Component 3: Cognitive Assessment
Introduction
Through participation in Osteopathic Continuous Certification, AOA board-certified physicians maintain necessary skills, explore advancements in medicine and demonstrate expertise in their specialty. OCC Component 3 requires successful participation in the Longitudinal Assessment program or completion of one (or more) psychometrically valid and proctored examinations. Either program type assesses a physician’s specialty medical knowledge, as well as core competencies in the provision of health care.
In 2021, the AOBOS announced the replacement of the traditional high-stakes recertification exam previously required every 10 years with a longitudinal assessment model designed to enhance flexibility and streamline the certification process. Longitudinal assessment leverages technology to facilitate continuous learning through shorter assessments, delivered frequently over time via a convenient remote online learning platform.
The AOBOS longitudinal assessment is administered through the CATALYST platform hosted by the National Board of Osteopathic Medical Examiners (NBOME). The platform is easily accessible from your computer, tablet or smartphone.
Primary Orthopedic Surgery Longitudinal Assessment
Registration
Diplomates currently holding a primary certification in Orthopedic Surgery will begin longitudinal assessment (LA) in the year of their current certificate expiration. Registration begins in the fall of the year preceding participation.
Newly certified diplomates are not required to participate in LA for one full calendar year after gaining certification. For example, if you are certified in November of 2024, you would register for LA in the Fall of 2025 and begin participation in May of 2026.
Annual schedule
- Annual registration opens: Oct. 1
- Registration closes: Jan. 5
- Annual assessment fee: $230
- First attempt available: May and June
- Re-attempt window: July
Process
The application can be found on the application page and is titled “AOBOS Longitudinal Assessment.” The assessment is administered annually, and participation is required each year for as long as you wish to maintain continuous certification.
There will be 15 questions annually from three of the nine primary orthopedic surgery content areas: reconstruction, sports, trauma, foot and ankle, hand, infection, pediatrics, spine and tumor. Assessment questions are not timed, and the assessment is in an open-book format. Questions can be answered at your convenience during the assessment window. The questions are article-based. References for the articles used for that year’s assessment will be posted on the website in January.
The passing score is 80%. You will receive immediate feedback upon answering a question, the platform will display the rationale for the correct answer and the reference for that answer. If you do not attain the minimum passing score on your first attempt, you will have access to your missed questions for a second attempt during July. Answering them correctly during the second attempt will raise your score.
References
The following references are provided as a preparation tool for the 2025 Orthopedic Surgery Longitudinal Assessment.
OCC for Subspecialty Certification in Orthopedic Sports Medicine
A longitudinal assessment model is in place for the cognitive assessment component of continuous certification in Orthopedic Sports Medicine.
Longitudinal assessment leverages technology to facilitate continuous learning through shorter assessments, delivered over time via a convenient remote online learning platform.
The AOBOS longitudinal assessment is administered through the CATALYST platform hosted by the National Board of Osteopathic Medical Examiners (NBOME). The platform is easily accessible from your computer, tablet or smartphone.
Registration
Those Diplomates currently holding a subspecialty certification in Orthopedic Sports Medicine through the AOBOS will begin longitudinal assessment (LA) in the year of their current certificate expiration. Registration begins in the fall of the year preceding participation.
For Diplomates subspecialty certified in Orthopedic Sports Medicine after Jan. 1, 2024: You are not required to participate in LA for one full calendar year after gaining certification. For example, if you are certified in November of 2024, you would register for LA in the Fall of 2025 and begin participation in 2026.
Diplomates subspecialty certified in Orthopedic Sports Medicine will only participate in longitudinal assessment for Orthopedic Sports Medicine, they will not be required to participate in longitudinal assessment for Primary Orthopedic Surgery.
Schedule
- Annual registration opens: Oct. 1
- Registration closes: Jan. 5
- Annual assessment fee: $270
- First attempt available: May and June
- Re-attempt window: July
Process
The application can be found on the application page and is titled “AOBOS Orthopedic Sports Subspecialty Longitudinal Assessment.” The assessment is administered annually, and participation is required each year for as long as you wish to maintain continuous certification.
There will be 20 questions annually from four content areas, consisting of three content areas covering Orthopedic Sports Medicine and one covering General Orthopedic Surgery. Assessment questions are not timed, and the assessment is in an open-book format. Questions can be answered at your convenience during the assessment window. The questions are article-based. References for the articles used for that year’s assessment will be posted on the website in January.
The passing score is 80%. You will receive immediate feedback upon answering a question, the platform will display the rationale for the correct answer and the reference for that answer. If you do not attain the minimum passing score on your first attempt, you will have access to your missed questions for a second attempt during July. Answering them correctly during the second attempt will raise your score.
References
The following references are provided as a preparation tool for the 2025 Orthopedic Sports Medicine Longitudinal Assessment.
OCC for Subspecialty Certification in Hand Surgery
A long-form exam is still required for the cognitive assessment component of OCC in Hand Surgery. Passing the subspecialty exam also extends certification in primary orthopedic surgery. The certification period is ten years.
Hand Surgery 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 |
| CATEGORY |
PERCENT |
| 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% |
Hand Surgery 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.
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, they have the right to appeal to this Board.
Appeals must be made on an appeal request form and submitted via email 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 by the committee will determine whether AOBOS accepts or denies the appeal.
Candidates will be advised of the Board’s decision by email. If the Appeal Committee accepts an appeal, 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 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.