Component 3: Cognitive Assessment


To complete Component 3 requirements for Osteopathic Continuous Certification in the primary specialty of Internal Medicine, a physician must pass a written examination. Component 1 must be verified prior to the exam.

Exam Process

The OCC Written Exam is offered every year. Subspecialty OCC exams are offered in August and the Internal Medicine OCC exam is offered in September. These are one-day computer-based exams made up of “choose the one best answer” multiple choice questions. Diplomates may begin taking the exam two years prior to the expiration date of their certification. AOBIM exams are evaluated using an absolute standard (pass/fail). Diplomates who are certified in a subspecialty or hold a certificate of added qualifications can simultaneously complete OCC in multiple areas by completing the exams on the same day. Diplomates must pass the exam for each area in which they intend to maintain certification. If you fail one exam but pass the other(s), you will need to sit for the entire exam that was failed at the next annual exam date.

Internal Medicine OCC Exam Content

There are 150 items on the Internal Medicine OCC exam. Candidates will have three and a half hours to complete the exam, which will cover all areas of Internal Medicine as thoroughly as possible, including:

  • Allergic disorders
  • Cardiovascular system
  • Endocrine disorders
  • Electrolyte disorders
  • Gastrointestinal system
  • Hematological system
  • Infectious diseases
  • Neurological system
  • Oncological disorders
  • Pulmonary diseases
  • Renal diseases
  • Dermatological manifestations of internal disease
  • Clinical pharmacology

Clinical situations involving diagnoses, cause, prognosis, and natural history of disease and treatment will be stressed in the above disorders. Clinically-oriented questions with case history data will be included, and in some questions candidates will be asked to interpret visual material such as physiological data, ECGs, urine sediments, peripheral smears, gastrointestinal imaging studies, chest radiographs, gram stains, dermatological lesions, and physical findings.

Hospital OCC Exam Content

The OCC in Internal Medicine with a Focused Practice in Hospital Medicine Exam will contain items common to the certification examination in Internal Medicine with additional content in the area of in-hospital medicine. At least 25% of the examination will contain items relating to consultative co-management, patient safety, quality improvement, epidemiology, medical ethics, decision-making, systems-based practice, and transitions to ambulatory medicine. Candidates will have three and a half hours to complete the exam.

Hospital OCC Exam Content
  1. 1. Allergy/Immunology Disorders
  2. 2. Cardiovascular disease
  3. 3. Endocrine/metabolic Disorders
  4. 4. Hematologic Disorders
  5. 5. Gastroenterologic Disorders
  6. 6. Oncologic Disorders
  7. 7. Nephrology/Urinary Tract/Electrolytes
  8. 8. Hypertension
  9. 9.Rheumatologic Disorders
  10. 10. Pulmonary Diseases
  11. 11. Infectious Diseases/Infection Control
  12. 12. Neurology/Psychiatric Disorders
  13. 13. Dermatology
  14. 14. ENT/Ophthalmologic Disorders
    • 1-2%
    • 10-15%
    • 5-7%
    • 3-4%
    • 5-7%
    • 2-4%
    • 6-8%
    • 2-4%
    • 2-4%
    • 8-10%
    • 6-8%
    • 4-5%
    • 1-2%
    • 1-2%
  1. 1. Clinical Pharmacology
  2. 2. Gynecology/Obstetrical Complications
  3. 3. Patient Safety/Quality Improvements
  4. 4. Transitions of Care
  5. 5. Palliative Care/Pain Management
  6. 6. Substance Abuse
  7. 7. Adolescent Medicine
  8. 8. Bioethics
  9. 9. Critical Care Medicine
  10. 10. Clinical Epidemiology
  11. 11. Pre-/Peri-operative Consultation
  12. 12. Geriatric Medicine
  13. 13. Nutrition
  • 2-3%
  • 1-2%
  • 2-4%
  • 2-4%
  • 3-5%
  • 1-2%
  • 1-2%
  • 1-2%
  • 5-6%
  • 1-2%
  • 3-5%
  • 2-3%
  • 1-2%

Subspecialty OCC Exam Content

There are 150 items on each Internal Medicine subspecialty OCC exam. Candidates are given three hours and 30 minutes to complete the exam. AOBIM offers the OCC exam in the following subspecialties:

    • Cardiology
    • Clinical Cardiac Electrophysiology
    • Critical Care Medicine
    • Endocrinology
    • Gastroenterology
    • Geriatric Medicine
    • Hematology
    • Infectious Disease
    • Interventional Cardiology
    • Nephrology
    • Oncology
    • Pulmonary Disease
    • Rheumatology

Conjoints If you hold subspecialty board certification through one of the conjoint committees the AOBIM participates in, please visit the conjoint website for info on OCC Component 3 requirements. Addiction Medicine Allergy and Immunology Correctional Medicine Hospice and Palliative Medicine Pain Medicine Sleep Medicine Sports Medicine Undersea and Hyperbaric Medicine

Applications and Payment

Diplomates must submit an exam application and fees no later than June 1 of the year they plan to take the exam. Applications received between June 2 and July 1 will be assessed a $100 late fee. No applications will be accepted after July 1.

OCC Cognitive Assessment
EXAM Type Fee
OCC—Primary $600
OCC—Subspecialty $450

Exam Results

If a diplomate passes the OCC Written Exam in a year prior to the year in which the certificate expires, the passing grade will be held and reported to the AOA when all OCC requirements have been met. The new certificate will be valid for 10 years from the date of the expiring certificate. In accordance with the AOBIM Standards Review Committee, the Written Exam is reviewed by a psychometrician to verify adherence to rule of practice established in the APA/AERA National Standards for Education and Psychological Testing. Pass and fail decisions are based solely on the content mastery displayed by the diplomate. Results will be released electronically through the AOBIM’s application portal. Candidates must be program complete and maintain AOA membership in order to access electronic results.

Exam Policies

Rescoring of Examinations

Candidates may obtain manual review of the computer scoring of the examination within one month of receiving exam results. Requests must be made in writing and submitted with a payment fee of $200. Candidates are not allowed to review specific items on the examination either before or after sitting for examination. The electronic scoring of the candidates results will be deleted 24 months after administration of the examination.

Right to Appeal

If a candidate feels that actions of the AOBIM 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 aobim@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. Candidates will be advised by certified mail within 30 days of final action of the board.

Compliance With Federal Regulations

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

  • Americans with Disabilities Act (ADA): The AOBIM 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.
  • Health Insurance Portability and Accountability Act (HIPAA): In compliance with the HIPAA Act of 1996 and any subsequent modifications, the AOBIM 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 AOBIM certification will be de-identified by the candidate prior to submission, such that the remaining information cannot be used to identify an individual patient.