Initial Certification Exam


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.


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

  • CV showing all activities from the time you entered osteopathic medical school to the present.
  • Copy of your current active medical license.
  • $1,200 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 $1,200 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.

If you choose not to sit 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 can be made by emailing aobnmm@osteopathic.org.

Exam Dates and Deadlines

From 2018 forward, the AOBNMM will only offer the Written exam, both initial and OCC, via computer in partnership with Pearson Vue. There will continue to be an exam administration in spring and fall. In addition, the Oral and Practical portions of the exam will take place in the fall of each year. Check back for updated information when the exam dates and locations are finalized.

Written Exam Content Outline

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

The exam is designed to elicit your knowledge of spinal mechanics, modality principles (e.g., osteopathic cranial manipulative medicine, counterstrain, facilitated positional release, myofascial release, muscle energy and HVLA, etc.), anatomy, neurology, physiology, and physical diagnosis. Diplomates are also advised to review radiology, orthopedics and pharmacology pertaining to Neuromusculoskeletal Medicine. Exam topics include:


Primary Certification: Written Exam
  1. Examine and diagnose patients with neuromusculoskeletal disorders.
  2. Osteopathic manipulation
  3. Therapeutic measures and modalities
  4. Special populations
  5. Professional roles and responsibilities
  • 30%
  • 36%
  • 12%
  • 14%
  • 8%

Oral Exam Content Outline

The Neuromusculoskeletal Medicine Oral Exam evaluates clinical reasoning and patient management skills as well as candidates’ ability to communicate their expertise in Neuromusculoskeletal Medicine. The Oral and Practical portions of the Neuromusculoskeletal Medicine Initial Certification Exam are scheduled seperately over two weekend days.

During the Oral Exam, at least two examiners will evaluate you as you work through presented case histories accompanied by pertinent physical exam and diagnostic testing results. Open-ended questions on the osteopathic management of patients represented in the cases will be presented for you to respond to within each case.

You will have two stations and three cases will be presented at each station, (six cases total), with 25 minutes to complete each station (total of 50 minutes). Cases may be presented via PowerPoint with accompanying lab imaging and relevant history and physical exam findings. Candidates must show their expertise in NMM/OMM, but they must also demonstrate that they are well-rounded, complete physicians who are able to think osteopathically about patient care.

Candidates should be prepared to:

  • 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 that includes the following:
    • Current standards of traditional medical care
    • Ordering and interpreting appropriate laboratory and imaging studies
    • Appropriate pharmacologic interventions
    • Rationale for and appropriate utilization of osteopathic manipulative treatment
    • Appropriate referral(s) if necessary
  • 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.
Primary Certification: Oral Exam
  1. Osteopathic examination and diagnosis
  2. Osteopathic manipulative treatment/measures and modalities
  3. Special populations
  4. Roles and responsibilities
  • 50%
  • 20%
  • 10%
  • 20%

Practical Exam Content Outline

The Neuromusculoskeletal Medicine Practical Exam is conducted on the basis of reciprocal demonstration of osteopathic manipulative treatment (OMT) techniques. Each candidate will diagnose and demonstrate treatment on another candidate. Candidates are randomly paired together at the selection of the examiners, but are scored individually. Time restrictions will be given at each of the five treatment stations. The Practical Exam includes, but is not limited to, these regions:

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

Each examinee must demonstrate an example of each of these major osteopathic treatment techniques:

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

The candidate may be offered the opportunity to select another technique, including but not limited to:

  • Chapman’s Visceral
  • Myofascial Release
  • Facilitated Positional Release
  • Soft Tissue/Articulatory
  • Respiratory Cooperation

Candidates should wear appropriate attire, such as gym shorts, shorts, t-shirts, lightweight activewear, or other clothing that allows for easy demonstration of OMT. No fragrances should be worn, and Spandex is not recommended. During the exam, candidates will remove jewelry, watches, belts, and shoes.


Primary Certification: Practical Exam
  1. Osteopathic examination and diagnosis
  2. Osteopathic manipulative treatment
  • 50%
  • 50%

Exam Scoring

The AOBNMM sets passing standards for the Initial Certification Exam using a measurement model known as “criterion-referenced standard setting.” Using this model, the board specifies the particular content and level of content difficulty necessary to be considered a passing candidate. Each section of the Initial Certification Exam is scored separately, and a passing score is necessary in each area of the certification examination.

All examination results will be reviewed by the board. Candidates are informed of results by email within 90 days of the exam.