Internal Medicine

Core Knowledge & Elements of Osteopathic Principles in the Discipline of Internal Medicine

Content Outline and Assessment Objectives

The Internal Medicine examination is designed for end-of-course or end-of-clinical rotation/clerkship assessment for students enrolled at a college of osteopathic medicine (COM). Individual COMs may also administer the examination at other times in accord with their curriculum goals and mission. This examination emphasizes core knowledge and elements of osteopathic principles and practice in the discipline of Internal Medicine that are essential for the predoctoral osteopathic medical student. The exam blueprint below contains the Internal Medicine topics covered in two dimensions: Dimension 1 – Patient Presentation and Dimension 2 – Physician Tasks.

Dimension 1: Patient Presentation

Topic	%
Allergy/Chemical/Skin/Miscellaneous	7–13%
Cardiovascular	7–13%
Endocrine/Nutrition/Metabolism	7–13%
Gastrointestinal	7–13%
Hematology/Oncology	7–13%
Infectious Diseases	7–13%
Neurology	7–13%
Renal/Hypertension	7–13%
Respiratory	7–13%
Rheumatology/Musculoskeletal	7–13%

Dimension 2: Physician Tasks

Topic	%
Health Promotion/Disease Prevention	5–15%
History/Physical/Diagnosis	35–55%
Management	20–35%
Scientific Mechanisms of Disease	15–25%

General Learner-Centered Objectives

Based on general learner-centered objectives, as outlined in the Internal Medicine Examination Blueprint, the examinee will be required to demonstrate the ability to apply:

1. Foundational content knowledge to situations and patient presentations encountered in clinical settings and important to Internal Medicine.
2. Foundational content knowledge and clinical problem-solving ability related to particular physician tasks critical to Internal Medicine.
3. Knowledge and clinical problem-solving as related to the Fundamental Osteopathic Medical Competency Domains, including osteopathic principles and practice and OMT, osteopathic medical knowledge, interpersonal and communication skills, practice-based learning and improvement, systems-based practice, professionalism and patient care.
4. Osteopathic principles and practice in commonly encountered patient care scenarios.

Selected Specific Learner-Centered Objectives for Internal Medicine

For Internal Medicine, the examinee will be required to demonstrate the ability to diagnose and manage selected patient presentations and clinical situations involving, but not limited to:

1. Allergy/Skin/Miscellaneous: atopic diseases, anaphylaxis, drug allergy, common dermatological conditions and skin lesions and chemical exposure
2. Cardiovascular: acute coronary syndromes, arrhythmias, chronic ischemic disease of the heart, congenital heart disease, hyperlipidemia, peripheral vascular disease, congestive heart failure, aortic dissection, valvular heart disease, pericarditis and endocarditis
3. Endocrine: weight gain/loss, adrenal disorders, diabetes mellitus, parathyroid and thyroid disturbances, pituitary disorders, disorders of the testes and women’s health
4. Gastrointestinal: diseases of the upper and lower gastrointestinal tract, liver, gallbladder and pancreas; gastrointestinal disease prevention, gastrointestinal tract cancer and other gastroesophageal issues
5. Hematology/Oncology: coagulation disorders, anemia, solid tumors, hematologic malignancies and screening and disease prevention
6. Infectious diseases: commonly encountered infectious and immunological diseases and host responses, HIV infections, bioterrorism, and infectious disease treatment and prevention/prophylaxis
7. Musculoskeletal: osteoporosis, somatic dysfunction, viscerosomatic relationships, inflammatory and non-inflammatory rheumatic diseases, vasculitis, and disorders of bone and muscle
8. Neurology: brain anatomy/function, stroke, disorders of the spinal cord and peripheral nerves, disorders of cerebral function and central nervous system neoplasms
9. Renal/Hypertension: fluid and electrolyte disorders, acute renal injury, chronic kidney disease, renal calculi, glomerular and tubulointerstitial disorders, obstructive uropathy and arterial hypertension
10. Respiratory: respiratory tract cancer, asthma, chronic obstructive pulmonary disease, pneumonia, pulmonary embolism, critical care medicine and respiratory failure

Selected Student and Faculty Learning Resources for Internal Medicine

In addition to the aforementioned objectives, examples of supplementary resources used by the NBOME to inform the development of the Internal Medicine exam are listed below:

• American College of Physicians (ACP) – IM Essentials for Use in the Internal Medicine Clerkship and to Prepare for USMLE Step 2 CK
• American Osteopathic Association (AOA) and American College of Osteopathic Internists (ACOI) – Basic Standards for Residency Training in Internal Medicine

Practice Questions

The Internal Medicine Practice Questions are primarily designed to assist the candidate in navigating through the examination, and it is provided to facilitate the actual testing experience. It is not designed to give the candidate a score or provide information about how a candidate might actually perform on the examination.

Launch Internal Medicine Practice Questions

Additional Resources

Title	Author	Edition	Year
Cecil Textbook of Medicine	Goldman & Schafer	26th	2019
Harrison’s Principles of Internal Medicine	Jameson, Fauci, Kasper, Hauser, Longo, & Loscalzo	21st	2022
CURRENT Medical Diagnosis & Treatment	Papadakis & McPhee	61st	2022
Resident Readiness: Internal Medicine	Klamen	1st	2013
The Washington Manual of Medical Therapeutics	Crees et al.	37th	2022
The Washington Manual of Outpatient Internal Medicine	De Fer & Sateia	3rd	2022
An Osteopathic Approach to Diagnosis and Treatment	DiGiovanna, Amen, & Burns	4th	2020
Foundations of Osteopathic Medicine	Seffinger	4th	2019