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Level 2 Performance Evaluation (PE) FAQ

The National Board of Osteopathic Medical Examiners, Inc. (NBOME) began delivering its written examinations by computer in July of 2005. The last paper-pencil COMLEX-USA Level 2-CE examination was administered in January of 2005 and the last paper-pencil COMLEX-USA examination for Level 3 was administered in June of 2005. The last paper-pencil COMLEX-USA Level 1 examination will be administered in October of 2005. This FAQ sheet is intended to provide a brief description of the computer-based COMLEX-USA examinations.

Why does it take 8-10 weeks to receive a score report?

With occasional short delays due to circumstances that are out of NBOME’s control, scores are generally available within 8-10 weeks of the examination date. This short time is required to ensure accurate, reliable and valid examination scoring and reporting. Scores are analyzed and checked for accuracy before the scores are released. Score reports will be forwarded by US mail directly to the candidate as well as the candidate’s osteopathic medical school. Pass/Fail results will also be available via secure access through the website. Candidates should consult with NBOME’s Bulletin of Information and Orientation Guide posted on the website for detailed information regarding score reporting.

Why did I fail COMLEX-USA Level 2-PE when my medical school grades, test scores, COMLEX-USA Level 1 or Level 2-CE scores, and/or my clerkship scores are very good?

Numerous published studies show that there is only a very modest correlation between COMLEX-USA Level 2-PE (and other national clinical skills examinations) and other measures of academic performances (e.g., academic grades in medical school years 1 and 2, COMLEX-USA multiple choice cognitive examinations such as Level 1, Level 2-CE, USMLE scores, MCAT scores, and clerkship grades). Consequently, the fact that a student may have performed satisfactorily or even quite well in an academic or other setting may not predict achievement in clinical skills. There is extensive literature that documents the low correlation between clerkship global rating forms and other academic measures (e.g., Multiple Choice Question- MCQ- examinations) as well as with national clinical skills examinations including COMLEX-USA Level 2-PE.

Indeed, a significant part of the reason the clinical skills examination exists is that cognitive knowledge is measured principally by MCQ examinations, whereas clinical skills and performance are measured by the COMLEX-USA Level 2-PE examination. The assessment format is not the same and the two are designed to measure different competencies. The available literature also suggests that physicians have a limited ability to accurately self-assess their own competency.

How do I request score confirmation?

As noted in NBOME’s Bulletin of Information, requests for score confirmation for COMLEX-USA Level 2-PE should be submitted in writing to: Score Confirmations, NBOME National Center for Clinical Skills Testing, Suite 150, 101 West Elm Street, Conshohocken, PA 19428. Requests must be received in writing within three months of taking the examination (or 30 days from the date of issue of the score report, whichever is later) and must include the $50 fee. The written request must include the candidate’s NBOME identification number, test session date, mailing address and signature. A Candidate score confirmation duplicates, on an individual basis, all of the mathematical computations performed in scoring of an examination. It does not include having videotape performances or written SOAP Notes rescored by additional examiners.

The candidate will be notified of the score confirmation results in writing within two weeks of the receipt of the request (at the address above).

Can I get more specific feedback about what I am doing wrong?

For candidates who did not pass, more specific feedback is provided on the back page of their score report. A breakdown for each of the two examination domains, defined in the report, is provided. Within the Biomedical/Biomechanical domain, further feedback is presented, by score component, for data-gathering (history-taking and physical examination), OMT, and the written SOAP Notes. “Proficient” performances are those that are well above the national standard. “Needs improvement” performances are those that are close to the cut-points and, as such, may be either just above the standard, or just below the standard. Therefore, depending on the entire performance within the Biomedical/Biomechanical domain, “needs improvement” performances may contribute to a final score of pass or fail.

How do I improve my performance or remediate?

Unlike formative assessments used at medical schools, COMLEX-USA Level 2-PE is a summative high-stakes assessment where performance is evaluated against a national standard. The public relies on a system of licensure that incorporates these types of competency-based assessments. To this end, remediation is not provided by the NBOME, and examination content (cases, etc.) must remain secure. Case-specific feedback (e.g., “What questions should I have asked,” or “What communication skills did I not demonstrate in the exam”) cannot be provided. Prior to retesting, candidates should consult with their dean or school representative to obtain reference materials and to formulate a remediation plan.

Typically, candidates will schedule specific activities with the faculty of their school, including clinical clerkships with direct observation, videotaping with real or standardized patients, and hands-on guided practice for defined skills (e.g., history-taking and physical examination, osteopathic manipulative medicine, writing SOAP Notes, doctor-patient communication, etc.).

What is “Irregular Behavior” as noted on the score report?

Any irregular behavior that would constitute unprofessional conduct, as outlined in NBOME’s Bulletin of Information and Orientation Guide, in regards to the application or registration for, the taking of, or the conduct after taking any COMLEX-USA examinations subject to NBOME’s policies, could result in invalidation of an examination or disqualification. This includes copying, fraud, or sharing of any examination content or material, use of prohibited reference materials during the examination, and verbally or physically harassing any NBOME staff at any time, including when contacting NBOME for information about failing scores. In addition, falsification of the medical record (written SOAP Notes) in COMLEX-USA Level 2-PE by documenting medical history that was not elicited, or physical examination maneuvers that were not performed, is considered irregular behavior and will be thoroughly investigated and dealt with as specified in NBOME’s Bulletin of Information.

If I failed, how do I reschedule for the examination?

Upon receipt of a failing score, you may register for another examination through our web-based registration system. When logging into the registration program, you should have several opportunities to reschedule for the examination, including specific seats which are reserved for students retaking the examination. If you do not see an acceptable date within 6-8 weeks or have specific questions, please call our Clinical Skills Testing Center directly at 610-825-6551 for assistance with scheduling.

When should I reschedule for the examination?

When rescheduling, be sure to allow adequate time to retake the examination prior to your school’s graduation deadline, and keep in mind the time required for remediation, rescheduling, and score report release (8-10 weeks).

Remember that passing COMLEX-USA Level 2-PE is a requirement for graduation, and therefore a requirement for starting a postgraduate medical education or residency training program.

Selected References

1. Kreiter, CD, Ferguson, K, Lee, WC, Brennan, RL, Densen, P. A Generalizability study of a New Standardized Rating Form to Evaluate Students’ Clinical Clerkship Performance. Academic Medicine. 73:12: 1294-1298. December 1998.
2. Hunt, DD. Functional and dysfunctional characteristics of the prevailing model of clinical evaluations systems in North American medical schools. Academic Medicine. 76: 254-259. 1992.
3. Methany, WP. Limitations of physician ratings in the assessment of student clinical performances in an obstetrics and gynecology clerkship. Obstetrics & Gynecology. 78: 136-141. 1991.
4. Carline, JD, Paauw, DS, Thiede, KW, Ramsey, PG. Factors affecting the reliability of ratings of students’ clinical skills in a medicine clerkship. Journal of General Internal Medicine. 7: 506-510. 1992.
5. Hartman, SE, Bates, BP, Sprafka, SS. Correlation Scores for the Comprehensive Osteopathic Medical Licensing Examination With Osteopathic Medical School Grades. Journal of the American Osteopathic Association. 101: 6: 347-349. June 2001.
6. Baker, HH, Cope, MK, Adelman, MA, Schuler, S, Foster, RW, Gimpel, JR. Relationships Between Scores on the COMLEX-USA Level 2-Performance Evaluation and Selected School-Based Performance Measures. Journal of the American Osteopathic Association. 109: 5: 290-295. May 2006.
7. Gimpel, JR, Boulet, JR, Errichetti, AM. Evaluating the Clinical Skills of Osteopathic Medical Students. Journal of the American Osteopathic Association. 103: 6: 267-279. June 2003.
8. Taylor, ML, Blue, AV, Mainous, AG, Geesey, MS, Basco, WT. The Relationship Between the National Board of Medical Examiners’ Prototype of the Step 2 Clinical Skills Exam and Interns’ Performance. Academic Medicine. 80:5:496-501. May 2005.
9. Ayers, WR, Boulet, JR. Establishing the Validity of Test Score Inferences: Performance of 4th-Year U.S. Medical Students on the ECFMG Clinical Skills Assessment. Teaching and Learning in Medicine. 13:4:214-220. 2001.
10. Boulet, JR, Gimpel, JR, Dowling, DJ, Finley, M. Assessing the Ability of Medical Students to Perform Osteopathic Manipulative Treatment Techniques.
JAOA. 104:5: 203-211. May 2004.
11. Davis, DA, et al. Accuracy of Physician Self-assessment Compared With Observed Measures of Competence. Journal of the American Medical Association. 296:9: 1094-1102. September, 2006.
12. NBOME Website: www.nbome.org BOI, Orientation Program, Instructional Program DVD, PE FACT Sheet, PE Score Reporting FAQ.

More Questions?

For those with further questions regarding the COMLEX-USA Performance Evaluation, the NBOME provides a Help Desk that can be reached at 1-866-479-6828.