Written Exam


To be eligible for certification in the subspecialty of Hand Surgery, candidates must meet the criteria below:

  • Be a graduate of a COCA-accredited college of osteopathic medicine.
  • Satisfactorily complete a one-year internship in an AOA-approved training program.
  • Must have completed a post-residency Hand Fellowship of one year.
  • Have attained certification in general surgery or plastic surgery by the American Osteopathic Board of Surgery or the AOBOS.
  • At least 50% of your total caseload must be in operative hand surgery, and you must have been in the active practice of hand surgery for at least two years.
  • Must hold full operating privileges in a hospital or surgery center.
  • Must provide a log of at least 125 major surgical cases in a consecutive 12-month period in the last three years. See page 7 of the Hand Surgery Handbook for submission guidelines.
  • Hold an unrestricted license to practice in a state or territory.
  • Adhere to the AOA Code of Ethics.


At the time of application, you must submit the following to the AOBOS:

  • Complete surgical log and submit through the application portal.
  • A copy of your Fellowship certificate.
  • A copy of the letter from the AOA granting approval of Hand Fellowship program/training and stating that the program is complete.
  • Copy of your current state medical license.

Exam Fees

An exam fee of $3,000 must accompany your completed application. No application will be considered complete until all fees have been paid.

If an applicant fails the exam, the fee for re-examination is $3,000.

Exam Dates and Deadlines

The Hand Surgery Subspecialty Written Exam is offered once per year, generally every fall in conjunction with the AOAO Annual Meeting. The application period opens in May, and applications are due August 15.

Exam Content Outline

The written exam consists of 100 “type A” (one best answer) multiple-choice questions. It is given in one part, and candidates have two hours to complete the exam.

Subspecialty Certification
Amputation 3-5%
Arthritis 13-15%
Infection 11-13%
Joint 10-12%
Microsurgery 6-8%
Nerve 12-14%
Osseous 9-11%
Pediatrics 3-5%
Soft Tissue 1-3%
Tendon 8-10%
Tumor 7-9%
Vascular 5-7%

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.