This page is for osteopathic physicians preparing for Osteopathic Continuous Certification, run by the American Osteopathic Association. It collects free practice sets by topic, worked examples with explanations, a study plan, and the rules we could verify for Family Medicine (AOBFP): the $225 annual fee, the 80% cumulative pass point, and untimed questions.

OCC Exam at a Glance

What changed for OCC in 2026

• Oct 26, 2026: Eligibility (Family Medicine (AOBFP)) changed to Mandatory for time-dated certifications; voluntary for non-time-limited certifications (previously Required for time-dated certificates; voluntary for non-time-limited ones).^[4]
• Oct 26, 2026: Registration opens (Family Medicine (AOBFP) Longitudinal Assessment) changed to October of the prior year (previously Opens in October of the year before the assessment).^[1]
• Oct 26, 2026: Registration deadline (Family Medicine (AOBFP) Longitudinal Assessment) changed to November 30, 2026 (previously All 30 questions due by Nov. 30, 2026).^[2]
• Oct 26, 2026: Time limit (Family Medicine (AOBFP) Longitudinal Assessment) changed to Untimed, at own pace (previously Untimed, at your own pace).^[1]
• Oct 26, 2026: Retake policy (Family Medicine (AOBFP) Longitudinal Assessment) changed to Second attempt on missed questions 7 days after the first attempt (previously Second attempt on missed questions 7 days after the first).^[1]
• Oct 26, 2026: Renewal (Family Medicine (AOBFP)) changed to 120 hours of CME every 3 years (previously 120 CME hours every 3 years).^[2]
• Oct 26, 2026: Validity (Family Medicine (AOBFP)) changed to 9-year certificate (previously 9-year certificate (expiring 2027–2035)).^[2]
• Oct 26, 2026: Other (update 2026-01-26) changed to The American Osteopathic Association transitioned OCC longitudinal assessments in-house to the AOA Learning Portal powered by Oasis for most specialties on January 26, 2026, delivering all items at once and opening remediation 7 days later. (previously The AOA moved OCC longitudinal assessments in-house to its Learning Portal (powered by Oasis), launching for most specialties on January 26, 2026. All items are now released at once, and a second attempt opens seven days after the first. Orthopedic Surgery assessments open on May 1, 2026.).^[3]
• May 1, 2026: The Orthopedic Surgery OCC longitudinal assessments opened on May 1, 2026 on the new learning platform.^[3]
• Jan 26, 2026: The American Osteopathic Association transitioned OCC longitudinal assessments in-house to the AOA Learning Portal powered by Oasis for most specialties on January 26, 2026, delivering all items at once and opening remediation 7 days later.^[3]

What the OCC is and how it works

According to American Osteopathic Association, “Diplomates will receive 30 questions during their first attempt.”^[1]

Osteopathic Continuous Certification (OCC) is the process the American Osteopathic Association and its specialty boards use to keep board certification current. It is not a single sitting. The longitudinal assessment is delivered online in the AOA Learning Portal (powered by Oasis), which started for most physicians on Jan. 26, 2026.

The details below are verified for Family Medicine (AOBFP). Other specialty boards can set their own fees, question counts and dates, so check your own board's page on the official certification site before you plan.

• Eligibility: OCC is mandatory for time-dated certifications and voluntary for non-time-limited certifications. For time-dated holders, failing to complete the process means losing certification when the current one expires.
• Certificate: a 9-year certificate, with 120 hours of CME required every 3 years.
• Longitudinal assessment: 30 questions per year, untimed and completed at your own pace. The pass point is a cumulative score of 80%.
• Fee and timing: $225 annual fee, paid at registration. Registration starts in October of the prior year, and the assessment is available from mid-to-late January through November. The listed deadline to complete 30 questions is Nov. 30, 2026.
• Retake rule: 7 days after your initial attempt, you automatically get a second opportunity to revisit missed questions and improve your score.

Our practice questions are written with AI tools and are not real exam questions. Treat them as topic practice, and use the official AOA and AOBFP pages for requirements.

Worked examples: how to reason through OCC questions

These are practice questions written for this site, not questions from the real exam. Each explanation shows why the right answer is right and why the others are wrong.

Example 1

Question: A physician wants to document a level 4 office visit (99214). Which elements must be present under the 2021 E/M guidelines?

1. Moderate medical decision making OR 30-39 minutes total time
2. 4 HPI elements and 2 exam systems
3. Detailed history, detailed exam, moderate MDM
4. Review of 10+ systems and complete physical

Answer: A. Moderate medical decision making OR 30-39 minutes total time

Explanation:

The correct answer is that a level 4 office visit (99214) needs moderate medical decision making or 30-39 minutes of total time. Under the 2021 E/M guidelines you choose one route, either decision making or time, and the note must support it.

The other options describe the older scoring model. Counting 4 HPI elements and 2 exam systems, requiring a detailed history and detailed exam, or requiring review of 10+ systems and a complete physical all treat history and exam as scored elements. They no longer set the level, although a medically appropriate history and exam are still documented.

Rule to remember: pick the level from decision making or total time, not from counting bullets in the history or exam.

Example 2

Question: Which OCC component requires osteopathic physicians to complete AOA-specified Category 1-A CME credits each cycle?

1. Professionalism
2. Lifelong learning / continuing medical education
3. Cognitive assessment
4. Practice performance assessment

Answer: B. Lifelong learning / continuing medical education

Explanation:

The correct answer is lifelong learning and continuing medical education. This is the part of OCC that sets the CME credit requirements, including AOA-specified Category 1-A credits, for each cycle.

Professionalism is about conduct, ethics and standing, not credit hours. Cognitive assessment is the knowledge check, which today is the longitudinal assessment, so it measures what you know and does not count CME. Practice performance assessment looks at how you review and improve your own patient care, and it has its own requirements separate from credit hours.

Rule to remember: if the question is about credits earned over a cycle, think of the CME or lifelong learning requirement. If it is about testing knowledge, think of the assessment. Confirm the current credit rules with your specialty board.

Example 3

Question: What is a benefit of participating in skills development workshops?

1. They focus only on theory.
2. They offer hands-on practice and skill improvement
3. They discourage interactive learning.
4. They replace real patient care.

Answer: B. They offer hands-on practice and skill improvement

Explanation:

The correct answer is that skills development workshops offer hands-on practice and skill improvement. The format exists so you can try a technique or procedure, get feedback and refine it in a controlled setting before using it with patients.

The claim that they focus only on theory is wrong because practice is the point of a workshop. The claim that they discourage interactive learning is the opposite of the format, which relies on participation. The claim that they replace real patient care is wrong because workshops supplement clinical work and do not stand in for it.

Rule to remember: when an option uses absolute words such as only or replace, check it carefully. Educational activities usually build on patient care and support it.

How to use these practice tests

Start with the official material. Read your specialty board's OCC requirements and longitudinal assessment FAQ so you know your fee, deadline, question count and pass point before you study anything else. For Family Medicine, that means the AOBFP pages. Write the dates that apply to you on a calendar.

Next, take a short diagnostic pass on the main practice test and note which topics feel slow. Then work through the topic sets in order of weakness. Good places to start are Musculoskeletal Assessment & Diagnosis, Pharmacology & Therapeutics and Preventive Medicine & Population Health. Add Professionalism & Medical Ethics and Evidence-Based Medicine & Research for the reasoning-heavy material.

After each set, read every explanation, including those for questions you got right. Keep a short list of rules you missed and reread it before your next session. The real assessment is untimed, so practise reading the stem carefully and eliminating wrong options instead of racing.

Because missed questions can be revisited after the retake window, treat our sets the same way: return to your wrong answers a few days later and see whether you can explain them without the answer in front of you. Our questions are not real exam items, so use them to build reasoning, not to predict content.

Sources & last verified

1. American Osteopathic Association — number of questions, time limit, passing score, exam fee (official source). “Diplomates will receive 30 questions during their first attempt.” Verified Oct 26, 2026.
2. American Osteopathic Association — validity, renewal, registration deadline (official source). “You currently hold a 9-year certificate. You are required to meet the following criteria for Osteopathic Continuous Certification.” Verified Oct 26, 2026.
3. American Osteopathic Association — delivery, other (official source). “AOA board-certified physicians* will complete their longitudinal assessments in the AOA’s Learning Portal (powered by Oasis) starting for most* on Jan. 26, 2026.” Verified Oct 26, 2026.
4. American Osteopathic Association — eligibility (official source). “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…” Verified Oct 26, 2026.

How we verify: editorial & fact-checking policy. Report an error: contact us.