Core Knowledge & Elements of Osteopathic Principles in the Disciplines of Foundational Biomedical Sciences

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 pre-doctoral 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	5-10%
Endocrine System and Metabolism	5-10%
Nervous System and Mental Health	10-15%
Musculoskeletal System	8-12%
Genitourinary/Renal System	6-12%
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

Topic	%
Molecular, Biochemical, Tissue, and Cellular Basis of Health and Disease, including Medical 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

Biochemistry

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.

Anatomy

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.

Microbiology

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

Physiology

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.

Pharmacology

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.

Neuroscience

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.

Anatomy

Title	Author/Editor	Edition	Year
Atlas of Anatomy	Gilroy, MacPherson, & Ross	1st	2008
Atlas of Human Anatomy	Netter	5th	2011
Clinical Anatomy by Regions	Snell	9th	2012
Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation	Frontera, Silver, & Rizzo	3rd	2015
Gray's Anatomy for Students	Drake, Vogl, & Mitchell	2nd	2012
Gray's Anatomy: the Anatomical Basis of Clinical Practice	Standring	41st	2016
Histology: A Text and Atlas	Ross & Pawlina	7th	2015
Junquiera's Basic Histology Text and Atlas	Mescher	14th	2016
Langman's Medical Embryology	Sadler	13th	2015
Moore Clinically Oriented Anatomy	Moore, Dalley, & Agur	7th	2013
Neuroanatomy through Clinical Cases	Blumenfeld	2nd	2011

Biochemistry and Genetics

Title	Author/Editor	Edition	Year
Harper's Illustrated Biochemistry	Rodwell, Bender, Botham, Kennelly, & Weil	30th	2015
Lippincott Illustrated Reviews: Biochemistry	Ferrier	7th	2017
Mark's Basic Medical Biochemistry	Lieberman & Marks	5th	2017
Medical Genetics	Jorde, Carey, & Bamshad	5th	2015
Thompson & Thompson Genetics in Medicine	Nussbaum	8th	2015

Clinical Medicine

Title	Author/Editor	Edition	Year
AccessMedicine	Numerous titles
Current Medical Diagnosis & Treatment	Papadakis	55th Edition	2016
Cecil Textbook of Medicine	Goldman	25th Edition	2016
DynaMed Plus	Regularly updated
Textbook of Family Medicine	Rakel	9th Edition	2016
Harrison’s Principles of Internal Medicine	Kasper	19th Edition	2015
Nelson's Textbook of Pediatrics	Kliegman	20th Edition	2015
Essentials of Obstetrics and Gynecology	Hacker	6th Edition	2016
Tintinalli's Emergency Medicine: A Comprehensive Study Guide	Tintinalli et al.	8th Edition	2016
Diagnostic and Statistical Manual of Mental Disorders (DSM)	APA	5th Edition (DSM-5)	2013
Synopsis of Psychiatry	Kaplan & Saddock	11th Edition	2014

Microbiology and Immunology

Title	Author/Editor	Edition	Year
Jawetz, Melnick, and Adelberg’s Medical Microbiology	Carroll, Butel, & Morse	27th	2016
Medical Microbiology	Murray, Rosenthal, & Pfaller	8th	2016
Principles and Practice of Infectious Diseases; Volume 1	Mandell, Bennett, & Dolin	8th	2015
Principles and Practice of Infectious Diseases; Volume 2	Mandell, Bennett, & Dolin	8th	2015
The Sanford Guide to Antimicrobial Therapy	Gilbert, Moellering, Eliopoulos, Chambers, & Saag	45th	2015
Cellular and Molecular Immunology	Abbas, Lichtman, and Pillai	9th	2018
Immunology	Male, Brostoff, & Roth	8th	2013
Janeway’s Immunobiology	Murphy & Weaver	9th	2016

Neuroscience and Neurology

Title	Author/Editor	Edition	Year
Basic Clinical Neuroscience	Young, Young, Tolbert	3rd	2015
The Central Nervous System	Brodal	5th	2016
Clinical Neuroanatomy	Snell	7th	2010
Essential Neuroscience	Siegel & Sapru	3rd	2015
Fundamental Neuroscience	Haines	4th	2013
Neuroanatomy in Clinical Context	Haines	9th	2015
Neuroanatomy through Clinical Cases	Blumenfeld	2nd	2011
Adams and Victor's Principles of Neurology	Ropper & Samuels	10th	2014
Bradley's Neurology in Clinical Practice; Volumes 1 & 2	Jankovic, Mazziotta, Pomeroy, & Daroff	7th	2016
Localization in Clinical Neurology	Brazis, Masdeu, & Biller	7th	2016
Orthopaedic Neurology: A Diagnostic Guide to Neurologic Levels	Hoppenfeld	1st	1997
Practical Neurology	Biller	4th	2012

Pharmacology

Title	Author/Editor	Edition	Year
Basic and Clinical Pharmacology	Katzung & Trevor	14th	2018
Drug Facts and Comparisons	Kastrup	70th	2016
Goodman & Gilman's The Pharmacological Basis of Therapeutics	Brunton, Chabner, & Knollman	13th	2018
Lippincott's Illustrated Reviews: Pharmacology	Whalen, Finkel, & Panavelil	6th	2015
Pharmacotherapy: A Pathophysiologic Approach	Dipiro, Talbert, Yee, Matzke, Wells, & Posey	9th	2014
Stahl's Essential Psychopharmacology	Stahl	4th	2013

Physiology

Title	Author/Editor	Edition	Year
Berne & Levy Physiology	Koeppen, Stanton	7th	2018
Ganong's Review of Medical Physiology	Barrett, Barman, Boitano, & Brooks	25th	2016
Guyton and Hall Textbook of Medical Physiology	Hall	13th	2016
Medical Physiology	Boron & Boulpaep	3rd	2016
Physiology	Costanzo	6th	2017

Additional References

Following are select resources related to the foundational biomedical sciences disciplines:

Biochemistry

• DNA Replication Objectives. Association of Biochemistry Educators. 2011.
• Blood Objectives. ABE. 2011.
• Carbohydrate Metabolism Objectives. ABE. 2011.
• Lipid Metabolism Objectives. ABE. 2011.
• Signaling Hormones and Diabetes Objectives. ABE. 2011.
• Protein and Amino Acid Metabolism Objectives. ABE. 2011.
• Nucleotide Metabolism Objectives. ABE. 2011.
• Medical Biochemistry Competencies (with UME appendix). ABE. 2011.

Genetics

• Medical School Core Curriculum in Genetics. Association of Professors of Human and Medical Genetics. 2013.

Microbiology and Immunology

• IDSA Guidelines for Preclinical Microbiology and Infectious Diseases. Infectious Diseases Society of America. 2010.
• General Principles of Foundational Science: Microbial biology. Immune System. USMLE Content Outline (pp. 3-5). National Board of Medical Examiners. 2015.

Pharmacology

• Knowledge Objectives in Medical Pharmacology. Association of Medical School Pharmacology Chairs. 2012.

Physiology

• Medical Physiology Learning Objectives. The American Physiological Society and the Association of Chairs of Departments of Physiology. 2012.