipline of Pediatrics that are essential for the predoctoral osteopathic medical student. The exam blueprint below contains the Pediatrics topics covered in two dimensions: Dimension 1 – Patient Presentation and Dimension 2 – Physician Tasks.

Dimension 1: Patient Presentation

Topic	%
Cardiology/Respiratory	18-25%
CNS – Behavior/Psychiatry	10-16%
Endocrine/Metabolism	4-8%
Gastrointestinal	8-14%
Genitourinary	6-10%
HEENT	6-10%
Hematology/Oncology/Lymphatics	6-10%
Musculoskeletal/OPP (Osteopathic Principles & Practice)	6-10%
Growth & Development	10-16%
Skin	6-10%

Dimension 2: Physician Tasks

Topic	%
Diagnostic Technologies	15–25%
Health Promotion/Disease Prevention/Health Care Delivery	10–20%
History & Physical	35–50%
Management	10–20%
Scientific Mechanisms of Disease	5–10%

General Learner-Centered Objectives

Based on general learner-centered objectives, as outlined in the Pediatrics Examination Blueprint, the examinee will be required to demonstrate the ability to apply:

1. Foundational content knowledge to situations and patient presentations encountered in clinical settings and important to Pediatrics.
2. Foundational content knowledge and clinical problem-solving ability related to particular physician tasks critical to Pediatrics.
3. Knowledge and clinical problem-solving as related to the Fundamental Osteopathic Medical Competency Domains, including osteopathic principles and practice and OMT, osteopathic medical knowledge, interpersonal and communication skills, practice-based learning and improvement, systems-based practice, professionalism and patient care.
4. Osteopathic principles and practice in commonly encountered patient care scenarios.

Selected Specific Learner-Centered Objectives for Pediatrics

For Pediatrics, the examinee will be required to demonstrate the ability to diagnose and manage selected patient presentations and clinical situations involving, but not limited to:

1. Cardiology/Respiratory: congenital disorders, neonatal respiratory distress, vascular diseases, and infectious diseases and other inflammatory conditions affecting the respiratory and cardiovascular systems
2. CNS-Behavior/Psychiatry: common behavioral problems, including sleep and colic in infants; tantrums, feeding issues, and potty training in toddlers; attention deficit disorder, encopresis, and oppositional defiant disorder in school-aged children; eating disorders, substance use/abuse, and conduct disorders in adolescents; pervasive developmental disorders, mood and anxiety disorders and headache
3. Endocrine/Metabolism: nutrition, diabetes, abnormal growth, thyroid disorders and menstrual disorders
4. Gastrointestinal: nutrition, obesity, failure to thrive, digestive difficulties, abdominal pain and infectious diseases affecting the gastrointestinal system
5. HEENT: allergies, dental health, congenital anomalies, and ophthalmic and otorhinolaryngologic disorders
6. Hematology/Lymphatics: common anemias, lymphadenopathy, immune system disorders, bleeding disorders, malignancies and toxicity
7. Integument: rashes, lesions and neonatal skin conditions
8. Musculoskeletal/OPP: structural disorders, sports medicine, trauma, somatic dysfunction, viscerosomatic relationships, infectious diseases affecting the musculoskeletal system and rheumatology
9. Normal Growth and Development: developmental milestones (e.g., Denver Developmental examination), puberty and the sequence of physical changes in development (e.g., Tanner scale), health promotion, variants of normal growth in healthy children, screening and disease and injury prevention, and anticipatory guidance and immunizations for newborns, infants, toddlers, school-aged children and adolescents
10. Renal/Urinary: congenital abnormalities, urinary tract infections, laboratory abnormalities and nephropathy and neoplasms affecting the renal system

Selected Student and Faculty Learning Resources for Pediatrics

In addition to the aforementioned objectives, examples of supplementary resources used by the NBOME to inform the development of the Pediatrics exam are listed below:

• American Osteopathic Association (AOA) – Pediatrics
• American Osteopathic Association (AOA) and American College of Osteopathic Pediatricians (ACOP) – Basic Standards for Residency Training in Pediatrics

Practice Questions

The Pediatrics Practice Questions are primarily designed to assist the candidate in navigating through the examination, and it is provided to facilitate the actual testing experience. It is not designed to give the candidate a score or provide information about how a candidate might actually perform on the examination. Launch Pediatrics Practice Questions

Additional Resources

Title	Author	Edition	Year
Nelson's Textbook of Pediatrics	Kliegman & Geme	21st	2019
The Harriet Lane Handbook of Pediatrics	Johns Hopkins Hospital	22nd	2020
An Osteopathic Approach to Diagnosis and Treatment	DiGiovanna, Amen, & Burns	4th	2020
An Osteopathic Approach to Children	Carreiro	2nd	2009
Foundations of Osteopathic Medicine	Seffinger	4th	2019

Psychiatry

Psychiatry

Core Knowledge & Elements of Osteopathic Principles in the Discipline of Psychiatry

Content Outline and Assessment Objectives

The Psychiatry examination is designed for end-of-course or end-of-clinical rotation/clerkship assessment for students enrolled at a college of osteopathic medicine (COM). Individual COMs may also administer the examination at other times in accord with their curriculum goals and mission. This examination emphasizes core knowledge and elements of osteopathic principles and practice in the discipline of Psychiatry that are essential for the predoctoral osteopathic medical student. The exam blueprint below contains the Psychiatry topics covered in two dimensions: Dimension 1 – Patient Presentation and Dimension 2 – Physician Tasks.

Dimension 1: Patient Presentation

Topic	%
Anxiety Disorders/Trauma and Stressor Related Disorders/Dissociative Disorders/Obsessive Compulsive and Related Disorders/Adjustment Disorders	14–20%
Neurocognitive Disorders	9–15%
Neurodevelopmental Disorders/Gender Dysphoria/Disruptive, Impulse-Control and Conduct Disorders	9–15%
Depressive, Bipolar and Related Disorders	20–25%
Personality Disorders	4–8%
Psychiatric Illness Due to Another Medical Condition	4–6%
Schizophrenia Spectrum and Other Psychotic Disorders	5–12%
Somatic-Symptom and Related Disorders	4-9%
Substance-Related and Addictive Disorders/Feeding, Eating and Elimination Disorders/Sexual Dysfunctions and Paraphilic Disorders	5–10%
Sleep-Wake Disorders	2–5%

Dimension 2: Physician Tasks

Topic	%
Health Promotion Disease Prevention/Health Care Delivery	5–20%
History & Physical	25–45%
Management	25–45%
Scientific Understanding of Mechanisms	10–25%

General Learner-Centered Objectives

Based on general learner-centered objectives, as outlined in the Psychiatry Examination Blueprint, the examinee will be required to demonstrate the ability to apply:

1. Foundational content knowledge to situations and patient presentations encountered in clinical settings and important to Psychiatry.
2. Foundational content knowledge and clinical problem-solving ability related to particular physician tasks critical to Psychiatry.
3. Knowledge and clinical problem-solving as related to the Fundamental Osteopathic Medical Competency Domains, including osteopathic principles and practice and OMT, osteopathic medical knowledge, interpersonal and communication skills, practice-based learning and improvement, systems-based practice, professionalism and patient care.
4. Osteopathic principles and practice in commonly encountered patient care scenarios.

Selected Specific Learner-Centered Objectives for Psychiatry

For Psychiatry, the examinee will be required to demonstrate the ability to diagnose and manage selected patient presentations and clinical situations involving, but not limited to:

1. Common Psychiatric Conditions: disorders presenting in the pediatric age group; delirium, dementia, amnestic and related disorders; schizophrenia and related disorders, psychiatric illness due to a general medical condition, somatic dysfunction in psychiatric conditions, substance-related disorders, eating disorders, sexual disorders, mood disorders, anxiety disorders, somatoform disorders, adjustment disorders and personality disorders
2. Health Promotion/Disease Prevention/Health Care Delivery: assessment of dangerousness, genetic counseling, cross-cultural issues, physician-patient relationship, health care financing and cost effectiveness, and medical ethics
3. History and Physical Examination: assessment methods (laboratory, neuroimaging, neurophysiologic, and psychological testing), interviewing, rating scales, assessment of physical findings and historical information, mental status examination, structural examination and DSM diagnosis
4. Management: evidence-based decision making, psychosocial interventions, clinical psychopharmacology and related somatic treatments such as electroconvulsive therapy, treatment complications, osteopathic manipulative treatment and treatment guidelines/best practices
5. Scientific Understanding of Health and Disease Mechanisms: mental health epidemiology, psychosocial foundations, neurobiological foundations, epigenetics, viscerosomatic relationships and other osteopathic principles

Selected Student and Faculty Learning Resources for Psychiatry

In addition to the aforementioned objectives, examples of supplementary resources used by the NBOME to inform the development of the Psychiatry exam are listed below:

• Association of Directors of Medical Student Education in Psychiatry (ADMSEP) – Educational Objectives for a Junior Psychiatry Clerkship
• American Association of Colleges of Osteopathic Medicine (AACOM) – Educational Council on Osteopathic Principles (ECOP)
• American Osteopathic Association (AOA) – Neurology and Psychiatry

Practice Questions

The Psychiatry Practice Questions are primarily designed to assist the candidate in navigating through the examination, and it is provided to facilitate the actual testing experience. It is not designed to give the candidate a score or provide information about how a candidate might actually perform on the examination. Launch Psychiatry Practice Questions

Additional Resources

Title	Author	Edition	Year
Diagnostic and Statistical Manual of Mental Disorders (DSM)	APA	5th (DSM-5)	2013
Synopsis of Psychiatry	Kaplan & Saddock	12th	2021
Introductory Textbook of Psychiatry	Black & Andreasen	7th	2020
An Osteopathic Approach to Diagnosis and Treatment	DiGiovanna, Amen, & Burns	4th	2020
Foundations of Osteopathic Medicine	Seffinger	4th	2019

Surgery

Surgery

Core Knowledge & Elements of Osteopathic Principles in the Discipline of Surgery

Content Outline and Assessment Objectives

The Surgery examination is designed for end-of-course or end-of-clinical rotation/clerkship assessment for students enrolled at a college of osteopathic medicine (COM). Individual COMs may also administer the examination at other times in accord with their curriculum goals and mission. This examination emphasizes core knowledge and elements of osteopathic principles and practice in the discipline of Surgery that are essential for the predoctoral osteopathic medical student. The exam blueprint below contains Surgery topics covered in Dimension 1 – Patient Presentation.

Dimension 1: Patient Presentation

Topic	%
Endocrine/Breast	5–13%
Fluids	5 - 12%
Gastrointestinal	26–35%
Hepato/Biliary	13–20%
Hernias	5-13%
Infections	4–8%
Skin/Subcutaneous Tissues	4 - 8%
Trauma	5–12%

General Learner-Centered Objectives

Based on general learner-centered objectives, as outlined in the Surgery Examination Blueprint, the examinee will be required to demonstrate the ability to apply:

1. Foundational content knowledge to situations and patient presentations encountered in clinical settings and important to Surgery.
2. Foundational content knowledge and clinical problem-solving ability related to particular physician tasks critical to Surgery.
3. Knowledge and clinical problem-solving as related to the Fundamental Osteopathic Medical Competency Domains, including osteopathic principles and practice and OMT, osteopathic medical knowledge, interpersonal and communication skills, practice-based learning and improvement, systems-based practice, professionalism and patient care.
4. Osteopathic principles and practice in commonly encountered patient care scenarios.

Selected Specific Learner-Centered Objectives for Surgery

For Surgery, the examinee will be required to demonstrate the ability to diagnose and manage selected patient presentations and clinical situations involving, but not limited to:

1. Abdominal defects and hernias in the adult and pediatric patient
2. Endocrine and breast and related issues: thyroid, parathyroid, adrenal, pancreas, pituitary and other glands; surgical issues of the breasts
3. Fluids: shock, fluid and electrolytes, surgical nutrition, coagulation and blood
4. Gastrointestinal and related issues: esophagus, diaphragm, stomach, duodenum, small intestine, large intestine, rectum, and appendix
5. General surgical issues in urology, gynecology, and pediatrics
6. Hepatobiliary and related issues: pancreas, biliary tract, liver and spleen
7. Osteopathic principles and practice in surgical care: somatic dysfunction, viscerosomatic relationships and osteopathic manipulative treatment techniques
8. Surgical oncology and surgical pathology
9. Trauma: musculoskeletal injury and fractures; blunt and penetrating chest injury diagnosis and care
10. Wounds and infections: skin and subcutaneous tissues, immunology and transplantation

Selected Student and Faculty Learning Resources for Surgery

In addition to the aforementioned objectives, examples of supplementary resources used by the NBOME to inform the development of the Surgery exam are listed below:

• Association for Surgical Education (ASE) – The Manual of Surgical Objectives, 4th Edition
• American Association of Colleges of Osteopathic Medicine (AACOM) – Educational Council on Osteopathic Principles (ECOP)
• American Osteopathic Association (AOA) – Surgery
• American Osteopathic Association (AOA) and the American College of Osteopathic Surgeons (ACOS) – Basic Standards for Residency Training in Surgery and the Surgical Subspecialties

Practice Questions

The Surgery Practice Questions are primarily designed to assist the candidate in navigating through the examination, and it is provided to facilitate the actual testing experience. It is not designed to give the candidate a score or provide information about how a candidate might actually perform on the examination. Launch Surgery Practice Questions

Additional Resources

Title	Author	Edition	Year
Essentials of General Surgery and Surgical Specialties	Lawrence	6th	2018
Sabiston Textbook of Surgery	Townsend	21st	2021
Schwartz's Principles of Surgery	Brunicardi	11th	2019
An Osteopathic Approach to Diagnosis and Treatment	DiGiovanna, Amen, & Burns	4th	2020
Foundations of Osteopathic Medicine	Seffinger	4th	2019

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