NBOME; C3DO Pilot - Core Competency Capstone Pilot Agreement

The Core Competency Capstone for DOs (C3DO) is a national, collaboratively developed clinical skills assessment created by the National Board of Osteopathic Medical Examiners (NBOME) to verify osteopathic clinical competencies for licensure eligibility beginning with the Class of 2029. Designed as a multi-station, standardized patient-based examination, C3DO evaluates core osteopathic skills to a national standard while being delivered locally at participating colleges of osteopathic medicine (COMs). The assessment is aligned explicitly with Dimension 2 of the COMLEX-USA Blueprint and uses a national case bank, standardized assessment tools, training protocols, and osteopathic physician examiners to ensure consistency and validity across administrations. C3DO's content focuses on common outpatient clinical presentations relevant to osteopathic practice.

Test specifications outline ten clinical presentation categories drawn from the COMLEX-USA Blueprint, including community health and patient presentations related to wellness, human development, endocrine and metabolic conditions, nervous system and mental health, musculoskeletal complaints, genitourinary/renal and breast issues, gastrointestinal and nutritional health, circulatory and hematologic systems, respiratory system presentations, and integumentary concerns. Because the examination contains six stations, not every category will appear on each administration; however, every candidate should encounter at least one case related to community health and wellness and two cases related to the musculoskeletal system. Examination format consists of six standardized patient encounters completed in one day over a 3-4 hour session. Each encounter allows 14 minutes for evaluation and treatment, followed by six minutes allocated for post-encounter questions, which include short answer, traditional multiple-choice, and extended multiple-choice formats. In three of the rooms, performance of osteopathic manipulative treatment (OMT) is observed and evaluated by certified osteopathic physician examiners where indicated on the patient chart. Data gathering and history/physical examination skills are assessed by standardized patients via checklists, while interpersonal and communication skills are measured with rubrics tied to eliciting information, listening, information delivery, empathy, and professionalism.

Notably, C3DO does not include a patient note (SOAP note) component; assessment of clinical reasoning is embedded within the post-encounter questions and item formats. Operational aspects such as onsite registration, orientation, transitions, breaks, and other logistics are managed by each participating COM, though encounter timing is standardized across administrations. The pilot phases and early participation by multiple COMs have been described positively: pilot participants reported that NBOME collaboration led to an effective and valid skills assessment tool that matured over time, integrated well with local academic culture, and provided opportunities for faculty development. Students and faculty alike reported that the pilot helped reinforce clinical learning, reduced anxiety by providing a cumulative assessment experience, and inspired improvements to other local examinations. C3DO aims to strengthen assessment of osteopathic clinical skills nationally while enabling COMs to deliver a standardized, competency-focused examination locally, supporting both candidate readiness for COMLEX-USA Level 3 and broader faculty and curricular development.