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Component 3: Cognitive Assessment


To complete Component 3 requirements for OCC in the primary specialty of Family Medicine, a physician must pass a cognitive assessment examination.

Family Medicine OCC Cognitive Exam

The OCC exam for the primary specialty of Family Medicine is a half-day computer-based exam comprised of single answer multiple-choice questions. Diplomates may begin taking the exam two years prior to the expiration date of their certification. These exams are offered twice yearly in the spring and fall.

For physicians holding time-dated certification, failure to successfully complete the OCC process will result in the loss of certification when their current certification expires.

For physicians with non-time-limited (non-dated, non-expiring) certifications, OCC participation is not required, although they may elect to do so voluntarily. Failure to complete the OCC process will not result in the loss of primary certification.

There are 200 single answer multiple-choice questions on the Family Medicine OCC exam. The exam is 3.5 hours with no scheduled breaks. Candidates are not permitted to leave the building during unscheduled breaks. Candidates may access personal items such as medication and food only if necessary.

OCC Cognitive Exam: Family Medicine
Addiction Medicine 3%
Preventive Medicine 5%
Psychiatry 4%
Medical Jurisprudence 3%
Allergy/Immunology including Rheumatology 5%
Cardiology 5%
Dermatology 5%
Endocrinology 5%
Gastroenterology 5%
Hematology 4%
Nephrology/Urology 4%
Neurology 5%
Osteopathic principles and practice 12%
Pulmonology 5%
Geriatrics 5%
General surgery 3%
Orthopedics 5%
Obstetrics and gynecology 4%
Pediatrics 5%
Sports medicine 3%

The approximate total number of test items in the OCC certification exam is 200. The above percentages are offered as a guideline only and may change with each exam administration.

Family Medicine OMT Performance OCC Exam

The OMT performance exam requires the candidate to diagnose and demonstrate an appropriate technique for each of three cases representing the areas of spine, extremities, and systemic diseases. Candidates will be scored on diagnosis, identification of landmarks appropriate to the technique, implementation and demonstration of appropriate technique, ability to discuss each technique, and professionalism. You must obtain a passing score on two of the three cases.


Beginning on January 1, 2020, the Osteopathic Manipulative Treatment (OMT) performance examination is no longer required for diplomates whose certification expires 12/31/2020 and thereafter. Diplomates holding certificates with expiration dates of 12/31/19 or earlier must still take the OMT performance examination as part of their OCC process.

To be eligible for the Family Medicine OMT Performance OCC Exam, physicians must:

  • Have held primary certification in family medicine for at least six years.
  • Be in current practice as a family medicine physician.
  • Be an AOA member in good standing at the time of application.
  • Hold an unrestricted medical license. An applicant that has a restricted license may petition the Board for the ability to enter the exam process based upon review of the reason for licensure restriction. A copy of the court order should be included with the submitted application documents.

Note: The candidate is responsible for maintaining awareness of all required CME credits to meet all the requirements for documentation of maintenance of Osteopathic Continuous Certification (OCC) upon successful completion of all required components. Candidates should supply documentation of attendance or completion of CME courses to the AOA in a timnely manner to be entered on their CME Activity Report.

How to Apply

To apply for the Family Medicine OMT Performance Exam, you must submit:

  • A copy of your most recent AOA CME Activity Report.
  • Copy of your state medical license with expiration date.
  • Copy of court order(s), if your license is restricted.
  • Summary of malpractice proceedings, if applicable.

Exam Fees

You must submit an exam fee of $400 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. A cancellation processing fee will be assessed once an application has been submitted. All cancellations must be submitted in writing.

Exam Failure

An opportunity to retake is offered during the same exam administration either later in the day or another consecutive day of testing. In the event of a failure on the second exam attempt within that session, the candidate will be required to document completion of a CME review course in osteopathic principles and techniques before retaking the OMT performance exam at a future date.

Geriatric Medicine OCC Exam

The 200-item single answer multiple-choice examination will cover the broad aspects of geriatric family medicine that physicians caring for the elderly are expected to know. Clinical situations involving diagnosis, etiology, prognosis and natural history of disease and management will be stressed. Specific areas of emphasis will include:

  • Addiction Medicine
  • Allergy/Immunology/Rheumatology
  • Cardio Vascular Disease
  • Dermatology
  • Emergency Medicine
  • Endocrinology
  • Gastroenterology
  • General surgery
  • Obstetrics/Gynecology
  • Hematology
  • Infectious Disease
  • Medical Legal
  • Nephrology/Urology
  • Neurology
  • Oncology
  • Ophthalmology/Otolaryngology (EENT)
  • Orthopedics
  • Osteopathic Manipulative Treatment
  • Preventive Medicine
  • Psychiatry
  • Pulmonology
  • Sports medicine

Conjoint OCC Exams

If you hold subspecialty/CAQ board certification through one of the conjoint committees in which the AOBFP participates, please visit the conjoint website for info on OCC Component 3 requirements.

Addiction Medicine

Hospice and Palliative Medicine

Pain Medicine

Sleep Medicine

Sports Medicine

Undersea and Hyperbaric Medicine

Exam Fees

Diplomates must submit an exam application, copy of their current medical license and fees no later than the published postmark deadline dates. Non-refundable late fees apply as determined for each exam administration. No applications will be accepted after the final deadline. Fees are subject to change.

Primary Certification
EXAM Type Fee
OCC Cognitive Exam fee $400
OCC Cognitive Exam non-refundable late fee $75
OCC Cognitive Exam re-examination fee $400
OCC Performance Exam fee $400
OCC Performance Exam non-refundable late fee $75
OCC Performance Exam re-examination fee $400

Exam Results

AOA reports certification results using standardized scores. Examination results are reported on a scale of 200 to 800 and an overall scaled score of 500 or greater is required to pass. The passing standard is determined by subject matter expert osteopathic physicians who practice in the field of the specialty. The passing standard is approved by the respective board.

Content area scores are provided as informative feedback when possible. No minimal requirement is set for performance outcomes for the content area scores. Content area scores are not used to compute your total test score or to determine your performance outcome.

Candidates are informed of results by email within 8 weeks.

Exam Failure

Candidates who do not pass the OCC cognitive examination may apply for reexamination at the next administration unless additional requirements apply. The reexamination fee is $400 and requires the submission of an online application.

Right to Appeal

If a candidate feels that actions of the AOBFP with regard to any part of the certification process constitute unequal application of the Bylaws or Policies and Procedures, unwarranted discrimination, prejudice, unfairness or improper conduct of the examination, he or she has the right to appeal to the board.

Appeals to the board can be made by emailing the request to AOBFP@osteopathic.org, along with any supporting documents necessary for proper review of the case. The appeal request must be submitted within 30 days of receiving exam results.

The board will not consider appeals based on examination content, sufficiency or accuracy of answers to exam questions, scoring of the exam, and/or determination of the minimum passing score.

ADA and HIPAA Policies

The AOBFP complies with all applicable federal and state regulations, including:

  • Americans with Disabilities Act (ADA): The AOBFP complies with all applicable federal and state regulations, including the Americans with Disabilities Act (ADA). The Board complies with requirements prohibiting discrimination and ensuring equal opportunity for persons with disabilities in employment, state and local government services, public accommodations, commercial facilities, and transportation, as well as regulations for Title II and Title III (and all subsequent regulations) as printed in the federal register. To request an ADA accommodation from the AOBFP, you can read the AOBFP ADA Handbook and submit an ADA Request for Accommodation Application.
  • Health Insurance Portability and Accountability Act (HIPAA): In compliance with the HIPAA Act of 1996 and any subsequent modifications, the AOBFP ensures that individuals’ health information is properly protected, while allowing the flow of health information to provide and promote high quality health care. All medical records submitted for review by candidates for AOBFP certification will be de-identified by the candidate prior to submission, such that the remaining information cannot be used to identify an individual patient.