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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


  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.


Atlas of AnatomyGilroy, MacPherson, & Ross1st2008
Atlas of Human AnatomyNetter5th2011
Clinical Anatomy by RegionsSnell9th2012
Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and RehabilitationFrontera, Silver, & Rizzo3rd2015
Gray's Anatomy for StudentsDrake, Vogl, & Mitchell2nd2012
Gray's Anatomy: the Anatomical Basis of Clinical PracticeStandring41st2016
Histology: A Text and AtlasRoss & Pawlina7th2015
Junquiera's Basic Histology Text and AtlasMescher14th2016
Langman's Medical EmbryologySadler13th2015
Moore Clinically Oriented AnatomyMoore, Dalley, & Agur7th2013
Neuroanatomy through Clinical CasesBlumenfeld2nd2011

Biochemistry and Genetics

Harper's Illustrated BiochemistryRodwell, Bender, Botham, Kennelly, & Weil30th2015
Lippincott Illustrated Reviews: Biochemistry Ferrier7th2017
Mark's Basic Medical BiochemistryLieberman & Marks5th2017
Medical GeneticsJorde, Carey, & Bamshad5th2015
Thompson & Thompson Genetics in MedicineNussbaum8th2015

Clinical Medicine

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

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

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


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


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:



Microbiology and Immunology



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