- What is COMLEX-USA Level 2-PE?
- COMLEX-USA Level 2-PE is a one-day examination of clinical skills where each candidate will encounter 12 standardized patients over the course of a seven-hour examination day.
- What clinical skills are assessed by COMLEX-USA Level 2-PE?
- The examination measures skills in two domains, the Humanistic Domain and the Biomedical/Biomechanical Domain. Doctor-patient communication, interpersonal skills and professionalism are reported as performance in the “Humanistic Domain.” History taking and physical examination skills including osteopathic palpatory skills, osteopathic manipulative treatment and osteopathic principles, documentation of the doctor-patient encounter in the form of a “SOAP” note, and some aspects of clinical problem-solving, integrated differential diagnosis, and formulation of a therapeutic plan are reported as performance in the Biomedical-Biomechanical Domain.” These skills are all assessed in the context of clinical encounters with standardized patients. English language proficiency is required to demonstrate these skills. Successful passage of two distinctive domains, the Biomedical/Biomechanical Domain and Humanistic Domain, is required to pass the COMLEX-USA Level 2-PE.
- Who is eligible to take COMLEX-USA Level 2-PE?
- Students in good standing at American Osteopathic Association (AOA) Commission on Osteopathic College Accreditation (COCA)-accredited colleges of osteopathic medicine who have passed COMLEX-USA Level 1 are eligible to take each of the COMLEX-USA Level 2 component examinations, the COMLEX-USA Level 2-PE, and the COMLEX-USA Level 2-Cognitive Evaluation (CE), in the sequence they choose.
Candidates become eligible to register and schedule examinations after their dean has approved them.
- Who is required to take the COMLEX USA Level 2-PE?
- Candidates are required to take and pass COMLEX-USA Level 2-PE to establish eligibility for the COMLEX-USA Level 3 examination. To obtain a license, DO graduates in the United States are required to have passed a national clinical skills examination. Additionally, the AOA COCA requires that all students pass COMLEX-USA Level 2-PE prior to graduation.
- Can students take COMLEX-USA Level 2-PE and USMLE’s Step 2 Clinical Skills (USMLE Step 2 CS)?
- COMLEX-USA Level 2-PE is designed for osteopathic medical practice and required for earning the DO degree, so only DO students are eligible to take this examination. The COMLEX-USA Level 2-PE examination blueprint reflects the distinctive practice of osteopathic medicine. All of the clinical cases are written by osteopathic physicians, and edited and refined by a case development committee comprised of osteopathic medical educators and clinicians. There is an appropriate emphasis on the palpatory component of physical examination, the patient-centered approach, and osteopathic manipulative treatment and the neuromusculoskeletal system as appropriate for osteopathic medical practice. The most appropriate evaluation tool for any profession is one designed particularly for that purpose. While DO students may elect to take both clinical skills examinations, they are not required to take USMLE Step 2-CS for graduation or for licensure.
- Why is it necessary to have a clinical skills examination as part of the COMLEX-USA examination series?
- The American public relies on a medical credentialing system that requires physician candidates to be evaluated against a common standard. While osteopathic medical students are evaluated by their schools and on clinical rotations, they are required to pass written COMLEX-USA components as an independent evaluation of this knowledge. The state medical licensing boards and the public rely on NBOME for this independent assessment of medical competencies.
In the interest of reducing medical errors as well as medical malpractice, many incidences of which are directly related to deficiencies in clinical skills and doctor-patient communication, the NBOME developed the COMLEX-USA Level 2-PE to assess these skills for licensure. Additionally, there is significant variation among the osteopathic medical colleges in assessment of clinical skills. Finally, numerous studies in medical education document the lack of actual verification of clinical skills and even the lack of direct observation of these skills.
Recognizing the importance of COMLEX-USA Level 2-PE to the profession and to the public, the AOA House of Delegates formally endorsed the addition of COMLEX-USA Level 2-PE into NBOME’s COMLEX-USA in 2003, and the first examination was delivered in September 2004. Passing the COMLEX-USA Level 2-PE is also a graduation standard for the DO degree required by the AOA COCA. In 2016, the Federation of State Medical Boards of the United States reported that surveys of state medical and osteopathic medical licensing boards revealed universal consensus on the importance of passing a national standardized clinical skills exam to assist them in protecting the public.
- Is there research to show that national clinical skills examinations are a valid and reliable part of the licensure pathway?
- Research conducted by the NBOME and other organizations show that these examinations do measure different but essential skills compared to the multiple choice based examinations. Having a national standard in place to determine minimal competency in these clinical skills is essential to the NBOME mission to protect the public and provide state licensing boards with a universal standard for the purposes of licensure.
Please refer to the Publications section of the NBOME website for a list of selected publications by the Department for Clinical Skills Testing about the COMLEX-USA Level 2-PE.
- Do the computerized COMLEX-USA examinations identify students with deficiencies in clinical skills?
- The COMLEX-USA Level 2-PE provides additional assessment of competencies that cannot be evaluated using computer-based multiple choice examinations (i.e., writing a patient note, communication and interpersonal skills, performance of OMT). Prior studies have shown modest correlations between performance on multiple-choice examinations and clinical skills performance. The experience of the Educational Commission for Foreign Medical Graduates, the National Board of Medical Examiners, and the Medical Council of Canada, all of which require clinical skills examinations for certification or licensure, is similar.
Many candidates may pass the multiple-choice examinations, but not possess the ability or the clinical skills to succeed in clinical encounters with patients.
- What other testing organizations utilize a national clinical skills examination?
- The NBME joined the ECFMG and the FSMB in 2004 to deliver USMLE Step 2 CS, a 12-station clinical skills exam required for all U.S. MD and international medical graduates. The MCC has utilized a standardized patient-based clinical skills examination as Part II of their Qualifying Examination for Canadian medical licensure for well over two decades. The National Board of Podiatric Medical Examiners (NBPME) utilizes the APMLE Part II CSPE to assess clinical skills of
podiatric medical students.
- Where do I take the COMLEX-USA Level 2-PE?
- The COMLEX-USA Level 2-PE is administered at two NBOME National Centers for Clinical Skills Testing (NCCST), at the NCCST-Philadelphia (in Conshohocken, Pennsylvania, near Philadelphia) and NCCST-Chicago (near O’Hare airport in Chicago, Illinois).
- What is the cost of the COMLEX-USA Level 2-PE?
- COMLEX-USA Level 2-Performance Evaluation Fees and information can be found here.
- Will there be sufficient opportunities for me to take COMLEX-USA Level 2-PE?
- Yes. However, you should schedule as early as possible (and no later than January 31st of your fourth year), especially if you have other scheduling needs to meet graduation or residency program requirements. The NBOME National Centers for Clinical Skills Testing in the Philadelphia and Chicago areas operate 12 months throughout the year, with examination administrations on weekdays and weekends as well as double testing sessions (morning and afternoon/evening sessions) on certain days. Examination dates are opened 12 months in advance on a rolling basis by month.
Candidates will be notified by their dean when they become eligible to schedule the examination and are encouraged to register as soon as possible to have the largest selection of dates from which to choose.
- Will there be additional testing sites in the future?
- To meet the increasing number of osteopathic medical students, a second NBOME National Center for Clinical Skills testing was added in Chicago, IL (near Chicago’s O’Hare airport) in August 2016. The Chicago site was selected primarily based on input from DO students. It is anticipated that scheduling needs of the national DO student cohort will be able to be accommodated at NBOME’s two sites for the immediate future.
- With the addition of a second national testing center in 2016, how will the NBOME ensure the examination is standardized?
- Rigorous quality assurance is conducted to ensure that the examination administration, cases, standardized patients, and scoring of the COMLEX-USA Level 2-PE provide for a standardized examination across both testing sites. Leadership ensures training of all staff is uniform across both centers, and training and administrative procedures are universal to all testing sites. Physician examiner scoring is facilitated through a distributed model, which includes remote
SOAP note and OMT physician examiners from across the country.
- How is COMLEX-USA Level 2-PE scored?
- Candidates will receive a score of “Pass” or “Fail” for the examination. Successful passing of COMLEX-USA Level 2-PE requires that the candidate pass each of two examination domains: the Biomedical/Biomechanical Domain and the Humanistic Domain.
The Biomedical/Biomechanical Domain measures skills in three areas: 1) data-gathering, 2) osteopathic manipulative treatment, and 3) documentation skills (SOAP Notes). The data gathering component reflects skills in history-taking and physical examination. The OMT portion represents performance in osteopathic assessment and manipulative treatment in select cases.
The following areas are assessed globally for OMT:
- Osteopathic Examination/Evaluation
- Patient/Physician Position for Treatment
- OMT Modality Selected
- OMT Technique
- Treatment Repetition/Duration
- Post-Treatment Assessment
The completed SOAP Note measures documentation (synthesizing information gathered in the clinical encounter), clinical problem-solving, integrated differential diagnosis and formulation of a therapeutic plan. Osteopathic principles are incorporated into each of the three areas.
The Humanistic Domain measures skills in Physician-Patient Communication, Interpersonal Skills, and Professionalism. Assessed skills within this domain include:
- Ability to elicit information
- Listening Skills
- Giving information
Highly trained standardized patients document history-taking and physical examination maneuvers performed, and record behaviors related to the humanistic physician attributes mentioned above. Trained osteopathic physician examiners score osteopathic manipulative treatment and SOAP notes.
- What if I do not pass the COMLEX-USA Level 2-PE?
- In the event that you do not pass, you will be able to reschedule to retake the examination upon receipt of the initial score report.
For first time takers in the 2017-2018 testing cycle, the pass rate was 93.2%. (Historic pass rates over the past 10 years have been in the 92-96% range.)
- Will some students be disadvantaged in taking COMLEX-USA Level 2-PE if there is variation in clinical skills training from school to school, especially in the area of osteopathic manipulative treatment?
- To help ensure standardization and fairness in osteopathic clinical skills assessment, the COMLEX-USA Level 2-PE is developed with input from faculty from osteopathic colleges across the country. Representatives from the Educational Council on Osteopathic Principles, as well as these faculty representatives, provide input in the areas of examination content, case development, scoring, and standard-setting. This helps to ensure standardization in the osteopathic skills being measured.
- How are fairness, objectivity, and reliability assured?
- Research and development since 1996 with further validation since the examination was implemented in 2004 provide ample evidence to support the use of COMLEX-USA Level 2-PE for assessing the clinical skills of osteopathic medical graduates. The standardized patients and osteopathic physician examiners are highly trained, and rigorous, industry-standard quality control measures are employed.
Representatives from many colleges of osteopathic medicine from all over the country have been involved in examination development and in setting the standards. Case development committee members, standard setting committee members, and osteopathic physician examiners scoring “SOAP” notes and osteopathic manipulative treatment are balanced to attempt to achieve broad representation with respect to native regions of the country, osteopathic medical specialties, gender, ethnicity, and other variables. Reproducibility of COMLEX-USA Level 2-PE scores is comparable to that found in other standardized patient examinations used for high-stakes board certification and licensure.
- Where can I learn more about COMLEX-USA Level 2-PE?
- Visit the COMLEX-USA Level 2-PE page for additional information. To speak to someone at the NBOME National Center for Clinical Skills Testing, call us at (866) 479-6828.