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Strengthening Osteopathic Clinical Skills in Pennsylvania: The C3DO Project's Collaborative Approach in Osteopathic Medicine February 2026 | Vol. 70, No. 1 Osteopathic medicine emphasizes a patient-centered approach that integrates the body’s structure and function in both diagnosis and treatment. At the heart of ensuring the osteopathic profession trains physicians dedicated to person-centered care in an increasingly technical world of healthcare is the Core Competency Capstone for DOs (C3DO) project—a groundbreaking initiative that brings together the National Board of Osteopathic Medical Examiners (NBOME) and leading colleges of osteopathic medicine (COMs). The C3DO project was conceptualized in response to the rapidly evolving landscape of healthcare education and practice, and patient needs. The COVID -19 pandemic resulted in a discontinuation of many national assessments for clinical skills as part of physician licensure. In response, the NBOME launched the Special Commission on Osteopathic Medical Licensure Assessment, which convened from 2021-2023 to evolve osteopathic clinical skills assessment into a national, standardized assessment that could be delivered at COMs.1 The resulting C3DO program, now in its fourth year of pilot testing, has grown to over 17 locations nationwide and will be integrated into the COMLEX-USA program starting in 2028 as an option to fulfill the requirement of clinical skills verification. Osteopathic medical education and practice is rapidly changing, and includes easier access to clinical information, more technology to assist in diagnosis and treatment, and expanded use of artificial intelligence in clinical decision making. However, osteopathic patient care still requires important clinical skills such as doctor-patient communication; interpersonal skills, professionalism and compassion; gathering a patient history; performing a physical examination; performing osteopathic manipulative treatment; and osteopathic clinical reasoning. C3DO provides an assessment of these skills, standardized in a format that can be delivered at COMs as part of a competency-based medical education program.2 Students achieve competency in these skills as demonstrated in C3DO, or have the opportunity to further develop them prior to licensure. First and foremost, C3DO elevates the quality of clinical training by setting a national standard for these skills and holding them as equivalent to the medical knowledge that is assessed through traditional multiple-choice tests. An educational program that prepares students to demonstrate these skills as a requirement of the profession will also enhance their readiness for residency training, and ultimately, improve their care of patients. At its core, the C3DO project thrives on partnership. The NBOME, renowned for its rigorous competency-based assessments (such as the COMLEX-USA series), provides the assessment design, standard setting, and psychometrics expertise necessary for measuring osteopathic clinical skills. Meanwhile, members of the osteopathic profession—including faculty and staff at the colleges of osteopathic medicine—contribute their educational leadership, faculty experience, and student insight. In 2026, C3DO will be piloted at 17 locations nationally, including the Lake Erie College of Osteopathic Medicine. “As the only medical school in Pennsylvania participating in the national C3DO initiative, LECOM is proud to lead the way in advancing clinical skills testing for the next generation of healthcare professionals. In a time when technological innovations such as AI, POCUS, and EMRs are rapidly transforming patient care, we remain deeply committed to preserving the human aspects of medicine. Clinical skills testing not only strengthens our students’ technical abilities, but also reinforces the critical importance of empathy, communication, and a patient-centered approach to care. At LECOM, we believe that the foundation of excellent healthcare lies in the ability to connect with patients as individuals, and this initiative is an essential step in ensuring that our graduates are fully prepared to meet the evolving demands of modern medicine." ~ Silvia M. Ferretti, DO, Provost, Senior Vice President, and Dean of Academic Affairs at LECOM The ultimate beneficiaries of the C3DO project will be the patients and communities served by the osteopathic profession. Keeping an emphasis on clinical competency, cultural sensitivity, and community engagement means that patients receive more person-centered, osteopathic care. The C3DO project stands as a testament to what can be achieved when educational and professional organizations join forces for a common goal. The number of COMs participating grows each year, and more COMs are scheduled to participate beginning in 2027. Overall, this demonstrates the profession’s commitment to fostering these fundamental patient-centered competencies. Through the partnership between COMs and the NBOME, C3DO is raising the bar for medical education, supporting student success, and improving health outcomes for our patients. For more information about the C3DO project, visit NBOME.org/C3DO.
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