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COMLEX-USA Level 2-Performance Evaluation FAQ

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

With occasional short delays due to circumstances that are beyond 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. Candidates and Deans will receive an email notifying them that score reports are available through the NBOME's secure Client Registration System (CRS) and a notice is posted on Facebook as well as the NBOME website homepage. Score reports can be accessed through the CRS using a unique identifier and passcode. 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 course grades and test scores, COMLEX-USA Level 1 or Level 2-CE scores, and/or my clerkship ratings are very good?

Numerous published studies show that there is only a very modest correlation between national clinical skills examinations (such as COMLEX-USA Level 2-PE) and other measures of academic performances (such as 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 ratings). 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 COMLEX-USA Level 2-PE. 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 a score confirmation?

Requests for score confirmation for Level 2-PE should be submitted via the NBOME Client Registration System. All requests must be received 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 results electronically via their CRS secure user account within two weeks of the receipt of the request.

The score confirmation checks the accuracy and computation of scores. The score confirmation does not include having videotape performances or written SOAP Notes rescored by additional examiners.

Can I get more specific feedback as to 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, documentation of SOAP Notes, doctor-patient communication, etc.).

What is "Irregular Conduct" as annotated 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, misrepresentation of findings documented on the medical record (SOAP Notes) in COMLEX-USA Level 2-PE by documenting medical history that was not elicited or physical examination maneuvers or techniques that were not performed is considered irregular conduct 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 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.

Is there a limit on how many times a candidate can take a particular level of COMLEX-USA examination?

The NBOME does not currently limit the number of times a candidate may retake an examination that he/she did not pass; however, a candidate may take the COMLEX-USA Level 1, Level 2-CE or Level 3 a maximum of four times in any 12-month period. NBOME guidelines state that the COMLEX-USA Level 2-PE may only be taken three times in a 12-month period. Be sure to check the policies of your academic institution for its retake guidelines, which may differ from the NBOME's.

A candidate may not retake any level of COMLEX-USA to improve his or her score, or for any purpose other than to pass a previously failed examination.

Notice of Planned Policy Change
Effective July 1, 2016, candidates taking COMLEX-USA examinations will be limited to a total of six (6) attempts for each examination (COMLEX-USA Level 1, Level 2 CE, Level 2 PE and Level 3), including but not limited to all attempts prior to July 1, 2016. After June 30, 2016, no candidate will be allowed to take any examination more than six (6) times without obtaining approval from the NBOME.

Selected References

Ayers, W. R., Boulet, J. R. 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.

Baker, H. H., Cope, M. K., Adelman, M. A., Schuler, S., Foster, R. W., Gimpel, J. R. 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.

Boulet, J. R., Gimpel, J. R., Dowling, D. J., Finley, M. Assessing the Ability of Medical Students to Perform Osteopathic Manipulative Treatment Techniques. JAOA. 104:5: 203-211. May 2004.

Boulet, J. R., Smee, S. M., Dillion, G. F., & Gimpel, J. R. (2009). The use of standardized patient assessments for certification and licensure decisions. Simulation in Health Care, 4(1), 35-42.

Furman, G. E., Smee, S. M., & Wilson, C. D. (in press). Quality assurance strategies for high stakes performance-based examinations. Simulation in Health Care.

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.

Hartman, S. E., Bates, B. P., Sprafka, S. S. (2001). Correlation Scores for the Comprehensive Osteopathic Medical Licensing Examination With Osteopathic Medical School Grades. Journal of the American Osteopathic Association, 101(6), 347-349.

Kreiter, C. D., Ferguson, K., Lee, W. C., Brennan, R. L., Densen, P. (1998). A Generalizability study of a New Standardized Rating Form to Evaluate Students' Clinical Clerkship Performance. Academic Medicine, 73(12), 1294-1298.

Langenau, E. E., Dyer, C., Roberts, W. L., Wilson, C., & Gimpel, J. R. (2010). Five-year summary of COMLEX-USA Level 2-PE examinee performance and survey data. The Journal of the American Osteopathic Association, 110(3), 1-13.

NBOME Website: www.nbome.org BOI, Orientation Program, Instructional Program DVD, PE FACT Sheet, PE Score Reporting FAQ.

Roberts, W. L., McKinley, D. W., & Boulet, J. R. (2009). Effect of first encounter pretest on pass/fail rates of a clinical skills medical licensure examination. Advances in Health Sciences Education.

Sandella, J. M., Roberts, W. L., Gallagher, L. A., Gimpel, J. R., Langenau, E. E., & Boulet, J. R. (2009). Patient note fabrication and consequences of unprofessional behavior in a high-stakes clinical skills licensing examination. [Supplement]. Academic Medicine, 84(10), S70-S73.

Weidner, A. C., Gimpel, J. R., Boulet, J. R., & Solomon, M. (2010). Using standardized patients to assess the communication skills of graduating physicians for the comprehensive osteopathic medical licensing examination (COMLEX) Level 2-performance evaluation (Level 2-PE). Teaching and Learning in Medicine, 22(1), 8-15.

Updated July 1, 2013

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.