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Osteopathic Principles & Practice

Core Knowledge & Elements of Osteopathic Principles

Content Outline and Assessment Objectives

The Osteopathic Principles and Practice 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 Osteopathic Principles and Practice that are essential for the predoctoral osteopathic medical student. The exam blueprint below contains Osteopathic Principles and Practice topics related to concept & philosophy, diagnosis, and treatment methods.


Osteopathic Concept & Philosophy
  • Osteopathic Philosophy & Musculoskeletal Structure/Function
  • Vascular, Lymphatic, & Neurologic Structure/Function
Osteopathic Diagnosis
  • Chapman's Reflexes, Cranium, Abdomen, Ribs
  • Cervical, Thoracic, & Lumbar Spine; Pelvis and Sacrum; Lower Extremities & Upper Extremities
Osteopathic Treatment Methods
  • Articulatory, Facilitated Positional Release, Still Technique, Balance Ligamentous Technique, Functional Technique,  Indirect, Exercise Therapy, Soft Tissue, & Myofascial Release
  • Muscle Energy, HVLA (High-Velocity – Low-Amplitude) Manipulation, Counterstrain, Cranial
  • Somatovisceral (Autonomic-Oriented Techniques), Visceral, Lymphatic

General Learner-Centered Objectives

Based on general learner-centered objectives, as outlined in the Osteopathic Principles and Practice 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 Osteopathic Principles and Practice.
  2. Foundational content knowledge and clinical problem-solving ability related to particular physician tasks critical to Osteopathic Principles and Practice.
  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 Osteopathic Principles and Practice

For Osteopathic Principles and Practice, 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. Osteopathic concept and philosophy: osteopathic tenets, musculoskeletal structure and function, somatic nerve structure, and lymphatic drainage
  2. Osteopathic diagnosis: observation, palpation, and range-of-motion testing of the lower/upper extremities, cervical/thoracic/lumbar spine, pelvis/sacrum, head, abdomen, and ribs
  3. Osteopathic treatment methods: counterstrain, muscle energy, myofascial release, high velocity low amplitude (HVLA), soft tissue, lymphatic technique, cranial osteopathic manipulative medicine, articulatory techniques, balanced ligamentous tension, ligamentous articular strain, facilitated positional release, Still technique, visceral technique, Chapman reflexes, and trigger points

Throughout these three categories, examinees will be required to demonstrate the ability to:

  1. Discuss the basic principles of the osteopathic philosophy and describe the impact on the health care delivery of osteopathic physicians.
  2. Discuss the scientific knowledge supporting the utilization of osteopathic principles and practices and osteopathic manipulative treatment (OMT), including the basic science of the mechanisms of OMT and somatic dysfunction, and the current evidence base for the clinical application of OMT.
  3. Define the types of physical examination findings consistent with somatic dysfunction.
  4. Define and describe the types of somatic dysfunction found within the ten body regions, including the head, cervical, thoracic, rib, lumbar, pelvic, sacral, abdominal, upper extremity and lower extremity body regions.
  5. Describe the symptoms and physical findings consistent with viscerosomatic, somatovisceral and somatosomatic reflexes.
  6. Define and describe indirect and direct types of OMT, including articulatory, balanced ligamentous tension, counterstrain, cranial osteopathic manipulative medicine, muscle energy, high velocity low amplitude (HVLA), visceral, lymphatic, exercise therapy, soft tissue and myofascial release techniques.
  7. Describe the basic principles of treatment of functional technique, facilitated positional release, ligamentous articular strain and Still techniques.
  8. Discuss the indications and contraindications of different types of OMT.
  9. Discuss the relative value, advantages and disadvantages of different types of OMT.
  10. Correctly diagnose somatic dysfunction within the ten body regions, prioritize a differential diagnosis and develop an appropriate care plan.
  11. Effectively communicate with patients and their families regarding risks, benefits and alternatives associated with the use of OMT.
  12. Maintain the safety and dignity of the patient while administering OMT.
  13. Identify viscerosomatic relationships and the role of the musculoskeletal system in health and disease by performing a structural examination and documenting findings reflective of this relationship.
  14. Show sensitivity to ethnic diversity as it may impact on the presentation of somatic and/or visceral dysfunctions.

Selected Student and Faculty Learning Resources for Osteopathic Principles and Practice

In addition to the aforementioned objectives, examples of supplementary resources used by the NBOME to inform the development of the Osteopathic Principles and Practice exam are listed below:

  • American Association of Colleges of Osteopathic Medicine (AACOM) – Educational Council on Osteopathic Principles (ECOP)

Practice Examination

The Osteopathic Principles and Practice Exam is 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. When an answer choice is selected, it will not be recorded for scoring and the selection will not be saved once another item is viewed. If you wish to track your answer choices, you must record them on your own. A special function is provided that allows you to view the correct answer for each item by clicking on the “Show Answer” button located below the answer choices. The “Show Answer” button will not appear on the actual examination.
OPP Practice Exam

Practice Questions

The Practice Questions for Osteopathic Principles and Practice 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 OPP Practice Questions

Additional Resources

Title Author/Site Edition Year
An Osteopathic Approach to Diagnosis and Treatment DiGiovanna, Amen, & Burns 4th 2020
Atlas of Osteopathic Techniques Nicholas 3rd 2015
Foundations of Osteopathic Medicine Seffinger 4th 2019
Glossary of Osteopathic Terminology ECOP/AACOM 2017
Greenman's Principles of Manual Medicine DeStefano 5th 2016
Osteopathic Core Competencies for Medical Students AACOM 2012
Somatic Dysfunction in Osteopathic Family Medicine Nelson 2nd 2014
COMAT Clinical Subjects
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