Initial Certification Exam

Eligibility

To sit for the Initial Certification Exam in Neuromusculoskeletal Medicine, candidates must complete AOA or ACGME-accredited training. Below are the recognized types of training:

• Three years of training in an ACGME-accredited in Osteopathic Neuromusculoskeletal Medicine program.
• Two years of training in an ACGME-accredited Osteopathic Neuromusculoskeletal Medicine program following completion of an AOA or ACGME accredited broad-based clinical year.
• One year of training in an ACGME-accredited Osteopathic Neuromusculoskeletal Medicine program following completion of an AOA- or ACGME accredited residency.
• Two years of training in an AOA-accredited Neuromusculoskeletal Medicine/Osteopathic Manipulative Medicine  program following completion of AOA-accredited internship or AOA-recognized ACGME PGY1 year.
• One year of training in an AOA-accredited “Plus One” Neuromusculoskeletal Medicine and Osteopathic Manipulative Medicine program following completion of an AOA or ACGME accredited residency in another discipline.
• Four years of training in an AOA-accredited Integrated Family Medicine/Neuromusculoskeletal Medicine program
• Four years of training in an AOA-accredited Integrated Internal Medicine/Neuromusculoskeletal Medicine program
• Training in a combined/integrated ONMM program that is acknowledged by the ACGME and whose curriculum has been approved by the AOBNMM.

Candidates must also:

• Maintain a current active state medical license. If your license expires before or shortly after the exam, you’ll need to provide a copy of your renewed license or pending renewal application.
• Adhere to the AOA Code of Ethics.
• Demonstrate eligibility for examination in any other manner required by the board.

Requirements

Once training requirements for eligibility are met, candidates must submit the following:

• Proof of completion of an AOBNMM-approved 40-hour Cranial Course.
• Copy of your current active medical license.
• $1,800 examination application fee.

The AOBNMM will verify your residency and/or internship completion once staff have received your application materials.

Exam Fees

An exam fee of $1,800 must be submitted with your completed application. This fee covers the written, oral and practical portions of the exam. No application will be considered complete until all fees have been paid with a credit card. No checks will be accepted.

If you choose not to sit for an exam you’ve been approved for, a penalty of $250 will be assessed and will be retained from any refund you may be entitled to. Cancellations must be made by emailing aobnmm@osteopathic.org.

Exam Dates and Deadlines

From 2020 onward, the AOBNMM will only offer the Written exam via computer from your home  in partnership with Paradigm/MonitorEDU. The Written, Oral and Practical portions of the exam will take place in the fall of each year. The Written and Oral exams are remotely proctored online and the Practical Exam will be an in-person, one-day exam. Check back for updated information when the exam dates and locations are finalized.

Written Exam Content Outline

The Osteopathic Neuromusculoskeletal Medicine Written Exam tests the knowledge and understanding of basic science and clinical knowledge, skills and principles critical to the practice of Osteopathic Neuromusculoskeletal Medicine. The three-hour, multiple choice exam consists of 150 case-based questions that require diplomates to choose the one best response.

The initial written exam includes the following topic areas:

• Assessment and Diagnosis of Conditions Presenting with Neuromusculoskeletal Symptoms
  • Indications and interpretation of diagnostic studies
  • Functional anatomic and physiological mechanisms underlying conditions presenting with neuromusculoskeletal symptoms
  • Assessment and diagnosis of acute and chronic articular, neurologic, and myofascial symptoms including, but not limited to, acute and repetitive strain injuries; degenerative, infectious, and inflammatory joint diseases; neuropathies; myopathies; and generalized pain syndromes
• Diagnosis and Osteopathic Manipulative Treatment (OMT) of Somatic Dysfunction
  • Diagnosis of somatic dysfunction of the ten body regions
  • Principles and procedures of OMT techniques including, but not limited to, articulatory, balanced ligamentous technique, counterstrain, functional technique, facilitated positional release, HVLA, ligamentous articular strain, lymphatic techniques, muscle energy, myofascial release, osteopathic cranial manipulative medicine, soft tissue, Still technique, and visceral manipulation.
• Comprehensive Osteopathic Management of Conditions Presenting with Neuromusculoskeletal Symptoms
  • Pharmaceutical, surgical, and lifestyle management of neuromusculoskeletal conditions
  • Orthotic, bracing, stretching, and exercise management of neuromusculoskeletal conditions
  • Principles and procedures of neuromusculoskeletal procedures including, but not limited to, joint, ligament, and trigger point injections; and peripheral nerve blocks
• Osteopathic Manipulative Medicine Considerations for Special Populations
  • OMM for pediatric, geriatric, hospitalized, obstetrical, and post-surgical patients
• Professional Roles and Responsibilities
  • Indications and procedural expectations for specialty referrals for conditions presenting with neuromusculoskeletal symptoms including but not limited to medical and surgical specialties, intervention pain management, rehabilitation, and counseling,
  • Practice management considerations for osteopathic neuromusculoskeletal medicine
  • Ethics and professionalism associated with osteopathic neuromusculoskeletal medicine

Oral Exam Content Outline

The Osteopathic Neuromusculoskeletal Medicine Oral Exam evaluates clinical reasoning and patient management skills as well as candidates’ ability to communicate their expertise in Osteopathic Neuromusculoskeletal Medicine and Osteopathic Manipulative Medicine.

During the online remotely proctored Oral Exam, candidates will verbally work through six cases that include relevant history and physical exam findings and accompanying diagnostic testing that will need to be interpreted by the candidate. The Oral Exam will be divided into two 25-minute sessions of three cases (six cases total). Within each session, all three cases must be completed within 25 minutes. The total exam time is 50 minutes. Candidates must show their expertise in NMM/OMM, but they must also demonstrate that they are well-rounded, complete osteopathic physicians, who are able to think osteopathically about comprehensive patient care. The Oral Exam will be recorded and scored asynchronously by AOBNMM-certified specialty physicians.

For each case, candidates will be presented with open-ended questions on the osteopathic management of the patients represented in the cases. These questions will be visually presented for candidates to read out loud and respond to within each case. Once each case is completed, the candidates may not return to previous cases. Candidates should prepare to answer the following questions during each case:

• What are your top three differential diagnoses based on the history and physical findings presented for this patient?
• To support your differential diagnosis what, if any, additional diagnostic studies, such as laboratory testing and/or imaging, would you order?
• What is your initial treatment plan at this time?

Diagnostic test information will be then be presented. Candidates will NOT be able to return to previous questions once findings are presented.

• Please interpret the diagnostic testing information provided.
• What is your diagnosis at this time?
• What is your short- and long-term treatment plan?

Through the questions presented in each case, the candidates should be prepared to verbally:

• Show an analytic approach to a clinical situation, including being able to develop and work through a comprehensive differential diagnosis.
• Generate and discuss an appropriate treatment plan at each time point presented during the case that includes the following:
  • Current standards of comprehensive osteopathic care
  • Ordering and interpreting appropriate laboratory and imaging studies
  • Appropriate pharmacologic interventions and lifestyle interventions
  • Rationale for and appropriate utilization of osteopathic manipulative treatment (OMT) technique modalities and approaches
  • Appropriate rehabilitative and/or specialty referral(s) if necessary
  • Short- and long-term treatment plans
• Demonstrate a professional demeanor, as well as clear and effective oral communication skills, throughout all sections of the Oral exam.
• Correctly identify indications, contraindications and rationale for OMT for a broad variety of direct and indirect OMT techniques.

Practical Exam Content Outline

The Osteopathic Neuromusculoskeletal Medicine Practical Exam assesses the candidate’s competency to diagnose somatic dysfunction and safely perform osteopathic manipulative treatment (OMT) techniques. The candidate’s performance of these tasks is evaluated during reciprocal demonstration of diagnosis and OMT on another candidate. Candidates are randomly paired together but are scored individually. The Practical Exam includes five testing stations where the examinee will demonstrate screening and diagnosis of somatic dysfunction within an assigned body region and demonstrate a specified OMT technique at each station. These body regions will include the head region and four additional randomly assigned body regions. Time restrictions will be given at each station.

The Practical Exam will assess screening and diagnosis of somatic dysfunction and OMT techniques for the following body regions:

• Head
• Cervical
• Lumbar
• Thoracic
• Rib
• Sacrum
• Pelvis
• Upper Extremities
• Lower Extremities

Each examinee must demonstrate technical skill and proficiency for the following four types of OMT techniques:

• High-velocity/low-amplitude (HVLA)
• Muscle Energy
• Counterstrain
• Osteopathic Cranial Manipulation

At one testing station, the candidate will be offered the opportunity to choose from one of the following four types of OMT techniques:

• Balanced ligamentous tension
• Facilitated positional release
• Myofascial release
• Still

Evaluation of the OMT techniques includes, but is not limited to, the localization, setup, activating force and reevaluation. Evaluation of both the diagnosis and OMT demonstrations include assessment of the candidate’s proficiency as demonstrated by their verbal narration of their demonstrations, efficiency and mastery of palpation, patient communication skills, ergonomics and task completion. Throughout the exam process, candidates will also be evaluated on their professional language and behavior.

Details pertaining to each year’s exam administration are sent to the candidates upon registration.

Request for Surrogate

If a candidate requires the use of a surrogate in their stead for the practical portion of the exam, they may do so provided all of the following requirement are met:

• Surrogate requests must be made at least 90 days in advance of examination.
• The candidate must provide a written (non-family member) doctor’s note providing medical documentation of reason for exception from treatment.
• The surrogate must be provided a copy of the below Surrogate Policy and release form by the candidate, which must be signed and submitted to AOBNMM.
• The candidate is responsible for the recruitment of their own surrogate to be treated in their stead by the assigned partner of the practical portion of the examination. The candidate will not treat their surrogate.
• The surrogate must remain with their candidate throughout the practical exam, being treated at all stations to be fair to the other candidate, even if the surrogate is only required for one station.
• The surrogate will be assigned an identification badge that corresponding with the identification badge of the candidate, printed with the “Surrogate” designation.
• AOBNMM will not pay the travel or any other expenses for the surrogate, and does not assume any responsibility for the expenses or presence of the surrogate.

Please submit signed surrogate policy agreements to aobnmm@osteopathic.org.

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.