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COMAT FBS Comprehensive

This summative and formative assessment is designed to assess first and second year osteopathic medical student knowledge in the foundational biomedical sciences as they prepare for COMLEX-USA Level 1. It may also be used by other health professional schools for formative purposes.

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The exam is given in two separate timed sections of 100 items each - 2 hours per section. There is an optional break halfway through the exam, the length of which is up to each COM’s discretion. Unused test time from section 1 will not be added to section 2. The FBS Comprehensive exam is offered in multiple forms, and all are psychometrically equivalent in content covered, level of difficulty, and reliability, allowing COMs to administer the FBS exams multiple times per year.

Exam Blueprint

Content Outline and Assessment Objectives

The FBS Comprehensive examination may be used for end-of-course 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 foundational biomedical sciences disciplines that are essential for the predoctoral osteopathic medical student.

The exam blueprint below contains the FBS topics covered in two dimensions: Dimension 1 – Body Systems and Dimension 2 – Disciplines.

Dimension 1: Body Systems

Topic %
Human Development, Reproduction, and Sexuality 3-9%
Endocrine System and Metabolism 8-12%
Nervous System and Mental Health 12-20%
Musculoskeletal System 8-12%
Genitourinary/Renal System 6-10%
Gastrointestinal (GI) System and Nutritional Health 8-12%
Cardiovascular and Hematologic Systems 10-15%
Respiratory System 9-14%
Integumentary System 3-6%
Foundational Biomedical Principles 12-17%

Dimension 2: Disciplines Blueprint

Topic %
Biochemistry and Genetics 12-20%
Foundational Anatomical Sciences 12-20%
Microbiology and Immunology 12-20%
Physiologic Basis of Health and Disease 12-20%
Pharmacologic Principles and Concepts 12-20%
Foundational Neurosciences 12-20%

General Learner-Centered Objectives

Based on the general learner-centered objectives outlined in the FBS 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 foundational biomedical science disciplines.
  2. Foundational content knowledge and clinical problem-solving ability related to physician tasks critical to medical practice.
  3. Knowledge and clinical problem-solving as related to the application of knowledge for medical practice in the Fundamental Osteopathic Medical Competency Domains.

Selected Specific Learning Elements

Please note that selected specific learning elements are included for disciplines only due to the overlap between these learning elements and what would be included with body systems.


  1. Apply knowledge of the structure and characteristics of biological molecules to predict normal and pathological function.
  2. Describe the structure and function of cellular components related to biochemical function.
  3. Apply knowledge of cellular responses to injury, and the underlying etiology, biochemical and molecular alterations, to assess therapeutic interventions.
  4. Explain how the regulation of major metabolic pathways and the synthesis/degradation of macromolecules function to maintain health. Identify major forms of dysregulation in disease.
  5. Describe and apply principles of bioenergetics and energy metabolism.
  6. Describe digestion, absorption, transport, and metabolism of nutrients in health and disease states.
  7. Describe measures of the application of principles to populations and individuals including prevalence, incidence, sensitivity, specificity, predictive value, and confidence intervals.
  8. Identify genetic disorders, genetic risk, principles of inheritance, occurrence, and explain mechanisms of testing, therapy, and counseling.
  9. Identify gene function: structure, replication, transcription, translation, exchange, and the functional and/or morphologic expression of the genetic condition.
  10. Describe cell signaling including receptors, ligands, and signaling cascades and their effects on cells.
  11. Describe the normal function of blood cells and other blood components as well as various hematological disorders, including anemias, coagulopathies, and jaundice.


  1. Distinguish between the normal and abnormal development at the level of the cell, tissue, organ, system, and organism.
  2. Identify anatomical processes as they relate to sex and reproduction.
  3. Identify microscopic and gross anatomical structures, functions, and their interrelationships in health and disease based on assessments, including imaging and examination.
  4. Recognize the clinical significance of the structural and functional neuroanatomy of the peripheral nervous system, including motor, sensory, sympathetic, and parasympathetic systems.
  5. Recognize the clinical significance of the organization of blood supply, venous drainage, and lymphatic systems as they relate to the constituents of each anatomical compartment or cavity.


  1. Understand the key elements of the innate and adaptive immune responses.
  2. Understand the principles of immunodiagnostic assays and immunotherapies.
  3. Identify the process leading to the activation of the immune system and its effector mechanisms.
  4. Understand the immune responses to control infectious agents; the development of immunologically mediated diseases; and the immune response to transplants and cancer.
  5. Specify the mechanisms of action of physical and chemical methods used to control microbial growth.
  6. Recognize the methodology used for the isolation and identification of microbial pathogens.
  7. Understand the following aspects of diseases caused by microbial pathogens:
    1. Epidemiology and mode of transmission
    2. Unique structural and life cycle characteristics of each pathogen
    3. Mechanisms of pathogenesis
    4. Primary disease manifestations
    5. Diagnostic methodology
    6. Mechanism of treatment and prevention


  1. Explain the physiological basis of cell excitability, general principles of synaptic transmission, and mechanisms underlying the neuromuscular junction.
  2. Explain mechanisms of muscle contraction, excitation-contraction coupling, and distinguishing characteristics of smooth, cardiac, and skeletal muscle function.
  3. Explain the normal function and regulation of the following systems: cardiovascular, pulmonary, endocrine, renal, gastrointestinal, and reproductive.
  4. Describe physiological responses to acid-base disturbances.
  5. Explain the integrative physiological mechanisms involved in the regulation of extracellular fluid volume and composition.
  6. Explain the compensatory responses to physiological stressors.
  7. Explain reflex control mechanisms including humoral and neural feedback and feedforward mechanisms underlying homeostasis and their alterations in disease.


  1. Apply knowledge of pharmacokinetics and pharmacodynamic concepts to ensure safe and effective drug prescribing with consideration of human health and disease.
  2. Describe mechanisms of action, target organ responses, and homeostatic responses to drugs.
  3. Identify indications and contraindications of pharmacotherapy, and monitor response for efficacy and adverse outcomes.
  4. Determine optimal drug therapy based on an understanding of relevant medical literature, pertinent research, regulatory processes, and pharmacoeconomics.
  5. Apply knowledge of individual variability to select therapeutic regimens and monitor response for efficacy and adverse outcomes.


  1. Apply principles of neuroanatomy at the cellular and organ level to evaluate normal and pathologic presentations:
    1. Identify neuroanatomical structures in normal and abnormal conditions.
    2. Utilize neurological exam findings to localize lesions.
    3. Locate and describe the various neurotransmitter systems.
    4. Use various imaging modalities to identify major anatomical landmarks.
    5. Describe the structural and functional neuroanatomy of the spinal cord, brain, brainstem, and cerebral cortex in normal and pathological states.
    6. Relate disruptions in blood supply to clinical presentations.
  2. Apply principles of the neuroanatomic sciences at the cellular, tissue, and organ level to evaluate pathologic presentations.
    1. Identify gross structures in abnormal conditions.
    2. Apply neurological examination principles to the pathologic condition.
    3. Describe imaging and specimen assessment of gross structures.
    4. Relate anatomical changes to clinical presentation.
    5. Apply osteopathic principles and practice to the evaluation of neural dysfunction.

Selected Student and Faculty Learning Resources

In addition to the aforementioned objectives, examples of supplementary resources used by the NBOME to inform the development of the FBS exams are listed below.


Title Author/Editor Edition Year
Atlas of Anatomy Gilroy, et al. 4th 2020
Atlas of Human Anatomy Netter 7th 2019
Snell’s Clinical Anatomy by Regions Wineski 10th 2019
Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation Frontera & Silver 4th 2020
Gray's Anatomy for Students Drake, Vogl, & Mitchell 4th 2019
Gray's Anatomy: the Anatomical Basis of Clinical Practice Standring 42nd 2020
Histology: A Text and Atlas Pawlina & Ross 8th 2018
Junquiera's Basic Histology Text and Atlas Mescher 16th 2022
Langman's Medical Embryology Sadler 14th 2018
Clinically Oriented Anatomy Moore, Dalley, & Agur 9th 2022
Neuroanatomy through Clinical Cases Blumenfeld 3rd 2021

Biochemistry and Genetics

Title Author/Editor Edition Year
Harper's Illustrated Biochemistry Rodwell, et al 32nd 2022
Lippincott Illustrated Reviews: Biochemistry Ferrier 8th 2021