DESCRIPTION OF EXAMINATIONS

The COMLEX-USA series is designed to assess the osteopathic medical knowledge and clinical skills considered essential for osteopathic generalist physicians to practice medicine without supervision. COMLEX-USA is constructed in the context of medical problem-solving which involves clinical presentations and physician tasks. Candidates are expected to utilize the philosophy and principles of osteopathic medicine to solve medical problems. The Clinical Presentation ("Dimension 1") of the COMLEX-USA examination blueprint identifies high-frequency and/or high-impact health issues that osteopathic generalist physicians encounter in practice. The Physician Task ("Dimension 2") specifies the major steps osteopathic physicians generally undertake to solve medical problems. Major categories of the two dimensions can be found in Table 1. Detailed topics covered by each category are in the CBT Tutorial available on www.nbome.org.

The COMLEX-USA series is an examination sequence with three Levels. While all examination Levels have the same two-dimensional content structure, the depth and emphasis of each Level parallels the educational experiences of the candidate. This progressive nature of the COMLEX-USA examinations ensures the consistency and continuity of the measurement objectives of the osteopathic medical licensing examinations. A description of the blueprints follows:

Table 1 - The COMLEX-USA Examination Blueprint

Osteopathic principles and practices, by design, are integrated throughout all areas of the examination, as this best reflects the manner in which osteopathic principles and practices permeate osteopathic medicine.

Table 1

COMLEX-USA Level 1 is constructed according to the COMLEX-USA examination blueprint. Candidates are expected to demonstrate basic science knowledge relevant to medical problems as defined by the Level 1 blueprint. Level 1 emphasizes the scientific concepts and principles necessary for understanding the mechanisms of health, medical problems and disease processes.

Level 1, taken in one day, is a problem- and symptom-based assessment integrating the basic medical sciences of anatomy, behavioral science, biochemistry, microbiology, osteopathic principles, pathology, pharmacology, physiology and other areas of medical knowledge as they are relevant to solving medical problems. The examination consists of two four-hour test sessions, each containing questions related to diverse clinical presentations and principles.

Level 2-CE

COMLEX-USA Level 2-CE is constructed according to the COMLEX-USA examination blueprint. Candidates are expected to demonstrate knowledge of clinical concepts and principles involved in all steps of medical problem-solving as defined by Dimension 2. Level 2-CE emphasizes the medical concepts and principles necessary for making appropriate medical diagnoses through patient history and physical examination findings.

Level 2-CE, taken in one day, is a problem-based and symptom-based assessment integrating the clinical disciplines of emergency medicine, family medicine, internal medicine, obstetrics/gynecology, osteopathic principles, pediatrics, psychiatry, surgery, and other areas necessary to solve medical problems as defined by the Level 2-CE blueprint. A similar problem-symptom based approach is used in Level 2 and in Level 1. The examination consists of two four-hour test sessions, each containing questions related to diverse clinical presentations and principles.

Level 2-PE

For case selection, Level 2-PE applies the Dimension 1 categories from the COMLEX-USA blueprint. The content (case selection) of Level 2-PE is crossed with the following axes:

Patient Presentation Axis

Standardized patients present in simulated ambulatory medical settings with problems and symptoms that are either acute, chronic, or provide opportunities for health promotion and disease prevention. In addition, the patients encountered are balanced to meet the examination specifications for patient gender and age as a reflection of national osteopathic physician practice patterns based on national survey data as well as expert judgment. In addition, the demographic and cultural profiles of patients are instrumental considerations in the case development process.

Osteopathic Medical Practice Axis

In any examination form, the following clinical skills are evaluated in the majority of the standardized patient encounters

Biomedical/Biomechanical Domain

• Osteopathic Principles and/or Osteopathic Manipulative Treatment
• History-taking and Physical Examination Skills
• Integrated Differential Diagnosis and Clinical Problem-Solving
• Written Communication and Synthesis of Clinical Findings (SOAP note format)

Humanistic Domain

• Physician-Patient Communication, Interpersonal Skills, and Professionalism

Successful passage of the two distinctive domains is required to pass COMLEX-USA Level 2-PE.

Clinical Content Axis

Based on Dimension 1 of the COMLEX-USA blueprint, expert judgment, and national survey data of osteopathic physician practice patterns, candidates will encounter standardized patients presenting with the symptoms, problems, or complaints that are common to primary care osteopathic medical practice. These include:

• Patients with Neuromusculoskeletal Symptoms/Problems
• Patients with Respiratory Symptoms/Problems
• Patients with Gastrointestinal Symptoms/Problems
• Patients with Cardiovascular Symptoms/Problems
• Patients with Other Symptoms/Problems

The Level 2-PE is a one day examination of clinical skills where each candidate will encounter twelve standardized patients over the course of a seven-hour examination day. The examination takes place at NBOME’s National Center for Clinical Skills Testing in Conshohocken, Pennsylvania (bordering Philadelphia, Pennsylvania). Examination design, test specifications, testing format and other details are available in the Orientation Guide for COMLEX-USA Level 2-PE on the NBOME’s website. A 28-minute DVD Instructional Program on COMLEX-USA Level 2-PE has been provided to the Office of the Dean at each of the colleges of osteopathic medicine, and is also available for viewing on NBOME’s website.

COMLEX-USA Level 2-PE is the clinical skills component of the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA). Consistent with NBOME’s mission to protect the public, COMLEX-USA-Level 2-PE helps to fulfill the public and licensing authority mandate for enhanced patient safety through the documentation of the clinical skills proficiency of graduates from osteopathic medical schools. The Performance Evaluation augments the written COMLEX-USA-Level 2-Cognitive Evaluation (CE) of osteopathic medical knowledge by providing an assessment of clinical skills. These clinical skills are: doctor-patient communication, interpersonal skills and professionalism, medical history-taking and physical examination skills, osteopathic principles and osteopathic manipulative treatment, and written communication skills (including synthesis of clinical findings, integrated differential diagnosis and formulation of a diagnostic and treatment plan). These patient-centered skills are evaluated in the context of clinical encounters with standardized patients, and are required to be personally performed as appropriate in a timely, efficient, safe, and effective manner.

Level 3

COMLEX-USA Level 3 is constructed according to the COMLEX-USA examination blueprint. Candidates are expected to demonstrate knowledge of clinical concepts and principles necessary for solving medical problems as independently practicing osteopathic generalist physicians. Level 3 emphasizes the medical concepts and principles required to make appropriate patient management decisions.

Level 3, taken in one day, is a problem-based and symptom-based assessment integrating the clinical disciplines of emergency medicine, family medicine, internal medicine, obstetrics/gynecology, osteopathic principles, pediatrics, psychiatry, surgery, and other areas necessary to solve medical problems as defined by the Level 3 blueprint. Level 3, like Level 2-CE and Level 1, is problem-based and symptom-based in presentation. The examination consists of two four-hour test sessions, each containing questions related to diverse clinical presentations and principles.

EXAMINATION SCORES

COMLEX-USA Level 1, Level 2-CE, and Level 3 Examination Scoring

The number of items answered correctly (the raw score) is converted to a 3-digit standard score and a 2-digit standard score for the purposes of making pass-fail decisions and for reporting the results. The conversion for standard scores involves information about the performance of examinees that have taken these examinations previously.

The 3-digit standard scores of COMLEX-USA Level 1, Level 2-CE, and Level 3 have a mean of 500. Standard deviations of the standard scores will be determined after the examinations are computerized. A 3-digit standard score of 400 or a 2-digit standard score of 75 on COMLEX-USA Level 1 or COMLEX-USA Level 2-CE is required to pass the examination. A 3-digit standard score of 350 or a 2-digit standard score of 75 on COMLEX-USA Level 3 is required to pass the examination.

Some items, which may be included in the examination solely for research purposes, are not included in the candidate’s score.

The percentage of examinees that pass or fail the examination is not predetermined. The passing score for all COMLEX-USA examinations is based solely on a candidate’s performance on the total examination, not on performance on individual content areas. The COMLEX-USA score reports include graphical performance profiles summarizing strengths and weaknesses for areas designated on the blueprint.

COMLEX-USA Level 2-PE/Clinical Skills Examination Scoring

Detailed information regarding examination scoring for COMLEX-USA Level 2-PE is available in the Orientation Guide that on the website. Scoring is criterion-based and reported as Pass or Fail only. Successfully passing the two distinctive domains is required to pass COMLEX-USA Level 2-PE. These include the Humanistic Domain, which is a measure of physician-patient communication, interpersonal skills, and professionalism, as well as the Biomedical/Biomechanical Domain, which includes history-taking, physical examination, osteopathic principles and osteopathic manipulative treatment, written communication (synthesis of clinical findings in a SOAP Note format), integrated differential diagnosis, and clinical problem-solving. Candidates who are unsuccessful in meeting the passing standards for either domain are provided further feedback on their score reports as to relative areas of strengths and weaknesses.

Score Reports

All COMLEX-USA Level 1 and COMLEX-USA Level 2-CE score reports will be mailed to both the candidate and the dean of the candidate’s school. COMLEX-USA Level 3 score reports will be mailed to both the candidate and the dean of the candidate’s school and may be released by the NBOME to the Director of Medical Education at the candidate’s internship hospital. No scores will be reported by telephone, e-mail or fax. During the initial 3-4 months of computerized testing, score reports will be mailed approximately 12-14 weeks from the date of the examination and at approximately 4-week intervals thereafter.

COMLEX-USA Level 2-PE score reports will be mailed to the candidate and the dean of the candidate’s school approximately 10-12 weeks from the date of the examination, but may be subject to additional delays that are contingent upon candidate scheduling and other variables. Candidates may also access their COMLEX-USA scores online using a unique candidate identifier and passcode, and Deans (and their administrative representatives) may access this information for their students as well as confirm test session dates using a secure school page of the system. Deans also receive aggregate score information for their students on an annual basis.

A duplicate score report may be sent to a candidate upon receipt of a written request within 30 days after the original release of the score. The candidate should allow 10 business days for delivery. Thereafter, a candidate must request an official certified transcript or a photocopy of the score report and pay a fee as determined by the NBOME.

Score Confirmation/Verification

Prior to mailing score reports, the NBOME conducts a thorough process of quality assurance to ensure that all candidate scores are accurate. However, a candidate who wishes for his or her scores to be rechecked may submit a written request for score confirmation/verification with the accompanying $50 fee.

For COMLEX-USA Level 1, Level 2-CE, and Level 3 examinations, score verification involves confirmation of responses recorded by computer. For the COMLEX-USA Level 2-PE examination, this process involves confirmation of the numerical aspects that make up the scores, but not further review or rescoring of videotaped performances or written SOAP Notes. Written requests for score verification for Level 1, Level 2-CE, or Level 3 should be submitted to the Chicago NBOME office within 30 days from the release of candidates scores.

Requests for score confirmation for Level 2-PE should be submitted directly to the NBOME National Center for Clinical Skills Testing. All requests must be received in writing within three months of the completion of the examination (or 30 days from the issuing of the score report, whichever is later) and must include the $50 fee for score confirmation/verification. The candidate will be notified of the score confirmation/verification results in writing within two weeks of the receipt of the request.