Written Exam


To be eligible for certification in Undersea and Hyperbaric Medicine, 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 internship.
  • Satisfactorily complete a one-year AOA or ACGME approved hyperbaric medicine fellowship.
  • Hold primary board certification from a participating certifying board: AOBEM, AOBFP, AOBIM or AOBPM.
  • Successfully sit for and pass all sections of the certification examination.
  • 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 conjoint examination committee:

  • A completed application.
  • Supporting documents
    • Each applicant must submit 10 multiple-choice questions (which must be textually referenced) in the area of Undersea and Hyperbaric Medicine.
    • Curriculum Vitae.
    • Copy of your current state license(s). Include a statement detailing any and all restrictions on your medical license in the state in which you practice.
    • Documentation of supervision of at least 500 treatments (with a distribution across the 13 treatment indications in proportion to the frequency with which they are encountered at the institution).
    • Two (identical) passport-sized photos, as well as your state ID (driver’s license).
    • Copy of Undersea and Hyperbaric Fellowship training certificate.
  • All applicable fees.


Exam Fees

The exam fee is $850, plus a non-refundable application fee of $250 ($1,100 total). If you apply within 60 days of the exam, you will be charged an additional $100 late fee. If an applicant fails any part of the exam, the fee for re-examination is $500, plus a non-refundable re-application fee of $150 ($650 total). If you submit your re-examination application within 60 days of the exam, you’ll be charged an additional $100 late fee. No application will be considered complete until all fees have been paid.

Exam Dates and Deadlines

The Undersea and Hyperbaric Medicine Written Exam is offered once per year, generally every March in conjunction with the American Osteopathic Board of Preventive Medicine exams. The application period opens the previous fall, with a deadline of Dec. 1.

Exam Content Outline

The written exam consists of 150 multiple-choice questions.

Fundamentals: 40%


  • Units
  • Gas laws, principals of buoyancy
  • Visions and acoustics
  • Physical properties of gases (density, solubility, thermal conductivity etc.)

Recognition and treatment of physiological/pharmacological effects/toxicity of gases

  • Oxygen: CNS; Pulmonary; Ocular; Blood
  • Carbon Dioxide
  • Nitrogen
  • Other (helium, argon, carbon monoxide, etc)


  • Chamber systems design, construction & maintenance, operations
  • ASME and NFPA regulations
  • Diving equipment/breathing systems

Decompression Theory

  • Decompression tables
  • Decompressing chamber attendants
  • Altitude effects of decompression
  • Diving effects of decompression sickness
  • Saturation
  • Repetitive
  • Bubble theory and detection

Pathophysiology and clinical manifestations of dysbarism

  • Barotrauma (otic, sinus, pulmonary, GI, other)
  • DCS: Neuro, Pulmonary, Skin, Joint, Other
  • AGE
  • Venous gas embolism
  • Long-term diving effects (dysbaric osteonecrosis, etc)
  • Management of pressure related diving chamber accidents
  • Effects of bubbles
  • Mechanism of gas entry and distribution
  • Diving casualties

History of Diving and Hyperbaric Medicine

Diving medicine: 30.5%

Physiological effects of diving

  • High pressure nervous syndrome
  • Breath-hold diving
  • Physiology of immersion
  • Surface decompression
  • Mixed gas diving effects
  • Inert gas narcosis
  • Thermal effects

Diving Operations

  • Bounce diving
  • Saturation diving
  • Caisson and tunnel work
  • Surface decompression
  • In water recompression
  • Diving at altitude
  • Flying after diving
  • Mixed gas diving
  • Recreational diving

Medical and technical support of diving

  • Medical standards for diving and chamber personnel: Commercial, Recreational, Hyperbaric Operations, Pregnancy, Patent foramen ovale, Prior history of DCS, Other.
  • Hazardous marine life
  • Other medical disorders: Drowning, Near drowning, Sudden death, Neurological disorder, Accident, Cardiac, Infection, Diabetes, Other
  • Psychology of closed spaces
  • Chambers, bells, habitats, and saturations systems
  • Underwater breathing apparatus

Clinical hyperbaric medicine: 26.5%

Indications for hyperbaric oxygen therapy – Including key articles/landmark studies and trials

  • Carbon monoxide poisoning – carbon monoxide complicated by cyanide poisoning
  • Clostridial myositis and myonecrosis (gas gangrene)
  • Crush injury, compartment syndrome
  • Enhancement of healing in selected problem wounds: Fundamentals of wound care
  • Exceptional anemia
  • Intracranial abscess
  • Neocrotizing soft tissue infections
  • Osteomyelitis (refractory)
  • Delayed radiation injury (soft tissue and bony necrosis)
  • Skin graft and flaps (compromised)
  • Thermal burns
  • Air or gas embolism
  • Decompression sickness
  • Other

Patient Management

  • Patient selection and care
  • Treatment protocols
  • The physiological effect of hyperbaric oxygen
  • Pharmacological effects of HBO
  • Management of oxygen toxicity
  • Patient monitoring and equipment
  • Complications of hyperbaric oxygen therapy
  • Contraindications of hyperbaric oxygen therapy
  • Osteopathic Principles and Practices

Research: 3%

Research Methodologies related to Undersea and Hyperbaric Medicine

  • Biostatistics, epidemiology, medical information sciences, decision analysis, critical literature review, and research design

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.