Written (Cognitive) Exam
Eligibility
The following requirements are in effect for exam eligibility:
- Candidate completed an AOA-approved family medicine residency within the past six years OR the candidate may apply for examination during their final year of an AOA- or ACGME-approved training and sit for the examination up to six (6) months prior to completion of their residency training program.
- Candidate must adhere to the AOA Code of Ethics.
- Candidate must demonstrate eligibility for examination in any other manner required by the Board.
Requirements
Once eligibility requirements are met, applicant must submit the following:
- A completed application.
- Required fees.
- Copy of residency certificate if training completed or Verification of Residency training form listing start and completion dates or copy of residency certificate if program is complete.
- Signed and dated Statement of Understanding for Issuance of Certification.
Note that although documentation of an active unrestricted state medical license is not a requirement for eligibility to sit for the certification exam, a copy of your state medical license showing an expiration date will be required to obtain certification.
Exam Fees
An exam fee of $550 must be submitted with your completed application. No application will be considered complete until all fees have been paid. Non-refundable late fees must be submitted with application based on published submission deadlines.
Cancellations must be submitted in writing and a cancellation processing fee will be assessed.
Exam Dates and Deadlines
The Family Medicine Cognitive Exam is offered twice yearly via remote proctored platform. Candidates will take the exam from the convenience of their home or office with the security of a remote proctor. The application period opens 6-8 months prior to the exam administration date. A letter confirming eligibility, the exam schedule with further deadlines (test date selection, cancellation, other requests) with instructions on selecting an appointment is provided to the applicant via email upon full processing of the application within four weeks. Applicants with deficient applications are notified of deficiencies.
Exam Content Outline
The Initial Certification exam is designed to measure the competency and knowledge, skills, abilities and judgments of qualified osteopathic family practice physicians.
2026 Fall Initial Certification Exam
There are 275 single-answer, multiple-choice questions on the Family Medicine Cognitive Exam. This is an approximately 5.5 hour exam with breaks between sections.
The breakdown of the exam is listed below.
- Non-disclosure agreement – 2 minutes
- Tutorial – 10 minutes
- Section 1 – 92 questions for 98 minutes
- 10-minute optional break
- Section 2 – 92 questions for 98 minutes
- 10-minute optional break
- Section 3 – 91 questions for 98 minutes
- Survey – 3 minutes
- Total exam length: 329 minutes
Exam Updates
The American Osteopathic Board of Family Physicians (AOBFP) is committed to ensuring a fair, valid and high-quality certification process. As part of our continuous improvement efforts, AOBFP will introduce a modest update to exam content beginning in 2027.
What is changing?
Starting with the 2027 exam administrations:
- The Early Entry Initial Certification (EEIC) Examination will include 200 total questions.
- The Initial Certification Examination will include 300 total questions.
This update includes the addition of 25 pretest items on each exam.
What are pretest items?
Pretest items are unscored questions embedded within the exam. They are not identified during testing and do not affect your score.
Why are pretest items important?
Pretesting is best practice in high-quality assessment programs. It allows AOBFP to:
- Evaluate new questions under real testing conditions
- Ensure questions are fair and reliable
- Maintain the overall quality and integrity of the examination
Only questions that meet rigorous statistical standards are used as scored items on subsequent exams. This process helps ensure that every scored question on the exam meets AOBFP’s standards.
Exam timing and structure
The addition of pretest items results in minor adjustments to total testing time and section length.
2027 Spring Initial Certification Examination: 300 items (including 25 pre-test items)
Three 105-minute sections with 100 items per section.
Total test time: 315 minutes (5.25 hours), plus break time
| Primary Certification: Family Medicine | |
|---|---|
| CATEGORY | PERCENT |
|
5% |
|
10% |
|
6% |
|
4% |
|
2% |
|
4% |
|
8% |
|
2% |
|
4% |
|
6% |
|
6% |
|
4% |
|
6% |
|
10% |
|
6% |
|
3% |
|
5% |
|
2% |
|
4% |
|
3% |
| Total | 100% |
*These percentages represent the minimum amount of content from each of the stated areas. Many items may address multiple areas listed above while other items will also assess other knowledge bases, such as pediatrics, adolescent medicine and geriatrics.
Exam Scoring
Scoring Criteria
AOA reports candidates’ certification results using standardized scaled scores. Scaled scores are more valid and reliable compared to raw scores and make scores comparable across different forms of the exam. The AOA reports scores on a 200 to 800-point scale with a scaled score of 500 or higher required to pass.
- A scaled score of 500 represents the minimum level of knowledge and skill necessary to pass the exam as established by AOA Certifying Boards.
- The highest possible scaled score is 800.
- The lowest possible scaled score is 200.
- Overall scores are based on the total number of items answered correctly, regardless of content area.
Results by Content Area
- When possible, a breakdown of exam scores by content area is provided to help you identify your areas of strength and areas that may need more development.
- The number of items for each content area indicates the relative amount of test questions on the exam for that content area.
- Content area scores are not weighted to calculate your overall score; each content area is scored separately after the overall analysis is complete.
Exam Failure
Candidates who do not pass the certification examination may apply for reexamination at the next administration unless additional requirements apply. The reexamination fee is $550 and requires the submission of an online application.
Pass Rate
The 5-year aggregate pass rate for the Family Medicine Written exam is 96.22%.
This pass rate includes board-eligible examinees who are first-time test takers in the past five years, excluding candidates retaking the exam.