Component 3: Cognitive Assessment


To complete Component 3 requirements for Osteopathic Continuous Certification in the primary specialty of orthopedic surgery, a physician must pass a written examination once per 10-year OCC cycle or complete a clinical pathway examination. Download the AOBOS OCC Handbook for detailed information.

OCC Written Exam

The AOBOS offers written OCC exams in the primary specialty of Orthopedic Surgery and the subspecialty of Hand Surgery. OCC primary specialty exams for certification in Orthopedic Surgery are offered in June each year, and applications are due in mid-January. OCC subspecialty exams for certification in Hand Surgery are offered in October of each year, and applications are due mid-August.

Subspecialty OCC exams for Orthopedic Sports Medicine are not currently offered.

OCC Primary Specialty exams are conducted at Prometric Testing Centers across the country. Approximately six weeks before the exam date, you will receive a scheduling permit that will allow you to schedule an appointment to take the exam. Physicians are advised to contact Prometric as soon as possible upon receiving the permit in order to reserve a spot at a preferred location.

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.

Written Exam Content

The OCC Written Exam consists of 100 multiple-choice questions. Questions are taken from the general orthopedic question pool, but are oriented more toward the clinical practice of Orthopedics.

OCC Primary Written Exam
Foot/Ankle 10-13%
Hand/UpperExtremity 10-12%
Joint 11-14%
Pediatrics 10-12%
Sports Medicine 11-14%
Spine 10-12%
Trauma 11-14%
Tumor 4-5%
Infection 4-5%
Other 0-3%

The AOBOS does not offer a review course, but suggests candidates study the most current Orthopedic Knowledge Update and Journal of Bone and Joint Surgery to prepare for the exam. More exam details are available in the AOBOS OCC Candidate Handbook.

OCC Hand Surgery Written Exam
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%
OCC Orthopedic Sports Medicine Written Exam
Lower Extremity: Hip 10-14%
Lower Extremity: Knee 15-21%
Lower Extremity: Foot and Ankle 11-17%
Upper Extremity: Shoulder 12-18%
Upper Extremity: Elbow 10-16%
Upper Extremity: Wrist and Hand 12-14%
Non-Operative 11-17%

OCC Clinical Pathway Exam

Diplomates may elect to complete a practice-based exam instead of the OCC Written Exam. The clinical pathway is essentially a standard Clinical Examination. It may be attractive to surgeons who have subspecialized and may have difficulty with a general orthopedic surgery examination.

Due to the expense of arranging and contracting examiners, the charge for this service is $6,500. The completed application, surgical logs, and other application documentation requirements are due by March 1. Once the application and required information is received, surgical logs will be reviewed by the AOBOS Board. After approval of the logs, two clinical examiners will be assigned to conduct the examination.

Download the Candidate Handbook more information on the exam.

Applications and Payment

The OCC Written Exam can be taken within three years of your certification’s expiration date.

OCC Written Exam
EXAM Type Fee
OCC Written Exam Fee $2,700
OCC Clinical Pathway Fee $6,500
OCC Late Application Fee $250

Exam Results

Scores will be posted on the online application portal approximately eight to ten weeks after the exam, and you will receive an email when scores have been posted. Written Exam results will also be sent via mail.

Exam Failure

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.

Exam Policies

Right to Appeal

If a candidate feels that the actions of the AOBOS with regard to any part of the examination constitute unequal application of the regulations and requirements or standards, unwarranted discrimination, prejudice, unfairness or improper conduct of the examination, he or she has the right to appeal to this Board.

Appeals must be made on an appeal request form and submitted via track-able delivery method within three days of the exam administration. Appeal request forms will be provided to all candidates prior to the start of the exam. All appeals submitted after the three day deadline will be denied for all exams except the Clinical Examination. Late appeals to this exam will be considered on a case-by-case basis.

A majority vote of the committee will determine whether the AOBOS accepts or denies the appeal.

Candidates will be advised of the Board’s decision by certified mail. If the Appeal Committee accepts an appeal, then the candidate’s examination will not be scored or recorded, and the candidate has the right to take a new exam at the next scheduled exam date with no additional fee. If applicable, the candidate’s original case log will be utilized and the next clinical exam will be conducted by different examiners.

If an appeal is denied by the AOBOS, the candidate retains the right to appeal to the AOA Bureau of Osteopathic Specialists (BOS) and AOA Board of Trustees.

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

Compliance With Federal Regulations

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

  • Americans with Disabilities Act (ADA): The AOBOS 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 AOBOS 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 AOBOS certification will be de-identified by the candidate prior to submission, such that the remaining information cannot be used to identify an individual patient.