The leadership of the Association of Pediatric Program Directors, Council on Medical Student Education in Pediatrics, Association of Medical School Pediatric Department Chairs, FuturePedsRes, and NextGenPediatricians, have issued a series of comprehensive recommendations designed to optimize the residency recruitment process and improve equity in applications to pediatric residency programs.

These statements align with the recommendations of the Coalition for Physician Accountability’s Undergraduate Medical Education to Graduate Medical Education Transition Review Committee (UGRC) —which focus on improvements to the transition from medical school into residency. The NBOME is a member of the UGRC.

The recommendations of pediatric leaders support of a holistic application review process, recognizing that applicants from all different backgrounds bring with them different clinical, research, and extracurricular experiences.

With respect to DO applicants  of pediatric residency programs, their recommendations include:

• Avoid overreliance on a single examination program when selecting candidates for residency, regardless of whether they are on allopathic or osteopathic licensing pathway.
• Do not require osteopathic applicants – nor make them feel like they are required – to undergo licensing examinations other than the osteopathic (COMLEX-USA) licensure exam.
• Implement processes that fairly consider osteopathic applicants within the context of the osteopathic (COMLEX-USA) licensure process.

Specified goals of these recommendations are twofold:  1) Helping learners find programs that support their career goals while providing an atmosphere conducive to how they learn best, and 2).  Creating a fair and equitable application and selection process for both learners and programs.

Read the full set of recommendations here.

“This comprehensive set of recommendations demonstrates an admirable commitment to equity and inclusion in the pediatrics community, clarifying for DO applicants that they are valued and welcomed to apply to pediatrics residency programs,” said John R. Gimpel, DO, MEd, president and CEO of the NBOME. “Clarifying that DO applicants are welcomed and can apply with their valid COMLEX-USA licensing exam qualifications is a major advance for Pediatrics and will positively impact the pediatric workforce needs and residency training programs nationwide.”

This group of recommendations from pediatric leadership is just the latest in a flurry of support from residency specialty organizations and other leaders across the house of medicine that seek to eliminate systemic bias in the residency application system.

Other champions of holistic review and inclusion for DO applicants and COMLEX-USA include the Association of Anesthesiology Core Program Directors, the American Association of Directors of Psychiatry Residency Training, the Council of Academic Family Medicine, and most recently, a group comprising the American Academy of Physical Medicine and Rehabilitation, the Association of Academic Physiatrists, and the American Osteopathic College of Physical Medicine and Rehabilitation.

With Mental Health Awareness Month wrapping up, we decided to reach out to NBOME National Faculty members who have helped osteopathic medical students maintain their mental health and keep working towards their dream of becoming osteopathic physicians. Here they offer their thoughts and advice.

Ryan Smith, DO, PhD, MBA, MSEd, is the chair for the NBOME National Faculty Department of Psychiatry, Neurology, and Clinical Neurosciences. He also is the associate dean of pre-clinical education and professor of psychiatry at the proposed Orlando College of Osteopathic Medicine, and is physician-in-charge at the New Hampshire State Psychiatric Hospital in Concord, NH.

Robert G.G. Piccinini, DO, serves on the NBOME Board of Directors and is in private practice in Sterling Heights, Mich.

Preparing for and taking COMLEX-USA exams can be stressful. What are some ways that students can manage their stress in healthy ways?

Smith: A reasonable amount of stress can be motivating for you to maximally prepare for your school and national board exams. 

However, excessive stress can contribute to metabolic syndrome and lead to health concerns and also can impair one’s ability to learn and retain in both the short- and long-term.

Reserve time for exercise, healthy eating and cooking, spending time with friends and family doing leisure-based activities, and, in general, ensuring that things that make you happy are priorities.

Piccinini: Make sure you are eating as healthfully as possible, and scheduling light to moderate exercise. It can be something as simple as going for a walk for 15-20 minutes. Also, when you schedule time for studying, you should schedule time to step away from it. It can be overwhelming, trying to learn so much information–there is a saying that medical school is like trying to drink from a fire hose. Schedule time for breaks, and also for things you like to do–don’t give up on those hobbies. Also, medical school can sometimes feel very isolating, so it’s important to keep in contact with friends and family and talk about your stressors.

Why is it so important to develop healthy coping mechanisms?

Smith: Healthy coping mechanisms, such as humor, mindfulness, relaxation, meditation, volunteering, etc., are all adaptive and can help you through difficult times.  Unhealthy (or maladaptive) coping strategies, such as excessive use of alcohol or substances, can impair your ability to learn, and negatively impact your health and ability to rise to the challenge of medical school. You cannot ultimately support patients if you, yourself, are not taken care of.

Piccinini: Simply put,

it doesn’t get easier after medical school. From the moment you start your career, you’re dealing not only with continuing to learn new information, but also employers, patients, and families (both patients’ and your own) who all have expectations of you.

Developing healthy coping mechanisms in medical school will help set you up for a better future. It’s similar to financial investing: you can do small things to start that will pay off in the long run.

Some research suggests that medical students have higher instances of mental health issues than their counterparts in the general public. What are some early warning signs to recognize that something may be off, and how can those be managed?

Smith: This is an absolutely critical concept to address.

In many cases, others may see signs of mental health distress before the affected person does, or they are unaware of the impact it is having on them.

Ask loved ones if they may have noticed anything that has changed.  If you do realize that you are starting to feel more depressed, anxious, and scattered, or see yourself falling into negative coping strategies, please reach out to a mental health professional. Each COM has dedicated mental health services available to each student 24/7/365 – take advantage of this if it is necessary for you!

Piccinini: A behavior change is a classic sign that something is going on. This could present as maladaptive behaviors–such as drinking, drug use, or partying heavily–or, it could be someone who normally is outgoing is now isolative. Sudden irritability or aggression can also be a warning sign. Sometimes, the person suffering may not realize it, which is why it is so important for them to check in with family and friends. If loved ones see these changes, they can discuss that with them.

How can students or their loved ones tell if bad feelings are in response to something specific, such as the stress of studying for exams, or if it’s something more chronic?

Smith: Some of us can experience symptoms of conditions such as generalized anxiety disorder (GAD), which are isolated and transient and related to an identified stressor (such as feeling anxious and keyed up around the time of COMLEX-USA).  This is normal!  Anxiety can be helpful–such as running away from rustling in the bushes. It can keep us safe. But you don’t want to be in a state where the anxiety is constantly plaguing you and is out of proportion to the stressor.  That may be an indication of a disorder, which can significantly impact your day-to-day functioning. If you think the latter might be the case, please seek help from some of the many resources available.

Piccinini: Whether you didn’t perform well on your COMLEX-USA exams, or your clinicals didn’t go well, or a patient yelled at you, bad days will happen. And those aren’t inherently bad–having bad days are how we recognize and cherish the good ones. But it’s the way we react to them that can signal trouble. 

If you feel like you’re in a perpetual “bad day” for more than a few weeks, or if you start to feel like you’re worthless or life isn’t worth living, those feelings warrant seeking help.

What piece of advice do you offer students to help maintain their mental health?

Smith: Seeking help for a mental health difficulty is not shameful, and does not make you seem “weak.”

It shows that you are utilizing the resources available to you, and seeking to improve yourself and prevent any further worsening of symptoms you are experiencing.  Remember, early treatment is best for most conditions, and that includes psychiatric disorders.

Piccinini: As you’re trying to study, it can feel like you’re sacrificing your life for medicine, especially if you see friends on social media enjoying a vacation or doing things you’re not able to do right now. But it’s important to remember this is just a fixed point in time; keep your eye on your goal, work your plan, and reach out if you need to.

The NBOME is pleased to announce that leadership organizations in another specialty field have come out in support of eliminating bias in residency applications, specifically for DO applicants, and of the equivalent use of COMLEX-USA qualifications.

Leaders in Physical Medicine & Rehabilitation (PM&R), namely the American Academy of Physical Medicine and Rehabilitation AAPM&R, the Association of Academic Physiatrists, and the American Osteopathic College of Physical Medicine and Rehabilitation AOCPMR have released a joint statement in support of reducing medical training bias against DOs and of promoting equality during undergraduate medical education UME and graduate medical education GME recruitment.

Their statement reads, in part:

“We encourage all Physical Medicine & Rehabilitation programs to clearly state their policy regarding the acceptability of COMLEX-USA and USMLE scores and recommend that programs accept COMLEX-USA when considering DO applicants to their training programs.”

Read the full statement here.

“The exciting field of PM&R has historically appreciated the value that DO residents bring to their residency programs and specialties, but confusion remained amongst many DO applicants and their advisors,” said John R. Gimpel, DO, MEd, president and CEO of the NBOME. “We are so pleased that this community has emphatically stood up in support of holistic review, of inclusion for DO applicants, and of acceptance of the DO licensure exam, COMLEX-USA.”

The NBOME is pleased to report that support for DO residency applicants and COMLEX-USA continues to grow among residency program directors. Previously, the American Association of Directors of Psychiatry Residency Training and the Council of Academic Family Medicine have issued statements in support of DO and MD applicants, and for the parity of the COMLEX-USA credential for DO applicants.

Now, the Association of Anesthesiology Core Program Directors (AACPD) has issued its own statement of support, which reads, in part:

“In the current environment, in order to recruit qualified applicants using a holistic review process, it should be unnecessary for any medical graduate to take redundant licensing examinations. Anesthesiology residency programs should implement processes that fairly consider osteopathic applicants within the context of their educational pathway and the osteopathic (COMLEX-USA) licensure process. Anesthesiology residency programs should not require osteopathic trainees to undergo other licensing examinations in addition to COMLEX-USA.”

Read the AACPD statement in its entirety here.

“The NBOME is so inspired by the AACPD’s inclusiveness and willingness to advocate for all applicants, holistic review and parity for the COMLEX-USA credential, and their guidance for program directors that COMLEX-USA should be the only licensure exam DO candidates need to take,” said Richard J. LaBaere, II, DO, MPH, chair of the board of directors the NBOME. “This will no doubt help encourage the rising number of DO students interested in anesthesiology to apply, ensuring that the field will see its best and brightest among DO applicants, help to diversify the educational milieu, and further assist in contributing to critical workforce needs in regions of need for this important specialty .”

The NBOME continues to engage in advocacy and education efforts supporting holistic review for all applicants with the undergraduate and graduate education communities and to assure inclusion and equitable treatment for DO residency applicants for GME training opportunities with their COMLEX-USA licensing examination credentials.  Visit our advocacy and education page for more on our work in these areas, and to see a list of residency programs that currently accept COMLEX-USA scores.

Following the Council of Academic Family Medicine’s statement in support of parity between DO and MD candidates and for the COMLEX-USA credential, the American Association of Directors of Psychiatry Residency Training (AADPRT) has issued its own supporting statement. It reads, in part:

“Historically, many DO graduates have been advised of a need to take both Comprehensive Osteopathic Medical Licensing Examinations (COMLEX-USA) and United States Medical Licensing Examinations (USMLE) when applying to psychiatry residencies. Taking two sets of examinations should be unnecessary. Passing COMLEX-USA examinations is required for graduation with the DO degree from Colleges of Osteopathic Medicine and for licensure in numerous jurisdictions. We encourage all psychiatry residency programs to clearly state their policy regarding the acceptability of COMLEX-USA and USMLE scores and recommend that programs accept COMLEX-USA when considering DO applicants to their training programs.”

“This endorsement from the field of psychiatry further underscores the body-mind-spirit connection that is so unique to osteopathic education and training,” said John R. Gimpel, president and CEO of the National Board of Osteopathic Medical Examiners (NBOME). “Osteopathic students should welcome this support from leaders in psychiatry, and know that they need not be deterred from pursuing post-graduate training in this field. We hope that this momentum of support continues in other specialty leadership groups.”

“This is clearly the right thing to do [by osteopathic medical students],” said Randon S. Welton, MD, president of the AADPRT. “I am delighted to have AADPRT support osteopathic graduates in this way.”

To read the statement in its entirety, visit AADPRT.org.

The NBOME continues to engage in advocacy and education efforts with the UME and GME communities to increase awareness and acceptance of osteopathic applicants and their qualifications. We support holistic applicant review and to the extent that licensure examinations are a part of that review, COMLEX-USA is the appropriate exam to evaluate DO applicants.

If you are aware of any residency programs that appear to dismiss COMLEX scores as part of the application process, please visit our Advocacy and Education page to fill out our Advocacy form.

To help ensure NBOME assessment content is written in an inclusive manner and free from bias, the NBOME has unveiled an additional tool for item writers and editors: the Mindful Language Item Writing Guide, which includes tips for incorporating diversity, equity, and inclusion (DEI) into NBOME test questions. The guide is available to NBOME National Faculty members for NBOME examination development purposes.

“This was a top priority for us and a goal we wanted to accomplish at the end of the first year of our Strategic Plan, Assessment Matters,” said Marie Fleury, DO, MBA, associate vice president for assessment services, who served as executive sponsor on the project. “The new guide is important for assuring incorporation of DEI concepts into our examination content and processes.”

Among guidance on topics such as person-first language; addressing race, ethnicity, gender, and religion; and identifying stereotypes, the guide also provides NBOME item writers and reviewers with an evidence-based checklist to ensure item content is free of bias.

“We have always provided item writers and reviewers with supplemental training resources for writing questions, but with the expansion of our Core Values to strengthen our focus on DEI, we took the opportunity to expand upon that guidance,” said Lisa Mysker, NBOME managing editor.

A core team of test developers, editors, and in-house DOs reviewed external references and NBOME test content to identify the topics to address. The group then met weekly to review specific topics and design a series of recommendations, which became the new guide.

“In recent years we’ve seen an increased focus from our subject matter experts and candidates alike on DEI,” said Evelyn Ronkowski, MFA, MAT, associate director for test development. “The feedback we’ve received from candidates on each question has been particularly helpful in creating this guide.”

In addition to using the guide to create new test items, NBOME editors and test developers have been using the guide to review existing questions and flag any test content that needs to be updated.

“The guide is an evolving document, and it’s going to be continuously updated based on the evolution of language and of health topics,” said Mysker. “As our item writers and reviewers create content, we are asking them to use this guide to keep these topics in mind.”

In addition to the guide, the NBOME also shares the following resources during Item Writing Workshops:

• AMA Health Equity Language Guide
• CDC Health Equity Principles for Inclusive Communication
• Conscious Style Guide
• APA Bias-Free Language Guide

The new guide has been used at recent item-writing workshops, and overall, the Test Development team says the response has been positive.

“The guide helps to recognize bias, avoid using stereotypes, and encourages the use of language that is mindful to the particular population presented,” said National Faculty Chair for DEI Bernadette Riley, DO.

“The guide recognizes healthcare disparities seen and hopes to address any barriers that could occur in testing.  It has helped me tremendously on exam content review of questions and has made me aware of my own implicit bias and to be mindful of how I address and acknowledge it in my role as faculty, Chair of DEI, and item writer.

Riley adds that the guide is considered a “living document,” and National Faculty work closely with NBOME staff and leadership to monitor and change it on a frequent basis when new education, environment, ideas, and bias come to light.

Those interested in contributing to NBOME assessments, such as COMLEX-USA and COMAT, may email nationalfaculty@nbome.org.

Additional staff who contributed to the development of the guide include Emmy Bean, MA, editor 1; Jenny Grisolano, MA, associate director of test development; Candice Pernell, MA, associate director for test development; Emily Platt, assistant editor; and Owen Schleif, editor 1.

This year was another record-breaking Match for DOs, with more than 6,800 DO seniors—or nearly 92 percent—matching into PGY-1 training positions. We spoke to a few residency program directors, both DO and MD, about the holistic review process they use during recruitment, and how it contributes to a more diverse and inclusive environment.

What do you do to ensure a fair and holistic review process?

In our review process, COMLEX-USA and USMLE scores are weighted equally, and score ranges are divided across a 0-, 1-, or 2-point scale. But test scores are just one of many factors to consider about an applicant. We also look for strong communication and interpersonal skills, and diversity in interests. Our goal is to have residents with a range of clinical and research interests in a given class.

Jason Margolesky, MD
Residency Program Director, Neurology
University of Miami Health System

UPMC Children’s Hospital of Pittsburgh is fortunate to have 6 program directors; we review all applications as a group prior to inviting students to interview, then review holistically after the interviews have been completed.  This approach allows the program directors to know each applicant fully along with their strength profile.

Katherine Watson, DO
Residency Co-program Director, Pediatrics
UPMC Children’s Hospital of Pittsburgh

We’ve started implementing blocking items from the application such as photos, pronouns, religion, date of birth, and gender/gender identity in order to attempt to remove some potential biases. All faculty participate in reviewing applications through random assignment of applicants. Looking at an electronic record doesn’t give a good feel for the person. It’s a drastic judgment and for that, we have standardized criteria to determine if an applicant should be offered an interview.

Rachel Nixon, DO
Residency Program Director, Family Medicine
Ascension Macomb Oakland Hospital

Our program developed a standardized rubric where most points are assigned based on what the applicants have documented on their ERAS application. Those candidates selected to interview are then scored based on their interview. We evaluate leadership experience, performance in the core clerkships, research experience, and objective measures of academic success. We also account for intangible qualities such as additional advanced degrees, volunteerism, strong letters of recommendation, and participation in team sports. These additional qualities show maturity, the ability to work in a team, and grit. Ultimately, our method helps us match those candidates whose goals align with the program’s mission and training environment.

Abhiram Kondajji, DO, MS
Core Faculty, General Surgery Residency
Cleveland Clinic South Point Hospital

What do you specifically look for when selecting candidates?

Margolesky:
We think a class is stronger when made of people with diverse backgrounds, interests, and experiences. Our current DO resident has been wonderful and a leader in her class. We had five DOs on our rank list, two high on the list, and a DO will join our PGY3 class in July.

Watson:
We know most outstanding trainees are not driven by one aspect, but are an entire totality with medical education, community engagement, prior life experiences, and research opportunities. UPMC fully acknowledges that standardized test scores are indicators for future success but they are not really part of the review for a raw score.  We acknowledge it and move on.  We believe in looking for pediatric trainees with prior community engagement, outstanding academic records, and research in areas that can have meaningful outcomes.

Diversity and training experiences bring a richness that is really important in training programs. We are dedicated to training future Pediatricians that reflect the diversity in the patients that we serve.  We all are better physicians when we surround ourselves with diverse perspectives.

Nixon:
We look for engagement within the community and leadership positions that indicate possible future leadership at our institution. We don’t have a strict board score requirement. We do require that an applicant has passed boards before interviewing and/or ranking. We review volunteer and research experience/exposure to see what they have done and what their interests may be. We have pretty basic criteria, and if it’s met, we will offer interviews to get to know the individual better.

Kondajji:
We seek candidates who understand the osteopathically focused component of our training environment. We want candidates who have a growth mindset and are team players that will fit into our family-centric training environment

.

What advice do you have for DO students and graduates who will be embarking on their residency applications and interviews in 2023?

Margolesky: Don’t hesitate to apply! We will read your application and consider you as we do all applicants.

Watson: Try to get a clinical experience rotation in the hospitals they are most interested in.

Nixon: Make sure you can show community involvement, which indicates life balance.  Provide letters of recommendation from those who actually know you, which is better than standard letters. If there is an extension of training or a break, comment on why so that it is addressed.

Kondajji:

1. Understand your personal goals in completing your training in a particular specialty or hospital. Will completing your training in a specific environment provide you more success in obtaining a fellowship or better prepare you for going into practice immediately?
2. Talk with your mentors and faculty to get a realistic expectation of where they see you thriving
3. Take the opportunity to attend a conference for your specialty of choice and network with residents and faculty from the programs you are considering.
4. Be prepared to address any weak sections of your application during the interview, or address how you spent your time in another area of interest, such as leadership.
5. Having fewer research topics listed and being well-versed in those is better than having many with a superficial understanding of the research.
6. When doing a Sub-I, you should embody the role of a resident to demonstrate that you are prepared for the challenges of residency. I.e.) know the patient’s history, new labs, and imaging details, and be ready to assist with any procedures.
7. Lastly, be yourself and own your osteopathic training and heritage. You have worked diligently to arrive at this point, and there is a program that will fit you and help you along your journey to achieve your aspirations.

For its part, the NBOME continues to advocate for a holistic residency review process and for DO students and their COMLEX-USA credential by reaching out to program directors and GME personnel to increase awareness and acceptance of COMLEX-USA scores as part of that process. For more, visit our Advocacy and Education page.

In February for Valentine’s Day, we took to social media to ask DO students how they show love to themselves. We recieved more than 700 responses, and will be sharing some of those in our #WellnessWednesday social posts throughout the year. We hope that by sharing these responses, it will help promote pride and self-love within the osteopathic community.

Below, you will see some of the most common ways that DO students show themselves love.

Thank you to everyone who participated!

How DO Students Love Themselves – All Responses

_aaronbautista	Making time to gym for at least an hour daily.
_justin_taylor31	Taking a night off and hanging with my fiancé
_maddiegcox	cuddling my dog and watching big bang theory
_sam.jacobson	By spending some time reading for enjoyment everyday.
_say_soe	Buying and playing board games!
24_arodriguez	By making time for friends! @maddiebturpen @lauren_s_flores
a_rae_rae14	Making Delicious Meals
aashana.p	By making myself 3 meals a day.
@ArianneSerrano_	By taking care of my personal indoor jungle (this is not even half of them) (pic)
abmonk26	Always making time to talk to my support system!
acat.stone	Running with @hjcurriee
acbeltrami	Spending time with my dog
@curiouskathy98	by taking showers & brushing my teeth. this always seems to be a good reset for me.
adrizzles	Working out, reading, and talking/spending time with the people I love!
aiyana58	Surrounding myself with supportive classmates, watching YouTube, and eating delicious homemade food. @homerocoss @asyuh @sebasmezae @ali_segovia8
ajursua	By playing music!
akinchita	I allow myself time to exercise, do leisure reading, and do meal prep!
alex_wilson98	working out at least 4 days a week!
alexandrajocronin	giving myself grace
alexis.de.lacy	Taking a moment to enjoy my coffee each morning ☕️
alexisgademsey	Light a candle, skincare, tea
allegra777artis	Spending time with my husband and daughters, positive thinking and making sure I get enough sleep.
alysonrosehill	A good long bath at the end of a day
amundafam	Sleeping in and hanging with my loved ones!
angelicag15	Treating myself with food
anhpho_flow	By taking time to be mindful in each moment
anisarosee19	Saying prayers and being grateful
antomifam	Treating myself to good meals and sharing with friends
arysingam	Spending time in nature or with loved ones!
@Din0_AL	Go for a run with my kids. Someone has to push the stroller right?!
ashleyarm_	Moving my body everyday, eating healthy meals
ashleybradley_	I show love to myself with evening yoga and dark chocolate.
@Din0_AL	Go serve! Find a simple way to give back to the community. Find someone to help. Spontaneous or scheduled, it doesn’t have to be grand but the act of helping another in need makes our own burdens and worries somehow lighter.
ayush.thapa7	Gaming
baby_seel	Gym everyday, but my favorite is self-care Saturdays! Face mask, tub, movie.
baileymckinney_	Giving myself a mental break when I need it!
banhhecuame	Eat good food and take power naps
beccashaneck	Being kind to myself and taking time each day to reflect ☺️
@euglycemic	I love myself by understanding that by helping/improving myself I can then be better equipped to be of service to others.
brooke_hightower15	I make time to workout and spend time with family!!
caithobbs13	Making delicious food !
callie___nicole	Reading a book after I get my kids in bed!
cbondy3	Gym and yoga!
cduechle33	Knowing when to step away from studying and spend time with family instead
cheystudiesmed	Spending time to cook something nutritious and delicious while having fun making it!
chrisalis97	Loving God!
claireschu21	Working out
cody_lanman	Getting outside to play some frisbee golf!
colenapier22	Love to others
colleenmispagel	Daily walks
connor_9davis	Physical Activity
cvino_9	Exercise
dannywlevy	Study breaks & practicing non-judgmental self compassion!!!!
dariasaur	Getting outside 🙂
deivapiravi10	I love myself by making sure to spend time on my hobbies.
derek_at_	Daily exercise!
dixiechicky	To decompress in my hobbies BY MAKING ART
doctors_and_dumbells	Staying active & music!
dr.amirkhiabani	Making time for the gym and giving back to the community
abbyyoss	By checking in with friends and family everyday and giving myself time to relax and recharge each day! And tabletop games/puzzles!
dr.patriot_619	Swimming and weightlifting
dv_nemeth	Scheduling a wellness day ahead of time and committing to it! One day to simply be me and be mindful ✨
e.min.nem	playing fetch with my dog 🙂
eleanoriodice	By cuddling my doggies and taking fitness classes at my local gym
electricelise	By taking care of my body mind and spirit and nourishing myself with yummy healthy foods
elenadavid	Working out and enjoying a good meal at one of my favorite restaurants!
ellielov3	Going to a nice restaurant
em.frack	Working out and reading a book before bed!
emmaprill	Cuddling my dog while I study! Helps keep me motivated
ezrayu	Going for a 5-6 mile run each day!
farwahaideri	sleeping and working out!!
g_r_a_c_e_c_h_e_n	Exercising! (& eaating:))
gabyfarabee	sleeping
gamoore	Taking a night off and spending time with sweet friends!
gatasoyyo	Giving my self space to enjoy music and dancing!
gbit4248	Hiking!
gifty_the_g.o.a.t	Positive thoughts and talking to family/friends ❤️
giofran	With positive affirmations
grace_lee74	Playing tennis!
grace.ah	By reflecting on how far I’ve come and appreciating what I have ♥️
hacheaito	By sleeping
haizeaaurelie	Letting myself sleep in and playing with my dog!
haleyansonn	Exercising and spending time with friends/family!
haliejols	Taking my dogs for walks and reading
hannahmwhite_35	Coffee and a good book!
heyitshayat	walking outside!
adamnewport12	By learning from every mistake in life, making it an opportunity for growth
@FaustianPacts	I write my anxieties into a journal to get them out of my head. Today, I wrote about the disability that makes some things more difficult (exams included), and after I wrote it out, I remembered all the ways that I can work around my disability and still do well.
hjcurriee	Sleeping in on the weekends!
imajinius	Weight lifting
in_nguyen_do	Watch Movies!
iobevevino	Self care and taking naps
isabellaregine	Yoga ‍♀️ with @caithobbs13
its_mysonkim	Going on walks and trying new food!
j.r.white95	By doing a COMSAE, JK. Going out with my wife and spending quality time.
jackieberman	scheduling daily timers and deadlines @liansunsun
jacobtretinik33	Teaching myself to play piano
jared_jmills	Exercising and making time for friends and family!
jasonyamashita	Rock climbing ‍♂️
jaysteach	Star Wars marathon!
@hopedaskalakis	I love myself by waking up early on a Sunday morning, taking my mini husky on a hike while listening to my favorite comedy podcast.
jenniiiibear	Cooking meals at home and going on walks with my significant other!
jessbailey_	Running!
@I_am_Lisha	Self-care! I treat myself to a delicious Starbucks coffee, take my dog on a walk, and do face masks at night!
jhlandrum98	By consistently working out and drinking good coffee☕️
jinajeunjun	Traveling, going for a walk during sunset time, treating myself with good coffee ❤️❤️❤️
jking00	By giving myself time to relax!!
jmichelle_mph	Self care
jmpirtle24	Going to the gym
jngu112	Lifting and video games!
jo_with_the_flow_	I love myself by letting myself sleep in on the weekends ❤️
jodibaus	Singing in the shower before heading to rotations!
joe2012miller	Traveling
jolly_rachers	cooking for my friends!!!
jones_tiffany7	Exercising or hanging out with family!
josclark36	Reminding myself that it’s okay to not be okay sometimes and talk through things with loved ones
jourdanstaffier	buy myself a new plant
joynish	by spending time with my loved ones
jryu13	Treating myself to boba
juanito22121995	Taking care of myself by doing activities such as soccer!
juicyj_whit	Getting Mexican food
jwhender89	Spending quality time with the wifey
k_goforth	FaceTiming my nephew
kaelenkay	Spend time with loved ones whenever I can
kailee_wegehaupt	By going for a run
@indoshade	Reminding myself that others have love for me and I am a loving person so I deserve the love I give myself.
kaitlyn.mcfar77	Watching guilty pleasure shows, aka Love Island
kaleyprieto	My daily walks &&&& food!!!!
kanananan8	By making time for my hobbies as I continue rotations and start board prep @libbyleann @azzyye @theresiajahja @blakebrummy
kasey.doney	By taking the time to cook a full breakfast every morning
kassey_ginelle	Working and playing with my dog!
kassidyfix	Lifting
@janetmback	By planning camping trips during vacations so that I have something to look forward to after exams!
katieburd198	Learning how to take time away from school daily and weekly. Moments for family, friends, and myself without guilt.
kauff_drop96	By jamming out to old 2000s alternative tunes!
kayla_brittany21	Going on walks outside with some good music
kaylaa__28	Reading!
keep_the_faith27	By baking bread and cookies and sharing them with friends ☺️
ketty.liang	Cuddling my cats!
kiersten_waugh	Cycling, eating healthy, and getting enough sleep!
kkellisisland	Baking and a long bike ride!
kokeakola15	Spending time with my kittens!
@LexDOesMedicine	I surround myself with good, positive, like minded people! No negative energy over here
kristinlsinger	By journaling my thoughts
kristynrobling	Eating good food!
kyleearthurs	By recognizing when it’s time to take a break— and doing that! As hard as it is
lancemaroki	Playing basketball whenever I can
lannfisch	Hiking! AND WALKING MY DOGS
lauraaaaisbell	Good food with friends!
@mckaylamariah	I love myself by taking breaks! I’ll go for walks or write in a journal, that way I can prioritize and cultivate my mental health!
lauren_s_flores	by exercising in some way every day!!
lauren_yorkie	By playing games to decompress!
laurevelti	A nice walk around the neighborhood and a hot chocolate
lex.garvin	Enjoying all aspects of life during the process
lexly03	Journaling and exercising!
liansunsun	Reflecting, journaling, and going to the gym
libbyleann	By giving myself grace as I learn as much as I can from each rotation.
lindahoainguyen	Exercising and going out with classmates! ❤️
lisa.a.millar	rock climbing ‍♀️
liz.mouw	I love myself by cooking a healthy dinner!
llhi_im_paull	Taking breaks and hammocking at the park
lo_7991	By doing yoga!!!
logan.rubin	Playing outside with my dog
luke_cimino	Working out, trying local restaurants and calling my parents each week
madari.armin	By not paying for digital files.
madisongueningsman	Getting outside and leisure reading
magicgirl.jpg	Finding good spots to eat at! HANGING WITH FRIENDS
@MRSAmaster	Taking time for my family, friends, and hobbies outside medicine! Reminding myself that this is all part of one long exciting journey to make my dreams come true!
malloryjae	I make sure I take time to go for a walk with my dog that is >1 mile at least 3x a week.
mariaochiai	Going to TJMaxx with friends on Fridays as a treat for the long week full of tests
mariefzaki	Service and love for one another
marinafonseca13	Working out and snuggling my kitties ❤️
marisamx3	Making time at the end of each day for doing something that brings me joy
maxmykhlyk	Running
mcamendez	Playing disc golf!
mcgroke63	Walking/playing with my dog Cali!
mdbebawy	Sleeping!
megamazing17	Daily exercise and once a week taking myself to try a new restaurant
megan_m55	Playing Rec sports and/or taking a couple hours to watch TV or a movie that brings me joy, hard to decide between the two!
megan_purich	By staying grounded in who I am and not comparing myself to others
meghana.sankaran	exercise @giannap_88
meghang__	Gym time
megro103	Playing with my dog, Luka
mehrubaaa128	Love me a nice hot girl walk with a good audiobook
meriah_parker	Taking a night off every week for just myself
merytopia	Shopping
meschro1	Walking my dog!
mitchell.paulson	Going to church and watching Premier League soccer at 6am on Saturdays
mntan	Exercising and spending time with my family.
monis.h.a	spoiling my dog!
mrselizabethashby	I love myself by making sure to get some amount of daily exercise and prioritizing getting enough sleep ❤️
myramaslam	spending time with family and running!
naaaptural_	Spending time caring for my plants, watching my favorite tv show, hanging out with family/friends or catching up on sleep!
naheedyd	Video Games!
narmisk	I love making a meal for myself! Especially going out of my way to make something new.
natalieyoung08	Workout and spending time with loved ones!
nguyen_199	Treating myself to good food!
nikkimehta08	Cooking new dishes!
nimanthi_kumara	Cooking and hanging out with my friends
notangelicangel	Skincare routine
@NotoriousS1Q3T3	I love myself by taking time each week to treat myself to a nice dinner at a restaurant! No matter how crazy life gets, I do this each week to reset and allow myself time to escape from everything!
o.w.e.n.c.s	cooking
oliviakathrynne	Cooking meals at home and going on walks!
oliviapupiecc	Exercising and reading ❤️
onlypotatoes	Sleep at least 8 hours a day
paigemaertz	taking myself to get my nails done
palsindh0704	Working out and trying new fitness classes!
pathtodomedicine	I take time to get lost in a book or work on a new crafting skill
pauldelgado_	Making time to exercise 4x week!
pedrolarosa1994	Mental breaks by playing basketball
phlyinnhawaiian	Sounds stupid but video games and anything with a ball
pjpony	Exercising and playing with my dog
@PagingDrNovak	I love myself by giving myself enough time to reflect. In medschool sometimes things happen and progress so quickly, I try to stop and smell the roses every once in a while to remember everything I put in to get to where I’m at now and just give thanks.
r.esti	coffee ☕️
r2d2ritu	Having a solid bed time routine to unwind!
r2woo2	Giving myself time to spend with the people I love
rachchauv	Prioritize fitness and health
raeann_dalton	Sleeping
rah.ema	Getting enough sleep, eating healthy & walking!
rai_soukou	Taking time to rest and partake in regular hobbies like soccer games
@SD_Harwood	I love myself daily with a hot cup of coffee and water before heading into the clinic. Once there, I remind myself that I’m still a student and still learning so showing myself grace when I don’t have the answers to patients’ questions and lean on my preceptors when I’m unsure.
reni.gandhi36	This may be hilarious but… Watching grey’s anatomy with a box of pizza hahaha even though I have watched this show from start to finish like a bazillion times
rewlise	Taking time to paint and cook!
richaeladenlinger	Spending time with friends and family
ruxandra.andriescu	Bubble bath, candles, and a glass of my favorite wine
sad.do25	Hiking & spending quality time with friends and family
sam_andryk	Moving my body and allowing myself to stop at the end of a busy day and go to bed even if there’s more to do
sarafina_112	Taking walks and cooking!
sarah.amaris	Watching Real Housewives every Saturday and Sunday morning
scraambledmeggs	Sunset walks
lauren_hoffmann	By being kind to myself and remembering how much I have improved since the beginning of school. I make time to exercise, spend time with people I love, and practice my faith.
serena_rockstar	Taking set breaks to spend time with friends
shantasiat_	Controlling intrusive thoughts by practicing positive thinking!
shelly_luv	Taking a nice stroll to class instead of driving ‍♀️
shreyabn	working out !! ‍♀️
simpleebekah	By giving myself grace whenever I struggle, pick the wrong thing, or don’t finish everything I planned to do.
sofizzzle	Making time to go for walks with my dogs, catching up with loved ines, and self care through plants and keeping the house clean
speci4l_k	Taking the time to do yoga, go to the gym, and watch tv with my husband❣️
stormylynn7	Weight lifting!
such.a.dahl	Grabbing dinner with friends after a long week of studying.
thedarlingdo	Quiet time & reflection!
thereemiful	By giving myself time for selfcare each day! Skin, hair, nails, makeup!
tranncathys	Cooking healthy and not-so-healthy meals
tweetylinh	Spending time with the people I love! Traveling & enjoying new experiences
@StudentDocSH	#5: hiking trails with my bestie (with pic)
@zach_rol427	Prioritizing time with my wife and non-medical activities too make sure I’m always refreshed and ready for what comes next!
veneethantony	Going to the boxing gym, and eating healthy!
vic_martinezz12	Long walks, great music & quality time with family and friends on the weekends!
wefoodtour	I am eating quality meals often! Exploring new cuisines is just one way I love myself and those around me. Check out the reels for food recs!
wonder.pho	By taking time to be surrounded by nature, every day, even for a little bit By eating something yummy
woolf_ryan	Working out and enjoying food
yajtooj23	By giving me a day to myself and no one else. By forgiving myself and giving me grace. By being honest and focus on improvement.
yendys_rose	A good stretch or yoga session! ‍♀️
zahacita	Going to the gym and eating good food on the daily!
zainabbb97	Spending time with family and friends!
@_ClaudiaTang	I love myself by giving myself time to gym after a long rotation day. It allows me to reset!
@_iTob	7 hours of zzzs. Non-negotiable
@_saenz95	Getting my sleep!
@abbycbass	By giving myself grace and taking it one day at a time
@AlexGolden117	By taking the time to reward myself by seeing live productions at the local theaters in town!
@alyssalambrec	I love myself by stretching me body each day and taking time to get fresh air.
@ArminMadari	By commenting on posts to get free stuff.
@ATSU_SOMA_LE	I treat myself to my morning smoothie. / I pause and take a few deep breaths
@BrianBurling12	Playing basketball with classmates
@chivajuan22	Taking mental health breaks such as playing soccer!
@curiouskathy98	by spending time with my loved ones
@DukeBayar	Doing what makes me happy
abbyyoss	I always try to spend time out in nature when the weather is nice! Whether that’s going for a walk, reading outside, sitting at the lake/river to soak up some sun! ☀️
@gfarabeeDO	sleeping
@GiorgiFran24	By being myself and accepting the flaws that come with being me
@GraceLi17488908	Exercise!
adrizzles	Planning trips and traveling with others or alone to experience new places/food, new people, and personal growth!
sebasmezae	Making time for the things that bring me joy. Things like cooking a home-made meal, sharing food with friends, watching movies, and going for a good run!
@joe2012miller	By setting aside time to do things that allow me to refocus like cooking and traveling.
@jordyn__austin	I love myself by allowing myself to sleep in when I can and watch my favorite shows/movies without feeling guilty!
@keep_the_faith4	By baking cookies and bread and sharing with friends ☺️
@KierstenWaugh01	Cycling, eating good food, and getting enough sleep!
@KKarmilkar100	Eat something nutritious and sleep at least 6 hours a night
@legere_ben20	I love myself by making sure that I take time everyday to do something that I enjoy wether it be hobbies or spending time with friends. In med school I feel like it’s easy to get wrapped up and not take time to smell the roses.
@LexDOesMedicine	By being intentional about setting time aside for myself and the things I enjoy.
@mackhalemed	Make time for the gym and poetry!
@MariaAl53214575	By catching up with family after a long day of studying!
@MarissaRose1411	By doing meditation and yoga to center myself 🙂
@mckaylamariah	I love myself by giving myself grace. I don’t know everything right now and that’s okay. I have the ability to learn and grow as a student and I will put my best foot forward to do that.
@MedicDO_Z	Taking a long walk with my dog at least 3x a week – it’s good for both of us!
@Meza_Seb	Making time for the things That bring me joy. Things like cooling a home-made meal, watching a movie, going for a good run!
@MinaliNemani	absolutely love nature walks
@MRSAmaster	Making time for the small things that bring me happiness outside medicine. Reading, family, friends. Not feeling guilty for taking time for myself.
@NemaniSonia	I love myself by reminding myself that I am where I belong and the work I’ve put in to be here should not be forgotten!
alexisgademsey	A red velvet latte from my favorite coffee shop ☕️♥️
@RameyCaleb	Drinking a cold Pepsi
@RealDocParker	I reward completing certain phases of School or individual achievements, such as a board exams, with a pair or two of Figs Scrubs.
@RealJoshDimond	I love myself by taking time to turn off from medicine and studying to do something else that I enjoy, like cooking dinner for my wife and daughter. 🙂
@RforRaya	By not letting expectations (whether mine or other’s) affect or define my life experiences.
amy___win	eating out with my sister and letting her pay
@SlayerCries	I stay connected to those who care about me throughout the day.
@StudentDocSH	I made a sticky note that has seven things that bring me joy: #7: going to the movies alone
@SydneyGrubb24	By cuddling up with a cup of tea, a fantasy novel, and my puppy after a long day of rotations
@tyreese__11	Playing Golf!
@TysonHillock	Write poetry and play guitar
_sam.jacobson	Taking the time to call family!
@AlexSherFNPtoDO	Remembering why I started this DO journey.
@f1_Elsa	I love myself by giving myself enough time to connect with those I love and with nature. Spending time outdoors is how I recharge and release stress.
@gfarabeeDO	order takeout haha
@I_am_Lisha	I love myself by listening to my body and giving myself a break so that I can recharge and come back stronger.
anastasiaglaz	A hike followed by a matcha latte, croissant, and flowers
@keep_the_faith4	By making time to go on walks with friends!
@KiranPhuloria	Spending time with my parents and finding new restaurants to explore!
@LexDOesMedicine	By treating myself once a week to a “solo date”
@Martinez12Vic	During the week: sun, exercise & chipotle During the weekend: quality time w/ friends, family, and sports
@RealJoshDimond	By constantly reminding myself to treat myself with the same kindness and respect with which I treat my patients.
@SlayerCries	I spend time with the people who care about me as often as I can
@StudentDocSH	#6 spontaneous road trips
24_arodriguez	By making time to spend with my significant other ❤️
abbyyoss	Taking time for self care! Mini spa nights, doing my nails, praying, all that good stuff!
acbeltrami	Trying to get fresh air and/or sunlight daily!
adrizzles	Trying new food or just treating myself to good food!
alex_wilson98	sleeping!
alexis.de.lacy	Making nutritious meals with my husband!
alexisgademsey	Buy myself fresh flowers! ☺️
allegra777artis	Spending time with my husband and daughters and making sure I give myself some grace.
alysonrosehill	Skin care routine!! @lauren_yorkie
amundafam	Buying any food or things I want bc I deserve it!
angelicag15	Going on date nights with hubby ❤️
anisarosee19	Taking care of my plants!
arysingam	Carelessly belting out my favorite musicals
asdflisatran	‪I love myself by listening to my body and giving myself a break so that I can recharge and come back stronger.‬
ayaamist	Calling family & friends to catch up
baby_seel	Physical fitness is hugely important to me. Gym, soccer, yoga, every day no matter how busy with school!
beccashaneck	Taking time to rest even with a busy schedule
bentonae	I go to hot yoga 5x/week!
bro_itskira	Listening to music or going on a run!
brooke_hightower15	Daily walks with my fur baby!
anhpho_flow	dressing cute just because
cheystudiesmed	Giving myself forgiveness when I fail in order to move on and do better 🙂
claireschu21	Playing with my dogs
desimnms	By reminding myself that I’m doing my best
doctors_and_dumbells	An episode of a favorite show to unwind
e.min.nem	Watch a quick episode of The Mindy Project or New Amsterdam
eisengel	I do cardio while studying and lift weights to clear my mind!
em.frack	Date nights and sleeping in on saturdays!
emmaprill	Spending time with my puppy and going to tutor some awesome elementary schoolers!
gabyfarabee	sleepingggg
hannahmwhite_35	Giving myself permission to take a break
heyitshayat	listening to music!
hisbrideandwhitecoat	praying every day during 20 minute walk in dedicated for level 2 ❤️
its_mysonkim	Treating myself by online shopping!
its_sarah_rae	Long hot baths!
jasonyamashita	Calling family
jaysteach	Walks with podcasts for decompressing
jessbailey_	Exercise!
jking00	Going to therapy, working out!
jmichelle_mph	Exercising
jodibaus	Being active throughout the day! Taking the stairs, going to an exercise class, whatever I can do!
joynish	going out to eeeaat
jryu13	Treating myself to boba
juliana_prov	Working out and spending time with family 🙂
kaitlinjeniece	I love to treat myself by buying my favorite meal and watching my favorite show!
kassey_ginelle	Scheduling time to talk to my family 🙂
kaylaa__28	Baking
kristynrobling	Hanging out with my friends!
kyleearthurs	Taking time to eat a full meal
kyra_hara	Listening to music / Positive self talk / Making time to be active
lancemaroki	Comfort meals
lauraaaaisbell	Taking a walk outside, especially with my friends!
lauren_yorkie	@alysonrosehill doing crafts!!!
liz.mouw	By working out or talking a walk outside when the weather is nice!
mackerrrrrr	Going to the gym, face masks, and girls’ nights with my besties❤️
mariefzaki	Reading my Bible and speaking to my family everyday no matter how busy my schedule is
mavard	Getting out into nature! ❤️
maxmykhlyk	Movies
meriah_parker	Spending time with my puppy
miriummammen	Giving myself permission to take a break and recharge without feeling guilty about it- hydrating, getting fresh air, skin care, reading, listening to music
mmallary	Making time for myself everyday!
mooreamaguire	Meditating every morning, and moving my body any way I can.
arjeanine_	I love myself by taking some time for meditation. It always helps reset my mind.
naheedyd	I bought a motorcycle last year even though no one wanted me to! #treatyoself
nimanthi_kumara	Taking time to talk to my friends and family
nutmeg_135	I celebrate my accomplishments big and small. They’ve all brought me to where I am today ☺️
paigemaertz	by going to yoga!!!!
rakhi.mira	Going to the movies every week with my best friend!
arysingam	Making a cozy cup of tea and sitting out in the sunshine ☀️
ruthieawarren	Taking a walk every day for my mental health
asdflisatran	Self-care! I treat myself to a delicious Starbucks coffee, take my dog on a walk, and do a face mask at night
keep_the_faith27	Having a glass of wine and watching reality tv!
ashleyyengbrock	Going fishing!
sarah.amaris	Getting massages regularly, my new form of self care!
scrambled.megggs	I take a study break with @sarariley7 @jpak313 @puppybearmuggsy @snehal__garg
shaafaeh	Taking care of myself mentally and physically
shantasiat_	Implementing self-care in my daily routine by reading books, exercising, & praying.
speci4l_k	Meditating‍♀️
student.doctor.shirli	Cooking a delicious meal
sulbaee	Assuring myself that it’s ok to take a step back and plan/do activities that bring me joy.
t_rawwthetaylor	Buying Starbucks on fridays
v.ortegas	Playing with my pup, catching up with my family and SO, and going for a run!
ayaamist	After a day of lectures and studying I like to care for my body by exercising. I usually do a 2-3 mile run just listening to music and being grateful for how my body and brain help me to accomplish my goals!
yendys_rose	A little music as I study
zainabbb97	Spending time with family and friends!
@karenbbarcenas	Spending time with family, exercising and drinking coffee
bobby.mcfarling	I find value in myself beyond medical school. I cook to express myself and show love to my friends and family. I cook to remind myself that I am something more than a test, a score, or student.
cduechle33	“Add to cart”
cheyness4lyfe	Talk to my dog for 30 minutes a day.
dr.lidoodles	I go on a solo hike to catch the sunset, filling my lungs with fresh air and touching grass
@SlayerCries	Taking time off when I need it so I can do better when I come back
@K_Stephen03	Playing in a basketball league
@keep_the_faith4	Watching the Bachelor!
@RealJoshDimond	I make sure to sleep in on the weekend when I’m not at the hospital.
@whitfignewton	Keep putting time into my hobbies outside of school/the classroom – I make sure I paint at least twice a month!
eisengel	Work on my hobbies! Nothings more cathartic than training Brazilian jiujitsu after a frustrating day
@KiranPhuloria	Spending time with my friends and baking cookies!
@ATSU_SOMA_LE	I talk to my friends about life.
@I_am_Lisha	Rewatching my favorite Rom Com!
@SoumyaSidana	Exercise, Netflix Documentaries, and hoping on a flight to somewhere new whenever possible! #LYSCOMSAE
goldenjared17	I love playing Pac-Man, it takes my mind off everything but the ghosts
hi_brianna__bye	Binge watching The Vampire Diaries for the millionth time. … Nothing like a good comfort show when everything else is full chaos.
egyptiantacos	I honor my body by making the time to go to crossfit classes with my friends at least 4 times a week and my mental and spiritual health by attending therapy!
nutmeg_135	I try to find new places to eat whenever I can. Nothing’s better than finding a new favorite spot to hang out with friends and enjoy good food ☺️
saraajohnson	Cooking dinner!
cballen_10	By taking time to go on a walk with my wife and dog
vishalii_k	Spending quality time with family and friends!
kendylcopp	Cooking myself a good meal
mmallary	Watching Netflix shows!
lilsoph_16	Going on hikes or trying out new coffee shops!
mackerrrrrr	Always have a good breakfast before starting my day
hisbrideandwhitecoat	by making time to cook homemade Mexican food and creating fun reels for my instagram channel! Not only does it remind me of my mom’s cooking ( living over 3,000 miles away from her thanks to medical school). this reminds me that there shall be light at the end of this tunnel… one day very soon 🙂
bhumi_patel04	Morning Coffee and a nice outdoor walk
kyleearthurs	By taking a nice stroll with my pup and enjoying nature!
mijitaa	Naps, snacks and laughs!
mostlymilly	Allowing myself to say “no” and focusing on things that make me happy
sarahbeach57	taking a walk outside ☀️☀️
ankita101	spending time with family and friends!
caitlincosby	Working out!
barcenaskaren	Spending time with family, exercising & coffee
adrizzles	Reflecting on how far I’ve come!
jazcam_04	Learning new musical instruments! I played piano for a long time and now I’m looking forward to learning how to play the bass
jessi.lee.peters	Mini yoga sessions in the morning to combat my study posture
cduechle33	Taking a nap
kristynrobling	Working out!!
heyitshayat	scrapbooking!
lannfisch	Exercising and eating healthy! ️‍♀️
claireschu21	Taking naps
_sam.jacobson	Sleeping in on the weekends!!
kkellisisland	Spending time with family and friends!
sarahkdale	Doing my best and accepting that it won’t be perfect ❤️
kiley_flynn_	Finding time to go to the gym and talk with family and friends
amytran2901	Staying in bed all day on my day off
jessiebarkhouse	Taking care of my plant babies – if I can figure out how to keep my succulents alive, then I believe I can figure out how to keep some of these prickly patients alive too
lexi_brez	Cooking for myself!
amy___win	Dedicating time to the gym and my night skincare routine
kyra_hara	Listening to music
shelby.j.terrell	Spending time with my pup!!
_meggaan	I love myself by taking time away from school and practicing self care
hachaelrolmes	Going on walks by the ocean on nice days and spending time with family and friends!
jmichelle_mph	Brunch
andrea_sparkman	Spending time with loved ones and eating some good food!
alysonrosehill	I love myself by always taking time to game
naaaptural_	Finding time for my hobbies: singing, painting and shopping
joynish	hanging out with my younger sisters so i can pretend to be a kid again
alexis.de.lacy	Cuddling my cat!
nimanthi_kumara	Setting time aside each day to do something fun
impuertoricanok	Going to the gym!!!
hannahmwhite_35	Go see a concert or a movie. You can always plan studying around an event you want to go to
jking00	Going to therapy!
bentonae	I take walks with my dog and partner!
medwithkirun	Working out!
mntan	Going on a hike!
jourdanstaffier	Taking my cat outside on her leash
rozziebloch	Spending time with friends and family
zainabbb97	Spending time with family and friends!
paigemaertz	by working hard in school to set myself up for a fulfilling and successful future
kaitlinjeniece	Phone calls with family ❤️
jasonyamashita	Playing songs I love on the piano
v.ortegas	Making sure I eat a yummy balanced meal
brooke_hightower15	I love myself by attending group fitness classes with friends!!
jazcam_04	Going out for a run especially on a beautiful day‍♀️
sulbaee	Make time in my schedule to workout.
katieburd198	Allowing myself to have hard days but also recognizing the many good days in between❤️
jessbailey_	Taking time to prepare meals
acbeltrami	By working out at least 5 times a day
mom_in_med	Sleeping and going on trips 🙂
yajtooj23	By eating tamales and watching ER.
juanito22121995	Spending time with my family!
tysonhillock	Coffee and a book before I start my day
mariefzaki	By doing the best I can in everything I commit to
tahlyn_miller	Exercising and watching Netflix before bed!
narmisk	I love going for a walk and just checking out of technology for a bit
jessiebarkhouse	Taking walks with my rescue puppy
kyra_hara	Finding time to be outside
jo_with_the_flow_	I love myself by attending cyclebar classes with friends!
kaitlinjeniece	By speaking kindness and truth over myself. Self talk is so important!
bbyyoss	Taking the time to talk to my mom every day for the love and encouragement and support!
karepearfalls	showing myself forgiveness
k_goforth	Calling my family
bro_itskira	Calling my friends and family!
ruxandra.andriescu	Making sure to minimize time around negative people and influences
asdflisatran	Rewatching my favorite rom com! ❤️
ellielov3	Reading a good book
its_mysonkim	Going on a walk with friends ‍♀️
alexisgademsey	Yoga and stretching ‍♀️‍♀️
zaronahang	Hanging out with friends
sgrinstead18	Playing with my doggies
mcamendez	Spending time with @rach_stephens_
paulqtvu	Get a good workout in
magicgirl.jpg	Daily stretches
dixiechicky	Reality TV >>>
anhpho_flow	Hot tub soaks post-workout
kvinso11	Good hygiene and long walks with my dog!
naheedyd	Learning a new dinner recipe tonight, Swedish meatballs.. fingers crossed I do a better job on this than my last exam
24_arodriguez	Spending time reading fantasy novels
brookeblan_	Exercising!
kassey_ginelle	Taking some time to read my book at night! Reading became a new hobby for me in med school and I love it now 🙂
bethanymariak	i invest time in my morning and nighttime skin care
kat__rhodes	Empowering someone, even if just to left that person feel heard. Especially when I want to isolate. That feeling of human connection gives me purpose and takes me out of my head, and the stress I felt before doesn’t seem so intimidating.
varsh.swamy	Spending time outside and + not feeling guilty for sleeping early!
wonder.pho	Jamming out to K-pop between sets‍♀️
ashleyyengbrock	Cooking for myself or going out and trying something I’ve never had before
medwithkirun	Meditating and taking breaks!
nimanthi_kumara	Setting aside time to read for fun in the evenings
kyleearthurs	Taking time during the weekends to read novels for fun, or watching movies to unwind
liz.mouw	By taking the time to talk to friends and family back home.
ankita101	planning fun things every once in a while to look forward to!
cballen_10	Getting up before the sun to give my day the best start that I can
gabyfarabee	staying active
bro_itskira	Making dinner and spending time with my friends!
kordikone	Remind myself that academics don’t determine my self-worth and treating myself ice cream after an exam no matter what the result is.
arysingam	Getting stronger at barre classes to get some movement in before long study days
naaaptural_	I like to find time for fitness classes like Zumba, Yoga or just going for a swim!
acbeltrami	Making time to talk to family on the phone
keep_the_faith27	Sometimes doing absolutely nothing is how I love myself
kristynrobling	Getting outside and enjoying nature!
_sam.jacobson	Making time to go out to dinner with friends!
lawfulnoodle	Playing DnD!
cheystudiesmed	Getting outside regularly and being in the sun!
v.ortegas	Allowing myself to take a guilt-free nap!!! Like I’m about to do after spending the morning in the OR
paigemaertz	by taking myself out and trying a new restaurant in my city
loadingdrdre	I love myself by dancing through the pain and laughing through the stress ❤️
magicgirl.jpg	by taking a bath and not forgetting to exfoliate
maheen9730	I love myself by allowing myself time each day to decompress and think about 5 things I’m grateful for in that day! This helps me have a balanced and positive perspective
speci4l_k	I always make sure to take time to eat dinner with my family and talk to love ones on the phone❣️
sarahbeach57	prioritizing getting adequate sleep
yajtooj23	By giving myself grace and permission to fail, but loving myself enough to learn from my failure.
hisbrideandwhitecoat	I journal and read back on the things that cause me great joy or peace when times get tough ❤️
meschro1	Playing with my nieces and nephews❤️
llhi_im_paull	Going on an adventure somewhere
kailee_wegehaupt	Sleeping in on the weekends!
_ebward	Taking walks outside and coffee with friends!
lilsoph_16	Catching up with friends and taking naps
mariefzaki	Drinking coffee and reading my favorite book
mhmdchahrour	Taking a break and relaxing
juanito22121995	Going for a walk to decompress!
naaaptural_	Spending time adjusting my playlists with my favorite music! (Soul, Neo-soul, R&B, Hip-Hop/Rap, Gospel, Jazz and even Bluegrass ☺️)
asdflisatran	Getting my 10k steps in!
jasonyamashita	Hiking and enjoying the beauty of nature around me
amy___win	Im starting to listen to podcasts during drives to stay grounded and gain new perspective
alexis.de.lacy	Always making the time to do my normal weightlifting routine ️‍♀️
claireschu21	Hanging out w my puppies.
alysonrosehill	Cuddling with my fur babies
amneahc	Prioritizing sleep and working out
naheedyd	I taught my fiancé occipital-atlantal release so he can do it for me when I get a headache, because even we deserve some good OMT time to time!
brooke_hightower15	Cook dinner and try new recipes with my fiancé ❤️
rozziebloch	Working out
jmichelle_mph	Taking a day off
notangelicangel	Playing with my cats!
narmisk	Reading a good book and getting lost in another world 🙂
brookeblan_	taking a dip in the hot tub and relaxing with my fiance!
aiyana58	Going to a barre class ‍♀️
jazcam_04	Exercising at the gym
jessbailey_	Spending time outside
kyra_hara	Making time to play pickleball with friends
sabrinab1799	Exercise and hobbies like singing 🙂
seanlee118	Eating pasta with family
joynish	by trying to win giveaways so i can save money
kendylcopp	stretching and exercising
thomas.sam	Reading a good book!
lancemaroki	Scheduled days off studying
lauraaaaisbell	Sleeping in every once in a while!
eisengel	Meditate
24_arodriguez	Going to yoga classes! ‍♀️
megamazing17	Making my sleep a non-negotiable
uh_maize_ing	Going to Pilates classes and taking relaxing baths!
anhpho_flow	facetiming an old friend to catch up on life~
mackerrrrrr	Scheduling at least 5 min a day for some “me time”
nutmeg_135	Rest my brain when it’s tired either by watching a show, listening to music, or going to bed early!
dixiechicky	Grabbing a bite of something sweet!
paulqtvu	Playing the piano
r2woo2	I enjoy doing puzzles, whether they be jigsaw or Rubik’s cubes or riddles
foggyreminiscence	Vinyasa yoga to start the day 🙂
@LexDOesMedicine	I Make it a priority to go to the gym once a day to get those endorphins flowing
@SlayerCries	I don’t overwhelm myself with the amount of information I try to take in at once.
nutmeg_135	I give myself permission to not be productive 100% of the time. Listening to a podcast, cooking a new recipe, discovering new music, just taking time to breathe and enjoy life
princessmegd	I love myself by taking care of my body (walks, yoga, new fitness classes), mind (learning medicine, meditation, leisure reading, new languages, journaling) and spirit (faith, positive self-talk, gratitude, fostering friendships).
@gfarabeeDO	staying active
@Hdpeterson19	The first 2 hours of every day, I am the priority. My wife and I go to the gym and start the day off taking care of ourselves!
@Din0_AL	Take some time and realize that as a student, we are still learning and growing. It’s OK to not know everything.
@zach_rol427	Rock climbing!
@I_am_Lisha	Getting my daily 10k steps in!
@faizandfurious	I try to be the best version of myself that I can be. Working out and studying every day balances my physical and mental needs so I can appreciate who I am. #LYSCOMSAE
@RealJoshDimond	By making sure I keep my body and living environment clean. Self care involves more than just treating yourself, the basics are important too.
r2woo2	Cooking house dinners with my roommates and my bf like homemade kbbq/hotpot, Korean soups and dishes, and Vietnamese noodles
@fryettesrules	By hiking with my dog or read on my couch next to the fireplace.
@mshllhmd	cooking good food to nourish my body and soul
@gfarabeeDO	playing with my cat
ravist	Living life in truth and authenticity, guided by love, and supported by forgiveness. To love one’s self truthfully, would mean to love others no differently.
@LexDOesMedicine	By cooking myself a good comfort meal and watching a few episodes of my favorite reality tv show!
reni.gandhi37	Sometimes… I just pack my bags and go for a weekend away to explore coffee shops
@StudentDocSH	learning to make latte art
@AkinchitaKumar	I like to cook & bake
@whitfignewton	make sure I move intentionally every day whether it’s a hard workout or just a walk around the block. makes a huge difference!
@RealJoshDimond	By giving myself a day off from studying, whenever possible, each week to spend with my wife and daughter.
@SlayerCries	Prioritizing sleep even when it means a little less study time.
@mckaylamariah	I like to take time to be with my family! It means a lot to have a solid support network throughout medical school!
@curiouskathy98	by binging netflix shows after a big final
@zach_rol427	Take time at the end of each day to reflect about the good parts of my day.
@StudentDocSH	painting little blueberries for my sister
@chivajuan22	Getting plenty of sleep!
kyleearthurs	Taking time to go to the gym! It always helps me feel less stressed which allows me to refocus on my studies
arjeanine_	Going on a walk! Fresh air and sunshine always reenergize me.
meschro1	Making dinner with my fiancé. Time together plus we have to eat!
baileymckinney_	Going on stress relief walks while listening to podcasts ☺️
sulbaee	Going on a run! Whether it’s 30 minutes or an hour any bit is a great reset!
jasonyamashita	Spending time reading my Bible and praying every morning
kaitlinjeniece	I favorite way to self care is to take a relaxing bath and watch my favorite show.
naaaptural_	Find time to spend with family and friends either at my apartment or a night out for dinner
keep_the_faith27	By taking time to rest and reflect on the week and splurge on a something sweet to end the week on a high note!
ellielov3	Spending quality time with my parents
bro_itskira	By spending time catching up with my loved ones!
briski_nino	taking a walk and getting that sunlight!!
reni.gandhi37	Watching sunsets! ❤️
brooke_hightower15	Taking care of my fur baby and making time to exercise!
ritaa_der	Laying in bed for hours on end and not feeling terrible about it
bro_itskira	By spending time catching up with my loved ones!
ankita101	taking naps!
nimanthi_kumara	Cooking dinner and watching a movie
adrizzles	Taking an evening to unwind and relax, whether it be after an exam day or in preparation for a crazy week!
paigemaertz	going to a local coffee shop with a hood book for a study break
jourdanstaffier	watching scary movies with my husband!
thesandycbass	Getting in some sort of exercise, challenging my mind with some anki, and watching some reality tv!
arysingam	Tapping into my creativity by cooking, beading, or dancing
marvaraa	reading a book or talking to loved ones; taking time out for hobbies
cballen_10	Yoga to relax my mind and reward myself for my hard work
g_r_a_c_e_c_h_e_n	reading romance novels
r2woo2	I have little plants that I got since COVID and I like growing green onions in mason jars to green up the house!
_sam.jacobson	Enjoying a latte every morning!
143charms	I spend time with friends and family. Every day I call a family member
jmichelle_mph	Cooking
vndanaaad	painting as a way to relieve stress!
margaretkh_	Praying daily in Eucharistic Adoration! 🙂
ruxandra.andriescu	Watching cute animal videos makes my heart happy
sarafina_112	Working on a fun art project!
medwithkirun	Watching tv and reading!
kaitlyn.mcfar77	Treating myself to a diet coke from McDonalds even though I know water is better for you ☠️
swarnimadas	Dancing the stress away! I love being able to move my body in a way that feels good and relaxing!
kkellisisland	Reading!
jazcam_04	Snuggling with my pups
claireschu21	Going on vacation
dv_nemeth	Writing in a Gratitude Journal ✍
notangelicangel	Going for walks
amytran2901	Going out for a walk
mntan	Coffee and Devotional time in the morning.
sarahbeach57	starting each day with a mug of tea
bobby.mcfarling	I love myself by never giving up on me.
morganshumaker	Calling someone I love everyday
amundafam	Getting a massage to help my achy back
jessicaa_bui	going to the gym
lilsoph_16	Painting/drawing and getting in touch with my creative side so I can unwind and not let myself be too hard on myself!
tysonhillock	Write poetry and play guitar
acbeltrami	Reading non medical books
joynish	by refreshing my dm’s every day this week to see if the nbome told me i’ve won btw have y’all chosen winners every day already or will you be doing it at the end of this week?
hisbrideandwhitecoat	Creating travel and wellness vlogs for my new YouTube channel !❤️
dr.lidoodles	I remind myself that it’s going to be okay. Keep going and move on one step at a time
safurateeq	Watch a Disney movie till the end
v.ortegas	Being nice when I talk to myself ❤️‍ it’s a hard road and we tend to judge ourselves too harshly
alexisgademsey	A nap with my weighted blanket
mackerrrrrr	Face mask, eye mask, feet mask, hand mask, hair mask, just every type of spa mask to relieve stress lol
mom_in_med	Napping and going on trips!
alexis.de.lacy	Eating chocolate
cheystudiesmed	I take myself out on little coffee dates as a way to treat myself while studying! ☕️
kristynrobling	Reading a new book with a cup of tea!
jessbailey_	Plants and baking
vishalii_k	Painting and reading!
yajtooj23	By playing my flute to allow for proper sublimation of stress through a creative outlet.
chrisalis97	Going out to eat with family
angelicag15	Binge watching Netflix shows on weekends
gabyfarabee	petting my cat
zainabbb97	Spending time with friends and family!
naheedyd	I’m open to sharing that I keep a mindfulness journal, because I believe it keeps me sane, and we shouldn’t be ashamed of battles with mental health
ashleyyengbrock	Lighting a candle and watching ASMR
shantasiat_	Reading crime novels
24_arodriguez	By baking my favorite treats for me and loved ones! ‍
megamazing17	Prepping nutritious food for the week to keep my body and brain well fed
brookeblan_	Calling my dad!
reni.gandhi37	Endlessly browsing my dream homes that I know I can’t afford
v.ortegas	Expressing gratitude every day. For the person that I am, for where I am, for the people that I love and love me back, etc
eric_babb_do	Make myself a handmade pasta dinner, a real comfort food
yajtooj23	By making sure I don’t allow myself to compromise the three pillars that keeps me healthy: good sleep, good food, and good exercise
wonder.pho	taking time to water my lil plants
joe_the_tree	By putting God, my wife, and children before work!
gbnska	I call my family and friends. They motivate me more than anyone else!
dannywlevy	By trying to win free comsaes cmon give it to me
magicgirl.jpg	Discovering new eating places by the end of the week!

DOs See Another Record-Breaking Match Day

More than 8,104 DO seniors and graduates participated in the 2023 National Resident Matching Program Main Match on March 17, with 7,132 matching into PGY-1 positions.

The NBOME applauds the extraordinary success of DO seniors who achieved a 91.6% match rate – the highest NRMP match rate on record.

DO seniors and graduates matched into a broad range of different specialties at institutions across the country.

“The 2023 Main Residency Match proved once again to be a highly successful Match with outstanding results for participants. We were excited to see the record number of primary care positions offered in this year’s Match and how the number of positions has consistently increased over the past five years, and most importantly, the fill rate for primary care has remained steady,” says NRMP President and CEO Donna L. Lamb, DHSc, MBA, BSN. “For the past 70 years, the NRMP has been proud to play a part in helping physicians transition into residency training and begin careers serving their patients and community.”

Congratulations to all who matched in the NRMP match as well as other match programs (e.g. military match) and best wishes for continued success on the Road to DO Licensure!

Match by the Numbers:

7,132 of DO seniors/grads matched.

146 more DO seniors matched than 2022.

41% increase of total DO match over the last 5 years.

Increases in DO senior match rates by specialty were seen in:

• Child Neurology (+24.94%)
• Internal Medicine/Emergency Medicine (+15.97%)
• Otolaryngology (+16.43%)
• Physical Medicine & Rehabilitation (+7.82%)
• Obstetrics & Gynecology (+4.24%)
• Surgery (+2.85%)
• Emergency Medicine (+2.78%)

With the National Resident Matching Program (NRMP) Match just weeks away, we are looking forward to another year of positive results for our osteopathic medical students. We’ve seen many questions from students asking whether they need to take both COMLEX-USA and USMLE exams in order to be competitive or even be a consideration for certain residency programs. However, we would like to point out that while the choice to take an additional examination is your own, so is your decision to stand up for fairness for your profession.

The primary purpose of COMLEX-USA and USMLE is for licensure to practice medicine. In all 50 states and abroad, COMLEX-USA scores are accepted for this purpose. However, while licensure exam scores continue to be used in the residency application process as part of a holistic review, we will continue to advocate for COMLEX-USA to be used for osteopathic applicants. Learn more about our advocacy and outreach efforts in our new Advocacy & Education page.

At the end of the day, DO students have been successful in the Match with only COMLEX-USA scores. We reached out to a few osteopathic students and DOs who chose to only take COMLEX.

Trent Perkins, OMS-IV, attends West Virginia School of Osteopathic Medicine and is very confident that he will have a successful match this year.  

“I decided to only take COMLEX because I always knew I wanted to be an emergency medicine physician and emergency medicine is a fairly ’DO friendly’ specialty even though it’s competitive. I was interested in going to areas that also have a substantial amount of DOs. I saw no benefit in paying for and sitting for double the board exams when I could fulfill my lifelong dream by only taking COMLEX-USA. If a program would discard my application because I only had COMLEX, an equivalent exam that tests the same knowledge as Step, it frankly wouldn’t have been a program in which I’d be happy training.

My prospects for residency were absolutely not hindered because of my decision to only take COMLEX. Even though I didn’t have Step scores, I interviewed at prestigious academic emergency medicine (EM) programs. I was extremely fortunate to actually have to turn down multiple residency interviews because I was offered more than enough.”

Molly O’Neil, DO, graduated in 2022 from West Virginia School of Osteopathic Medicine.

“I knew that any program I went to, I’d want to be somewhere where they valued my osteopathic degree. Since I studied osteopathic medicine, I didn’t want to take Step. Also, the financial burden of sitting for two exams is a lot. I’m happy that I only did COMLEX and I wouldn’t change it if I had to go back.

When applying to programs, I chose to avoid certain ones because I didn’t have a Step score. But I’m not sure if I’d want to be at those residencies anyway if they didn’t appreciate COMLEX-USA.

The state I am originally from has many programs that appear to only accept Step scores. Because of it, they are very MD-heavy. I wanted to be close to home, but I decided not to apply to any EM programs that didn’t respect the licensing examination for my profession. I ended up matching to my number one program at Conemaugh Memorial for EM residency. I’ll graduate in 2025.”

Whitney Briggs, DO,  graduated from Liberty University College of Osteopathic Medicine and is currently a PGY-2 in emergency medicine at Ohio State University

“I took only COMLEX because I felt strongly that I shouldn’t need to take two separate board exams to prove my medical knowledge base was worthy of being at certain programs. I felt that if a program suggested that they couldn’t interpret my COMLEX-USA score or evaluate me as an applicant without USMLE, that it wasn’t a program I wanted to be at.”

Olivia Travis, OMS-IV, attends Lincoln Memorial University-DeBusk College of Osteopathic Medicine and will be participating in this year’s Match.

“My decision to only take COMLEX was multifactorial. I originally was going to take USMLE as I had been told that it is more difficult to match to competitive specialties with only COMLEX-USA scores. However, I ultimately decided that the cost and time it took to take both exams was not worth it. Honestly, I was nervous how this would affect my ability to match in EM.

I am from Texas, and a number of programs in Texas only accept USMLE. But I applied across the Southeast and found that there were at least 32 EM programs that accepted COMLEX–USA. And there are even more in the Northeast. Out of those 32 programs I applied to, I received interview invitations from 19 programs, which proves that those programs don’t just say that they accept COMLEX-USA, but they truly mean it.”

Although there remain some programs (more in some specialties than others) who struggle to understand COMLEX scores, that doesn’t have to be the deciding factor, and choosing both examinations has only proven to encourage this bias against DO students. Instead, we encourage all students to reach out to us via our Advocacy form with programs that appear to not accept COMLEX-USA or have inequivalent requirements for DO students so that we may have the privilege to advocate on your behalf and those following in your footsteps.

With this year’s Match will come even more success stories, and we want to hear yours. Share your match story with us and whether you matched with just your COMLEX-USA scores by reaching out to us at communications@nbome.org or by posting to social media using #IMatchedwithCOMLEX.

More than 25 percent of the first-ever class of osteopathic physicians were women, and many milestones for women osteopathic physicians followed: in 1929, Meta Christy, DO, became the first female African American osteopathic physician; in 1936, Margaret Barnes, DO, took and passed the first-ever osteopathic licensure exam;  in 1993, Barbara Ross-Lee, DO became the first female African American dean of a U.S. medical school (DO or MD); and in 2010, Karen Nichols, DO, became the first female president of the American Osteopathic Association.

Over the past decade, there has been an 18 percent increase in the proportion of female DOs in active practice, and more than 54 percent of first-year osteopathic students were female for the 2021-2022 academic year.

On this National Women Physician’s Day, we are highlighting the extraordinary career of NBOME Board Vice Chair Lori Kemper, DO, who has treated patients in private practice and spent nearly 30 years in graduate medical education. She has been the dean of Midwestern University, Arizona College of Osteopathic Medicine, since 2007.

Kemper says she always knew she wanted to be a physician, and while applying to medical schools, she saw the difference a DO could make, firsthand.

“My mom had been in a car accident, and our family doctor (an MD) referred us to a DO to help treat some resulting facial numbness,” Kemper explains. “I went with her and watched him perform what I know now is a cranial manipulation. After months of suffering with this numbness, it just went away. I said, ‘Mom, I want to do that.’ And I started applying to DO schools.”

After graduating from Kirksville College of Osteopathic Medicine (now AT Still University Kirksville College of Osteopathic Medicine), Kemper spent 25 years practicing family medicine in Chandler, Arizona and Tempe, Arizona.  She began asking her alma mater to send osteopathic students to her for training because she says she “wanted to pay it forward.”

One of the students she trained was the daughter of the board chair of Tempe St. Luke’s Hospital in Arizona. Through that relationship, Kemper was able to start a family medicine residency at the hospital, and she led that program for 13 years.

Kemper was also good friends with Karen Nichols, DO, who, upon being promoted from her role as assistant dean at Midwestern, advised Kemper to apply. She did and would go on to serve as assistant dean of Graduate Medical Education before finally moving up to dean after then-Dean James Cole, DO retired in 2007.

“I always tell my students to be open to whatever comes,” Kemper says.

In addition to always wanting to be a physician, Kemper says she has always had a passion for leadership.

“Even when I was in band in school, I was always challenging the first clarinet!” she says.

Indeed, during her career, she has served as commissioner to the American Osteopathic Association (AOA) Commission on Osteopathic College Accreditation (COCA), as chair of the Board of Deans of the American Association of Colleges of Osteopathic Medicine (AACOM), as president of the Arizona Osteopathic Medical Association, and has served on the Board of the NBOME for more than a decade.

For young, female osteopathic students who may be considering leadership roles, Kemper offers two pieces of advice: pick your battles, and stick to your morals.

“It’s worthwhile to think about what’s most important to you, and not to move from that, but also recognizing you won’t win every battle. But if you don’t move from those morals, you will ultimately be successful.”

She also recognizes that there were many people who helped guide her to success, including Nichols; Kathleen H. Goeppinger, PhD, the president and CEO of Midwestern; Janice Knebl, DO, interim chair and professor of internal medicine and geriatrics at Texas College of Osteopathic Medicine; Robyn Phillips-Madson, DO, MPH, the founding dean of the University of the Incarnate Word School of Osteopathic Medicine; and, her husband and her father.

“My father used to say, ‘Remember after everything you do, you have to look yourself in the mirror.’ He taught me that a reputation is hard to build and you can lose it quickly. And if you want to be heard, don’t speak often but when you do, speak the truth.”

Kemper is optimistic about women’s role in the future of the osteopathic profession.

“When I started in osteopathic medical school, maybe one-tenth of my class was female, and now it’s more than half. That means very soon, women will be running things. They already are in many cases; we have a high percentage of deans who are women, and a high percentage of women in leadership,” she says. “Osteopathic medicine has always been welcoming to women; AT Still welcomed them into his first class, and our entire profession is based on human beings, not men versus women. I don’t know that if I had gone down the MD path if I would have had all the opportunities I have.”

Kemper adds that as an NBOME Board member, she has seen how inclusive the organization has become, and how that has contributed to its lasting success.

“The Board of the NBOME, as long as I’ve been on it, has been always a mix of men and women, but I never felt like I was in the minority,” Kemper says. “Not just board but leadership team – that is laudable as well. The efforts to attract a diverse set of people with diverse ideas has helped the NBOME be more robust.

Any place where there is that celebration of inclusion of all people – it makes for a stronger organization.”

The NBOME began transitioning its administration of the COMLEX-USA series to Pearson VUE with Level 3 in January, and registration for Level 1 and Level 2-CE are now open. As candidates and COMs alike prepare for this transition, here are a few things to keep in mind about testing with Pearson VUE.

 
1). Breaks are scheduled differently.
Moving forward with Pearson VUE, each candidate will receive a 60-minute pool of break time, to be used across three scheduled breaks however they see fit. For example, a candidate may choose to utilize the first and third break in 15-minute increments, and the second as a lunch period for 30 minutes. This time does not count against overall testing time; however, unscheduled breaks (those outside the scheduled break time) will count against testing time.

For more information on what to expect on Testing Day for each Level, visit home.pearsonvue.com/nbome.

2). Level 1 and Level 2-CE exams will be administered on any day there is a Pearson VUE testing center open and available. To find a list of Pearson VUE testing centers, visit home.pearsonvue.com/nbome.

3). There will be non-testing dates for Level 1 and Level 2-CE in the spring.
The NBOME typically does not offer testing between cycles for Level 1 and Level 2-CE. This year, to accommodate the transition to Pearson VUE, there will be no testing for COMLEX-USA Level 1 between March 16-May 3, 2023, or for COMLEX Level 2-CE between April 16-June 5, 2023.

For more, visit nbome.org/assessments/comlex-usa/examination-dates.

4). When scheduling Level 3 2-day examinations, candidates must do so no less than 40 days prior to the start of the testing window which includes the first desired testing date. For example, if a candidate wished to schedule the first day of their Level 3 exam on March 9, they will need to register on or before February 1.

For more on registration deadlines and scheduling requirements for Level 3, visit nbome.org/assessments/comlex-usa/examination-dates.

Note that your NBOME account will now display two lines on the ‘My Exams’ page – one for each day of the Level 3 exam. These two lines does not mean the exam was purchased twice.

5). Rescheduling is permitted up to 24 hours in advance of your appointment.
However, the scheduling windows for each Level would still apply. If you wish to reschedule Level 1 or Level 2-CE, you must select a date no less than five days from the day you decide to change. For example, if you decide on the 25^th that you want to reschedule, the earliest you could do so would be the 30^th.

For Level 3, you would need to reschedule by the scheduling deadline for each testing window.

Rescheduling/cancellation fees may also apply if you are within 30 days of your current scheduled date.

For more information on registration and scheduling deadlines, visit nbome.org/assessments/comlex-usa/examination-dates/.

6). When rescheduling Level 3 2-day examination, Day 1 and Day 2 of your examination must be scheduled within a 14-day window and Day 1 must be scheduled before Day 2. If it is not possible to reschedule your current appointments, and you see dates available outside your 14-day window that you would prefer, please cancel your existing appointment and schedule a new appointment for your desired dates.

These registration timelines help ensure that your examination will be properly delivered at the testing center.

7). Reach out to the NBOME accommodations team if you have been previously approved by the NBOME to receive test accommodations for COMLEX-USA exams. Before registering for or scheduling an exam, please email testacc@nbome.org with the COMLEX-USA exam for which you are seeking to schedule, so that the approved accommodations can be added to your registration profile.

For more information, visit our Test Accommodations page.

 
For additional information on the Pearson VUE transition, please see our FAQs for Level 1, Level 2-CE, and Level 3.

Our Client Services team is also available to answer any questions, Monday-Friday, 8am-5 pm CT, at ClientServices@nbome.org.

PHILADELPHIA, PA—The National Board of Osteopathic Medical Examiners (NBOME), an independent, not-for-profit organization that provides competency assessments for osteopathic medical licensure and related health care professions, is pleased to recognize the 2022 Item Writer and Case Author of the Year award winners from its distinguished National Faculty. Throughout the year, this group of individuals graciously volunteered their time and expertise to contribute to the COMLEX-USA and COMAT examination programs.

Each year, the NBOME selects the best-in-class item writers and case authors from a large group of contributors whose work supports our mission to protect the public through osteopathic competency assessment. Congratulations to these esteemed awardees for their exemplary commitment to producing valid and high-quality exam content.

COMLEX-USA Level 1 Item Writer of the Year

Patricia Sexton, DHEd

Sexton is the associate dean of medical education at Kirksville College of Osteopathic Medicine at AT Still University. She joined the National Faculty in 2014 and has contributed her time and expertise to the COMLEX-USA Level 1 and Level 2-CE examinations. She wrote nearly 20 items this year, in such high-need areas as medical ethics and humanistic behavior.

COMLEX-USA Level 2-CE Item Writer of the Year

Ronald Januchowski, DO

Januchowski is the associate dean for curriculum, assessment and medical education, at Edward Via College of Osteopathic Medicine – Carolinas Campus and has served the National Faculty since 2015.  He submitted 20 items to the COMLEX-USA Level 2-CE examination that touched on a variety of important and difficult topics, and is also a member of the COMLEX-USA Level 2-CE advisory committee.

COMLEX-USA Level 3 Item Writer of the Year

Jessica Ziebarth, DO

Ziebarth is an assistant professor of physical medicine and rehabilitation and chair of specialty medicine at Idaho College of Osteopathic Medicine and has been a member of the NBOME National Faculty since 2019. Her clinical scenarios are challenging yet realistic, and will further bolster the COMLEX-USA Level 3 item pool.

Clinical Decision-Making (CDM) Case Writer of the Year

Eileen Conaway, DO

Conaway is a core faculty member at Tidelands Health MUSC Residency program in Myrtle Beach, South Carolina and has been with the National Faculty since 2013. She develops detailed and realistic scenarios in which candidates must apply their real-world experience effectively and assure they are able to avoid measures that cause harm to patients.

COMLEX-USA Osteopathic Principles and Practice (OPP) Item Writer of the Year

Raymond Hruby, DO

Hruby is a professor and past chair at the College of Osteopathic Medicine of the Pacific and has served the National Faculty since 2014. He has been a prolific item writer for the COMLEX-USA Level 3 examination, which reflected the NBOME’s OPP standards and a high level of detail.

Preventive Medicine and Health Promotion Item Writer of the Year

William Elliott, MD, PhD

Elliott is chair of biomedical sciences and chief of pharmacology at the Pacific Northwest University of Health Sciences College of Osteopathic Medicine, and joined the National Faculty in 2013. A productive item writer, he consistently writes items that test difficult concepts in high-need areas.

COMAT Clinical Subjects Item Writer of the Year

Joseph Lynn, DO

Lynn currently is a psychiatrist and founder of Long Island Mind, a psychiatry private practice in NY. Over the previous item development cycle, he wrote many high-quality items with a 94 percent acceptance rate. In addition to his item writing efforts, he participated in the 2022 COMAT Clinical Virtual New Item Review and is a COMAT Subcommittee member.

The National Board of Osteopathic Medical Examiners (NBOME), an independent, not-for-profit organization that provides competency assessments for osteopathic medical licensure and related health care professions, is proud to announce the following appointments to its National Faculty Chair positions effective January 2023:

Competency Domain Chair
Interpersonal and communication skills in the practice of osteopathic medicine

Charles Finch, DO

Finch joined the National Faculty in 2013, most recently serving as COMLEX-USA Level 2-CE Chair and as an exam contributor. He is also the 2022 recipient of the John E. Thornburg, DO, PhD, National Faculty Leadership Award.

Chair for Diversity, Equity, and Inclusion

Bernadette Riley, DO

Riley joined the National Faculty in 2013, most recently serving as an exam contributor, and was named COMAT Clinical Item Writer of the Year in 2020. She regularly treats patients with severe disabilities and those who are transgender, and is passionate about improving healthcare disparities and access to care for underserved populations. She also lectures nationally on LGBTQIA+ care.

Department Chair: Family Medicine (interim)

Robert N. Agnello, DO

Agnello joined the National Faculty in 2014, most recently serving on the COMAT Family Medicine Subcommittee and as an exam contributor.

COMVEX Chair

Michael F. Oliverio, DO

Oliverio has served the NBOME for more than 20 years, most recently serving as COMLEX-USA Level 3 Chair and as an exam contributor. He is also the 2022 recipient of the John E. Thornburg, DO, PhD, National Faculty Leadership Award and is a member of the NBOME Board of Directors.

Foundational Biomedical Sciences (FBS) Division Chair – Physiology

Edward Wagner, PhD

Wagner has served as an exam contributor for COMLEX-USA Level 1 and COMAT FBS for nearly 20 years, most recently as Physiology Discipline Lead for COMAT FBS.

COMLEX-USA Level 3 Examination Chair

Brett Stecker, DO

Stecker has served the NBOME for more than a decade as an exam contributor and as member and vice chair of the COMLEX-USA Level 3 Advisory Committee. He was named Item Writer of the Year three times for his work on COMLEX-USA Level 2-CE, and is a two-time winner of Case Author of the Year for Clinical Decision Making.

Finally, the NBOME Board would like to extend its thanks and gratitude for those who completed service in their National Faculty Chair positions in 2022:

• Janis S. Coffin, DO, Clinical Sciences Department Chair – Family Medicine

2020-2022

• Samuel M. Cosmello, RPh, DO, Clinical Sciences Department Chair – Radiology & Diagnostic Imaging

2020-2022

• Timothy Dombrowski, DO, MPH, National Faculty COMVEX Examination Chair

2019-2022

• Furhut R. Janssen, DO, COMAT Examination Chair – Psychiatry

2019-2022

• Joyce M. Johnson, DO, MA, Clinical Sciences Department Chair – Preventive Medicine & Health Promotion

2020-2022

• Kathleen P. O’Hagan, PhD, Foundational Biomedical Sciences Division Chair – Physiology

2020-2022

• Michael F. Oliverio, DO, COMLEX-USA Level 3 Examination Chair

2013-2022

Part of the inaugural class of The Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation, Kennedy Sherman, OMS-III, is intent on being part of the change in the osteopathic community.

Here, Sherman—who also participates in the NBOME Student Experience Panel—shares her thoughts on utilizing practice questions and COMLEX-USA Level 1 going Pass/Fail, and her experience thus far on the Road to DO Licensure.

Why did you decide to choose osteopathic medicine as a profession?

In high school, I was interested in the medical field, already loving science and math classes. When I tore my ACL my junior year, I got the spark when I realized I wanted to pursue an occupation in the medical field. Throughout college, I shadowed different physicians, but still did not know the difference between MDs and DOs. It was not until my junior year when I visited OSU that I learned what osteopathic medicine was and the tenets that highlighted the whole person. I immediately loved the place, loved the people—loved the practice.

How do osteopathic principles stand out to you personally?

In the first year of medical school, you learn the tenets. You memorize them, know them by heart, but I feel like you never fully make a connection to them until you see them happen in real life. Whether it is an athlete who has something going on mentally that is making them physically fatigued or it’s RSV season where children are needing simple rib-raising techniques to help their body self-heal, it has been really eye-opening for me to see what we learned come to life.

How do you feel about COMLEX-USA going pass/fail and what was your experience in taking the exam?

I took the exam on the very first day of it going Pass/Fail. With Level 1 being my first board exam, I knew there was going to be a lot of pressure on how I performed. Since the test was Pass/Fail, it took some of the stress away from getting a high score and allowed me to focus more on learning the material. Getting a Pass gave me a boost of confidence and sense of accomplishment. I recently was invited to join the NBOME Level 1 Score-Reporting Task Force to help advise on the delivery of information provided to the students.

Did you also take USMLE?

I did not take Step 1. After joining the NBOME’s Student Experience Panel and hearing some of the discussions about DO advocacy, I decided that I did not need to take both exams, especially since they are both Pass/Fail.

While I have not picked what specialty I’m going into, I do not plan to take Step 2 either. With the single accreditation system for graduate medical education merger that recently happened, I believe my COMLEX Level 2-CE score will be a great testament of my knowledge for residency programs.

How did you prepare for COMLEX, and what advice do you have for others about to take the exam?

Since I knew I was going to take Level 1 in May, I started planning early. In February, I made my daily schedule and chose what resources worked best for me. The biggest thing I would recommend is to do a lot of practice questions. During the spring semester, I started incorporating practice questions into my study habits. This allowed me to get used to the exam format and wording. If you are familiar with the way questions are asked prior to studying for your exam, it will allow you to shift your focus towards learning the material and getting your timing down.

What are you looking forward to the most in the next stage of your journey?

I started rotations in July and have completed five different rotations. I’m getting to the point where I am excited to see what specialty I decide to pursue. So far, I have enjoyed all my rotations, which is a good and bad thing because how am I going to choose?

Honestly, finding what I am passionate about is what I am looking forward to in the future. As of now, I am really interested in family medicine, pediatrics, and sports medicine. However, I am continuing to keep an open mind while finishing rotations, as I still have a few more specialties that I am looking forward to rotating with in the upcoming months. Where will I end up?

As part of its Strategic Plan, the NBOME is committed to updating and innovating our assessment examinations to ensure that DOs meet a national standard to provide safe, quality, and effective patient care.

While the recent Supreme Court ruling in Dobbs v. Jackson may affect future osteopathic physicians in some states more than others, the NBOME requires that its national licensure and other standardized assessments remain fair, accurate, and valid for all exam candidates across the U.S.

To that end, the NBOME has created a Reproductive Health Task Force, to determine the impact of the Supreme Court’s decision on its national examinations. While the NBOME anticipates minimal impact on its exam content, the task force will help develop guidelines that support currency, fairness, and validity in our examinations regarding reproductive health topics.

The task force comprises a diverse group of osteopathic physicians from across the country and across multiple disciplines and is led by OB-GYN Anita Showalter, DO, MA.

Showalter was chosen to lead the task force due to her years of experience providing much-needed care to the women and babies in her community. She is a distinguished fellow of the American College of Osteopathic Obstetricians and Gynecologists and received that organization’s Mentor of the Year award in 2017. She also served on the NBOME Board of Directors from 2012-2021.

“The physicians of the Reproductive Health Task Force are excited to serve NBOME and its stakeholders by assuring the assessments remain fair and relevant,” said Showalter. “The variety of specialties, geographic areas, and backgrounds represented will provide broad expertise for the task at hand.”

The NBOME joined the Coalition for Physician Accountability’s Undergraduate Medical Education (UME) to Graduate Medical Education (GME) Transition Review Committee (UGRC) in 2020 to focus on improvements to the current state of transitioning from medical school into residency.

Today, members of the UGRC—including NBOME President and CEO John R. Gimpel, DO, MEd—co-authored an article in the Journal of Graduate Medical Education that expands on the committee’s 34 recommendations originally published in August 2021.

The article, “How the Quadruple Aim Widens the Lens on Transition to Residency,” explores some of the UGRC’s recommendations within the framework of the Quadruple Aim of healthcare: lower costs, improved patient outcomes, improved care team experience, and improved patient experience.

Several of the UGRC’s recommendations dovetail with the Quadruple Aim by addressing issues related to providing trustworthy and accurate advising resources for applicants; mitigating structural biases in the residency application process; and creating competency standards that more directly relate to improved patient experiences.

The article also notes a fifth potential aim: equity, which aligns with the URGRC’s recommendations related to diversity, equity, and inclusion, as well as those promoting the equitable treatment of applicants.

The authors note, “Recommendations focused on equity are aimed at mitigating structural biases toward underrepresented in medicine applicants as well as international and osteopathic applicants, many of whom struggle with belonging. Residency program directors are in the unique position of training the next generation of physicians and advancing the health of the public through the development of a sustainable, diverse, and competent workforce.”

DO students report sometimes experiencing bias and lack of familiarity with their educational pathway, degree designation, or even on the basis of their licensing examination.

“I believe most residency program directors (PDs) understand the distinctive osteopathic pathway and the value that interviewing and matching DO applicants brings into their program,” said Gimpel. “Most PDs understand that COMLEX-USA is the licensure exam for DOs, is accepted in all 50 states and other U.S. jurisdictions, and is taken by 100 percent of DO students. Many also know that COMLEX is easy to use in the ERAS system as part of a holistic review of DO residency applicants, and most are using COMLEX for DOs.

“It is our hope that those who are not will eliminate the biased and archaic practice of asking DO applicants for USMLE results,” he added.

Authors implore decision-makers across the UME to GME transition to consider the UGRC’s recommendations not only as a way to improve the transition to residency for applicants, faculty, and staff but as a way to improve the health and well-being of patients. They state that implementing those recommendations will ensure a stronger, more diverse workforce, which will ultimately contribute to better patient care and patient outcomes.

Along with the NBOME, the paper’s authors represent a number of prestigious academic institutions across the house of medicine, including Johns Hopkins University School of Medicine, Stanford University, the University of Texas Health Sciences Center/McGovern Medical School, the University of Illinois, and the National Board of Medical Examiners (NBME).

Fellow members of the UGRC include the American Medical Association (AMA), the American Osteopathic Association (AOA), the Educational Commission for Foreign Medical Graduates (ECFMG), the Association of American Medical Colleges (AAMC) and the American Association of Colleges of Osteopathic Medicine (AACOM), and the NBME.

PHILADELPHIA— The National Board of Osteopathic Medical Examiners (NBOME), an independent, not-for-profit organization that provides competency assessments for osteopathic medical licensure and related health care professions, honored Charles A. Finch, DO, and Michael F. Oliverio, DO, with the John E. Thornburg DO, PhD, National Faculty Leadership Award at its annual Board Meeting in December.

The Thornburg Award is bestowed periodically to National Faculty leadership members who have distinguished themselves by their longstanding contributions to examination development, committee work, or related activities. It is named for longtime National Faculty Chair John E. Thornburg, DO, PhD, who diligently served the NBOME in numerous capacities for four decades.

Charles A. Finch, DO, is a clinical professor of emergency medicine and chair of the Integrative Medicine Department at Midwestern University — Arizona College of Osteopathic Medicine. In addition, he currently practices at International Medical Direction, LLC, and is an attending emergency medicine physician at Dignity Health Arizona.

Dr. Finch has provided numerous contributions as a leader on NBOME’s National Faculty. NBOME. He served on the Case Development Committee and as a SOAP note physician examiner for the COMLEX-USA Level 2-PE from 2005-2020, and during that time, he became active in test development with other COMLEX-USA examinations, particularly the COMLEX-USA Level 2-CE.

He served as National Faculty Chair for the COMLEX-USA Level 2-CE from 2014-2021, and also served on the COMLEX-USA Composite Examination Committee, with leadership roles on numerous task forces and work groups.

In 2021, he co-authored a manuscript published in the Journal of Osteopathic Medicine entitled “Examining Concurrent Validity between COMLEX-USA Level 2-Cognitive Evaluation (CE) and COMLEX-USA Level 2-Performance Evaluation (PE),” a seminal publication on the validity of COMLEX-USA. He continues to serve on the NBOME Blueprint Subcommittee and is engaged in National Faculty activities, including item-writing workshops.

Michael F. Oliverio, DO, is a solo practice osteopathic physician delivering osteopathic manipulative medicine and osteopathic family medicine to his patients on Long Island, New York since 2003.

Dr. Oliverio earned his DO degree from the New York College of Osteopathic Medicine (now the New York Institute of Technology College of Osteopathic Medicine) in 1997 after completing a one-year undergraduate fellowship in OMM.

His service to the NBOME began in 2001 as an exam reviewer/item writer. Most recently, he served as National Chair for COMLEX-USA Level 3 from 2013-2022. During that time, he helped to shepherd the adoption of Clinical Decision Making items and the expansion of COMLEX-USA Level 3 to a two-day exam, with an updated, competency-based blueprint.

Dr. Oliverio has served on numerous National Faculty task forces and subcommittees, including the innovative POCKET Committee. He also served as a standard-setting panelist for COMLEX-USA Level 2-PE.

In 2020, Dr. Oliverio was elected to the NBOME Board of Directors, and will continue his service to the NBOME in 2023 as National Faculty Chair of COMVEX.

“Our National Faculty is one of our most important resources for ensuring the assessment products offered by the NBOME remain fair, valid, and reliable,” said John R. Gimpel, DO, MEd, president and CEO of the NBOME. “Dr. Finch and Dr. Oliverio are two examples of the unparalleled expertise offered by our National Faculty members.”

PHILADELPHIA, PA—The National Board of Osteopathic Medical Examiners (NBOME), an independent, not-for-profit organization that provides competency assessments for osteopathic medical licensure and related health care professions, honored Susan I. Belanger, PhD, RN, MA, with the 2022 NBOME Clark Award for Patient Advocacy at its annual Board of Directors Meeting on December 10.

The Clark Award recognizes those who have demonstrated outstanding commitment to patient safety, patient protection, and quality of care.

Belanger is the senior vice president for mission integration and the system ethicist at Covenant Health System in Lewiston, Maine. She is also an adjunct professor at Georgetown University School of Nursing and Health Studies in Washington, DC. Previously, Dr. Belanger was senior research scholar and ethics liaison at Georgetown University Medical Center. In her more than 30 years of progressive leadership experience, she has served as director of education, training and research at Sibley Memorial Hospital, as well as vice president of nursing and division leader of acute care services at St. Mary’s Regional Medical Center in Lewiston, Maine.

Belanger earned both a master’s and doctoral degree in nursing from The Catholic University of America in Washington, DC, and a master’s degree in bioethics and health policy from Loyola University in Chicago, Illinois. She completed a master’s degree in mission leadership in May of 2021. She has published and presented widely on the subject of ethics and has more than 20 years’ experience providing clinical ethics consultations. She has had roles in education and training in programs ranging from in-hospital settings to the university environment.

Belanger has considerable experience with the osteopathic profession from her tenure as a hospital vice president in Maine and has earned numerous honors and awards, including being twice honored with the Founder’s Day Award from her alma mater. Throughout her career, she has demonstrated a passion for improving end-of-life care, and this continues to be an important area of emphasis.

In October 2010, while teaching medical ethics at Georgetown, Belanger was elected to the NBOME Board as a public member. In December 2015, she was installed as an Executive Committee member and currently chairs the Standard and Assurances Committee and serves as a member of the Awards Committee. She is also a public member of the American Osteopathic Association’s Commission on College Accreditation.

“Throughout her career, Susan has demonstrated a passion for improving end-of-life care, and this continues to be an important area of emphasis,” said John R. Gimpel, DO, MEd, president and CEO of the NBOME. “She is an ideal candidate for this award.”

PHILADELPHIA, PA—The National Board of Osteopathic Medical Examiners (NBOME), an independent, not-for-profit organization that provides competency assessments for osteopathic medical licensure and related health care professions, honored Geraldine T. O’Shea, DO, with the NBOME Santucci Award at its recent Board of Directors meeting.

The Santucci Award is the highest honor the NBOME bestows, given to members of its Board, staff, or committees for outstanding contributions to the mission of the NBOME and requires a minimum of ten years of service to the organization.

O’Shea has practiced osteopathic internal medicine at the Foothills Women’s Medical Center in Jackson, Calif. since 1998 and serves as the center’s medical director. A 1993 graduate of the Western University of Health Sciences College of Osteopathic Medicine of the Pacific, she completed her internal medicine residency at the Maricopa Medical Center in Phoenix, Ariz.

O’Shea served as president of the Osteopathic Medical Board of California from 2006 -2012 and as president of the American Association of Osteopathic Examiners from 2013- 2015. She has also served on the Federation of State Medical Boards as member of their Nominating Awards, Audit, and Finance committees.

As past-president of the Osteopathic Physicians and Surgeons of California (OPSC), O’Shea was chair of the California delegation to the American Osteopathic Association’s (AOA) House of Delegates between 2006 and 2014, and received the OPSC’s Lifetime Achievement Award in February 2012.

O’Shea has served the AOA in many capacities, including as a trustee since 2013. She recently completed her three-year term as chair of the AOA Strategic Planning Committee, delivering the organization’s strategic plan for 2020-2025.

O’Shea became a member of the National Board of Medical Examiner’s Board of Directors in 2009 and has served on the Awards, COMLEX-USA Composite Examination, Finance, Compensation, Liaison and Executive committees, and on the SAS for GME Task Force. She was also NBOME Board secretary-treasurer from 2015- 2017, chair-elect from 2017-2019, and Board chair from 2019-2021.

“Dr. O’Shea served her tenure at the helm of the NBOME Board of Directors almost entirely during the worst period of the COVID-19 pandemic,” said Richard J. LaBaere II, DO, MPH, board chair of the NBOME.

“Through it all, she provided agile and stable guidance as well as stewardship of the NBOME in a very different, most often virtual environment. Her professionalism, sense of humor, and wisdom were instrumental to Board members and Staff during such unprecedented circumstances, and her steadfast commitment to what is best for the patients remains an inspiration for all.”

PHILADELPHIA, PA—The National Board of Osteopathic Medical Examiners (NBOME), an independent, not-for-profit organization that provides competency assessments for osteopathic medical licensure and related health care professions, announced the addition of two new members to its Board, and thanked outgoing members for their service with Meritorious Service Awards, at its annual meeting in December.

New members

David A. Forstein, DO, is Rocky Vista University’s (RVU) inaugural provost in Parker, Colorado, and chair of the American Osteopathic Association’s Commission on Osteopathic College Accreditation. He also serves on the Board of Directors of the Accreditation Council for Graduate Medical Education, where he is also Chair of the Committee Requirements. He holds clinical faculty appointments at Clemson University School of Health Research, University of Medicine and Dentistry of New Jersey – School of Osteopathic Medicine, Edward Via College of Osteopathic Medicine, and Jefferson Medical College.

Sherri L. Wise, CPA has served as President and CEO of the Osteopathic Founders Foundation since 1996. She was appointed to the Oklahoma Science and Technology Research and Development Board by Governor Brad Henry and reappointed by Governors Mary Fallin and Kevin Stitt. She currently chairs the Oklahoma Seed Capital Investment Fund for the Oklahoma Center for the Advancement of Science and Technology.  She has served the osteopathic profession in many other roles and is a 2005 recipient of the American Osteopathic Foundation Horizon Award.

Outgoing members – Meritorious Service Award Recipients

James M. Andriole, DO has served the osteopathic profession in numerous roles, including the American Osteopathic Association, the American Association of Osteopathic Examiners, and the Florida Osteopathic Medical Association (FOMA). In 2010, he was appointed to incoming Florida Governor Rick Scott’s Health and Human Services Transition Team. He received the Distinguished Service Award, the highest honor bestowed by the Florida Osteopathic Medical Association, and the Archie Feinstein, DO, Lifetime Achievement Award from the AAOE in 2017. Andriole was elected to the NBOME Board in 2009 and most recently served on the Finance Committee, the COMVEX Subcommittee and the Test Accommodations Committee.

Terri Donlin Huesman, MBA, currently serves as the president & CEO of the Osteopathic Heritage Foundations (OHF). During her tenure of more than 20 years with the OHF, she has led the development of strategic initiatives and funding priorities that build capacity at the national, state, and regional levels to proactively advance osteopathic medical care, research, and community priorities through partnerships, collaborations, and leveraged resources. Donlin Huesman was elected to the NBOME Board during its December 2015 Annual Meeting, and serves on the Nominating and Compensation committees and as chair of the Audit Committee.

Mollie M. James, DO, MPH, has served as a member of the NBOME National Faculty since 2011 and has participated in numerous examination committees. She was honored in 2013 as the Item Writer of the Year for COMLEX-USA Level 3. Elected to the NBOME Board of Directors in December 2016, she most recently served on the NBOME’s Standards & Assurances Committee and the Audit Committee. She recently founded the James Clinic, a primary care and functional medicine concierge practice.
 
 
 
 
“We are so grateful for the contributions of our outgoing members, and welcome the energy and experience of those who are joining our Board,” said Richard J. LaBaere II, DO, MPH, board chair  of the NBOME. “Their tireless work in guiding our organization ensures our continued success and growth.”

On Friday, December 9, 2022 the NBOME Board of Directors reviewed the Core Competency Capstone for DOs (C3DO) Task Force’s recommendations and selected four Colleges of Osteopathic Medicine (COMs) to participate in the 1^st set of pilot projects for the Core Competency Capstone for DOs:

• Campbell University School of Osteopathic Medicine
• Marian University College of Osteopathic Medicine
• Midwestern University – Arizona College of Osteopathic Medicine
• Rocky Vista University College of Osteopathic Medicine

The C3DO Task Force and the Board of Directors weighed many factors and came to the final selection after careful deliberation.

The NBOME looks forward to working closely with the selected COMs over the coming months. Pilots are planned to take place April through June, 2023.

As efforts move forward in the planning and execution of the project, the NBOME will continue to publish the progress of further pilot development and administration to ensure that all of the colleges of osteopathic medicine can follow updates to this investigative process.

The NBOME appreciates the time and effort taken by all fourteen COMs that submitted a proposal and anticipates the possible inclusion of those COMs and others in future pilots and implementation of the C3DO.

The NBOME is best-known for developing COMLEX-USA, the only osteopathically distinctive licensure examination series accepted for licensure in all 50 states and multiple international jurisdictions. We take immense pride in knowing that these examinations contribute to ensuring we have a workforce of competent, caring, and compassionate osteopathic physicians who serve the best interests of their patients, aligned with the osteopathic philosophy in which they were trained and educated.

Even after you complete your Road to DO Licensure, and after you pass COMLEX-USA Level 3, the NBOME still works to support you as your professional journey continues. Beyond licensure, we work with practicing physicians to help them maintain the quality of care patients expect from a DO.

Here are just some of the ways the NBOME supports DOs beyond the Road to DO Licensure:

NBOME National Faculty

Our network of more than 700 diverse thought leaders spans all areas of the country and all aspects of the osteopathic profession, from educators, to full-time practicing physicians, to experts in assessment, licensure, and regulation.

National Faculty members assist the NBOME in building and maintaining COMLEX-USA, our COMAT assessments, and other services such as COMSAE and WelCOM, through the writing and development of test items, cases, and rationales, and standard-setting and related quality assurance initiatives.

As a result, members of our National Faculty earn CME (category 1A and 1B) credits through the American Osteopathic Association (AOA), enjoy an expanded professional network, and participate in scholarly activities that can bolster applications for promotion and tenure.

You can get your residents involved in scholarly activity with the NBOME as well. Nominate senior residents (those who have completed their COMLEX-USA series) for test-development activities and faculty development in our “Residency Recruitment program.” For more information, email NationalFaculty@NBOME.org .

CATALYST Platform

CATALYST is a longitudinal assessment platform designed to enhance continuous professional development. It allows for targeted learning, in that it assesses knowledge over time, identifying trouble spots and increasing the volume and frequency of relevant content related to opportunities for improvement. It provides learning outcomes in real-time and can be customized to fit around a physician or learner’s busy schedule.

The AOA uses CATALYST to administer its osteopathic continuous certification (OCC) for 14 of its specialty certifying boards. The AOA’s OCC is designed to provide opportunities for continuous professional development centered on patient care, practice enhancement and lifelong learning. Three more specialty certifying boards are expected to use CATALYST for their exams beginning in January 2023. NBOME uses the CATALYST platform as well to power other assessments (e.g., WelCOM, resident-in-training formative assessments) across the continuum.

Online Learning

The new-and-improved NBOME Learning Center offers on-demand, self-paced, online learning activities that provide continuous professional development and CME opportunities for osteopathic physicians and other health care professionals.

These opportunities include:

• The NBOME Learning Assessment Series—NBOME-developed modules to help medical educators learn more about test question and assessment development, scoring, and related topics
• On-Demand CME Activities—self-paced, and approved for AOA CME credit, and developed in partnership with colleges of osteopathic medicine and osteopathic specialty boards.

Assessment of the competencies required to practice osteopathic medicine is at the core of the NBOME’s mission to protect the public. But as you can see, the NBOME also has many other ways to meet that mission while also supporting practicing DOs and related health professionals as they continue on their professional journey.

We hope that you’ll stop by the NBOME booth at OMED 2022 to hear from NBOME staff and leadership about these and more opportunities for professional development.

Recognizing change leaders who work to educate and advocate for DOs and their credentials.

While the NBOME has worked with other osteopathic organizations such as AACOM and AOA to broaden our advocacy and outreach, other change leaders in medical education are showing a commitment of support for the DOs in their community. We would like to recognize the cadre of academic Family Medicine organizations who made that commitment.

Recently the Council of Academic Family Medicine (CAFM), comprising the Association of Departments of Family Medicine, Association of Family Medicine Residency Directors, North American Primary Care Research Group, and the Society of Teachers of Family Medicine, released a joint statement on residency program application recommendations which embrace parity between DO and MD candidates.

These recommendations state:

1. Family Medicine program directors should avoid overreliance on a single examination program when selecting candidates for residency, focusing instead on a holistic review of applicants, regardless of whether they are on the allopathic or osteopathic licensing pathway.
2. Osteopathic applicants to Family Medicine residency programs should not be required – nor made to feel like they are required – to undergo licensing examinations other than the osteopathic (COMLEX-USA) licensure exam.
3. Residency programs and their sponsoring institutions should implement processes that fairly consider osteopathic applicants within the context of the osteopathic (COMLEX-USA) licensure process.

“Family Medicine has, historically, had one of the highest match rates for DOs. It is rewarding to see the strong relationship between osteopathic physicians and this specialty being recognized from within,” said John R. Gimpel, President and CEO of NBOME. “We know that our students will welcome this declaration of support from the leaders of graduate medical education in Family Medicine. We hope that these recommendations signal how change is being embraced at the highest levels and will encourage other specialty leadership groups to show their support for osteopathically distinctive licensing credentials.”

The NBOME engages in advocacy and education efforts with the UME and GME communities to increase awareness and acceptance of osteopathic applicants and their qualifications. We support holistic applicant review and to the extent that licensure examinations are a part of that review, COMLEX-USA is the appropriate exam to evaluate DO applicants.

If you are aware of any residency programs that appear to dismiss COMLEX scores as part of the application process, please reach out to us at advocacy@nbome.org or visit our Advocacy and Education page to fill out our Advocacy form.

The NBOME stands with the American Association of Colleges of Osteopathic Medicine (AACOM) in its efforts to spearhead H.R. 8850, the Fair Access in Residency (FAIR) Act.

Introduced on September 15 by U.S. Representatives Diana Harshbarger (R-TN), Chellie Pingree (D-ME), and Sam Graves (R-MO), the FAIR Act aims to ensure that all Medicare-funded residency programs accept COMLEX-USA by addressing the unfair and unsustainable system that excludes DO students from residencies or requires them to take the USMLE.

“We applaud AACOM’s efforts to ensure DO parity in graduate medical education (GME), and we are grateful to Reps. Harshbarger, Pingree, and Graves for their continued support,” said John R. Gimpel, DO, MEd, president and CEO of the NBOME.

“While COMLEX-USA is first and foremost a licensure examination, we recognize its secondary use in residency applicant selection,” Gimpel added. “We continue to advocate for a holistic residency selection process, but to the extent that a licensure exam is used as part of that process, it should be the one that has an evidence-based design to align with the practice of osteopathic medicine and the distinctive educational pathway leading to the DO degree, and evidence to support its validity in that regard.”

“It’s more critical now than ever that we ensure our taxpayer-funded residency training programs are fairly and equally deploying all the best talent of tomorrow’s doctors and specialists, from both DO and MD educational backgrounds,” said Harshbarger. “This bill is an important step toward ensuring transparency and equality in our taxpayer-funded GME programs, with the ultimate goal of increasing the number of physicians trained and serving our communities.”

“As one of the fastest growing health professions in the country, doctors of osteopathic medicine provide essential care in our communities, particularly in rural and underserved areas. It’s ridiculous that osteopathic medical students are facing discrimination and extra hurdles to accessing federally funded residency programs. The FAIR Act will help to ensure more accountability from these programs,” said Pingree.

“In a day and age when doctors are in short supply, specifically in rural areas, it’s critical they are able to complete their training and begin practicing,” said Graves. “This bill will remove some of the hurdles which can keep them from taking the next step in their training.”

As efforts continue to pass the FAIR Act, please visit AACOM’s Action Center to learn more and to learn how to contact other legislators for their support.

At the American Osteopathic Association’s (AOA) Annual House of Delegates (HOD) meeting in July, delegates from across the profession of osteopathic medicine reviewed numerous resolutions and enacted policies to help guide the work of the AOA and the future of the osteopathic medical profession.

During this meeting, the HOD supported two key resolutions related to NBOME, COMLEX-USA, and the credentials of DOs and DO students:

Resolution 213—reaffirms the AOA’s position that the only examinations able to fully evaluate the ability and competency of osteopathic physicians for licensure are the examinations developed by the NBOME.

Resolution 200—states that the AOA will work with the American Association of Colleges of Osteopathic Medicine, the American Association of Medical Colleges, the American Council of Graduate Medical Education and other relevant stakeholders to ensure that graduate medical education programs employ a holistic review of all residency candidates, and to consider COMLEX-USA equivalently to USMLE.

“COMLEX-USA is designed to assess the unique ways that osteopathic physicians are educated, trained, and practice,” said John R. Gimpel, DO, MEd, president and CEO of the NBOME. “Its intended purpose is to ensure DOs meet a national standard for licensure, to provide excellent care to our patients. As more and more GME programs use licensure exam results in the application process, we will continue to advocate for the equivalent use of osteopathic qualifications as part of a holistic residency application process. This includes licensure exams, COMAT, AOA Board Certification, and the DO degree itself.

“We welcome the input of the students and residents, as well as DOs in education, regulation and practice roles, as we stand up together in advocating for our distinctive profession and its valid and trusted credentials,” he added.

The discussion around Resolution 213 in particular included a lively debate among osteopathic medical students, osteopathic educators, state licensing representatives, and practicing osteopathic physicians about the need for a distinctive set of licensure assessments for osteopathic physicians.

While a few suggested that combined licensure exam for DOs and MDs (with an additional osteopathic manipulative treatment [OMT] component) would suffice assessing osteopathic competencies, many others disagreed.

The debate centered on the ways COMLEX-USA integrates osteopathic principles and patient-centered cases, how it aligns with the curricular pathways at DO schools, the secondary use of COMLEX-USA in residency applications, discriminatory practices uses by a subset of residency program directors, and the distinctive practice of osteopathic medicine.

Natasha Bray, DO, MSEd, interim dean of OSU College of Osteopathic Medicine—Talequah and NBOME National Faculty chair for COMAT internal medicine, noted concern for any circumstance where the misuse of a licensing exam as a basis for discrimination against DO students but added that a distinctive licensure pathway must be affirmed.

“Our profession must standup for the well-being of our students and against undue hardship (financial and emotional) being placed on our students by an undercurrent of expectation to sit for two licensing examination series,” she said. “However, we must continue to support the licensing pathway for physicians in practice and our responsibility as a profession to self-govern and determine the qualifications for the safe practice of osteopathic medicine.”

Many felt that the AOA and others need to advocate with the ACGME and residency program directors to eliminate discriminatory practices.

Jean Rettos, DO, an associate clinical professor at Ohio University Heritage College of Osteopathic Medicine, testified that the concept of simply adding an osteopathic component to a USMLE-based exam was not the solution for full parity; rather than “changing or diminishing our identity,” it would be better to partner with organizations such as the AOA and ACGME to eliminate biases against osteopathic medical students, leading to equality in the residency application process within the established single accreditation system.

NBOME Board member and longstanding Florida Board of Osteopathic Medicine representative and Florida delegate James Andriole, DO, agreed, testifying that an add-on OMT test is not the answer.

“The only valid exam for osteopathic medical students and residents is the COMLEX-USA. It truly measures what osteopathic medical students are taught, and it ensures the protection of the public by measuring the skills, knowledge, and unique philosophy of the osteopathic physician,” he said. “An add-on exam will not do that and would do nothing to protect the distinctiveness of the osteopathic medical profession.”

To underscore that distinctiveness, Marc Kaprow, DO, immediate past-president of the Florida Osteopathic Medical Association, presented an informal review of the exam blueprints of COMLEX and the USMLE. He explained that words such as “the patient” and “communication” appeared significantly more times in the COMLEX blueprint, and suggested that due to the alignment of COMLEX-USA with the education and practice of osteopathic physicians, that exam is the only valid and trusted instrument to assess osteopathic physicians.

The meeting ended with consensus that both resolutions presented an opportunity for the profession to come together to eliminate biases and discriminatory practices that create hardship for DO students and DOs. The group agreed it was a timely discussion, as the profession continues to grow in both numbers and in its reputation and trust across the house of medicine and with patients.

“Long-term resolve and consistency in policy and action help to preserve the distinctive practice of osteopathic medicine,” said Kevin Klauer, DO, EJD, CEO of the AOA. “The HOD spoke loudly, regarding its commitment to and support of an osteopathically distinct competency assessment for licensure as designed and administered by the NBOME. This commitment is important for all current and future DOs.  However, the HOD recognized the undue burden imposed on osteopathic medical students, expecting them to also take the USMLE series to compete for residency slots. The AOA is committed to advocating for our student colleagues to abolish this unfair expectation.”

Ernest R. Gelb, DO, president of the AOA, added: “Throughout my career, the AOA has partnered with many, including the NBOME, to protect and preserve our distinctive philosophy. I was moved by the actions of the AOA House, as it reaffirmed this charge, honoring our profession and protecting the credentials of all DOs and osteopathic medical students. Our efforts to protect our philosophy must and will be complementary to the needs of our medical students and not at their expense.”

PHILADELPHIA, PA—The National Board of Osteopathic Medical Examiners (NBOME), an independent, not-for-profit organization that provides competency assessments for osteopathic medical licensure and related health care professions, has announced the members of the task force that will provide oversight for its Core Competency Capstone for DOs (C3DO) project.

The C3DO Task Force comprises individuals from across the osteopathic medical education and licensure spectrum, and were selected to be a diverse and broadly representative group from around the country and based on their expertise and experience in developing, administering, and validating performance assessments of osteopathic clinical skills, predominately in the osteopathic medical school environment.

The task force members are:

Kathryn Brandt, DO, MS MEdL
Department Chair, Primary Care
University of New England College of Osteopathic Medicine

Nils Brolis, DO
Medical Director, Simulation Center
Rowan University School of Osteopathic Medicine

Alexios G. Carayannopoulos, DO, MPH
Chief, Physical Medicine and Rehabilitation
Lifespan Physician Group and Rhode Island Hospital

Millicent Channell, DO, MA
Associate Dean for Curriculum
Rowan University School of Osteopathic Medicine

Heather Ferrill, DO, MS MEdL
Dean
Rocky Vista University College of Osteopathic Medicine

Elizabeth Gignac, DO
Chair of Simulation and Clinical Education
Campbell University School of Osteopathic Medicine

Joe Kingery, DO, MBA
Dean
University of Pikeville Kentucky College of Osteopathic Medicine

Tom Lindsey, DO
Associate Dean of Simulation and Medical Technology
VCOM-Carolinas

Gretchen Lovett, PhD, MA
Professor of Clinical Sciences
West Virginia School of Osteopathic Medicine

Saroj Misra, DO
Associate Dean of Clinical Affairs, Core Faculty Family Medicine Residency
AT Still University- Kirksville College of Osteopathic Medicine

Richard Ortoski, DO
Regional Dean, Professor and Chair, Primary Care Education
Lake Erie College of Osteopathic Medicine

Kim Pfotenhauer, DO
Director of Clerkship Curriculum
Michigan State University College of Osteopathic Medicine

Richard Sloan, DO
Associate Professor of Osteopathic Principles and Practice
Idaho College of Osteopathic Medicine

Christina Weaver, DO
Assistant Dean of Innovation and Clinical Curriculum, Assistant Professor
AT Still University School of Osteopathic Medicine

“We thank all of the many applicants who have volunteered their skills for this task force,” said Dennis Dowling, DO, consultant coordinator for the C3DO Task Force. “The level of interest shows how invested our profession is in ensuring that clinical skills competencies remain integral to osteopathic medical education, licensure and practice.”

The work of the Task Force has already begun, with its orientation meetings held on September 13 and 15. This work includes the creation of a request for proposals (RFP), to be released by September 30. This RFP is a guide for schools to apply for participation in the first round of C3DO pilots anticipated to begin in spring 2023.

The NBOME will also be convening an advisory panel in 2023 to offer counsel as the various pilot phases progress.

For more on the Core Competencies for DOs project, visit nbome.org/C3DO.

How the NBOME works to educate and advocate for DOs and their credentials

As part of its advocacy outreach, the NBOME considers all of the interrelated organizations which can affect academic healthcare, and, in turn, impact osteopathic students, residents and physicians. Most recently, we worked with Doximity, which is the leading physician networking platform that supports more than 80 percent of U.S. physicians, to improve opportunities for osteopathic students and physicians.

Doximity also serves as an important resource to osteopathic students when they investigate potential residency programs, similar to the AMA-FREIDA or EMRA Match platforms. However, we learned in Spring 2022 that the platform’s Residency Navigator and Insights tool only provided the NRMP Charting Outcomes for MDs and USMLE scores.

We reached out to Doximity co-founder, Nate Gross, MD, who was responsive and deeply committed to supporting osteopathic students and physicians. Before the end of the summer, Gross and his team updated the Residency Navigator and Insights tool, and reiterated their commitment to improving tools for all medical students.

The changes made include:

• A filter for DO students to see COMLEX-USA scores of matched DO applicants per specialty
• Scores page now opens automatically with the DO filter pre-selected for osteopathic students to improve their experience
• Scores page shows the number of DO applicants per specialty and proportion of matched applicants

“We greatly appreciate that a key leader in healthcare network technology has shown their commitment to easing stress and eliminating biases DOs face during the UME to GME transition. We know that our osteopathic students will be overjoyed to hear about this change,” said Melissa Turner, MEM, associate vice president for strategy & quality initiatives. “We hope that changes such as these will inspire other companies that touch medical education to embrace support for osteopathically distinctive licensing credentials.”

The NBOME will continue its advocacy and education efforts to help reduce biases against DOs, level the GME playing field for DOs, and show the incredible asset DOs can be to residency program directors.

If you are aware of any residency programs that appear to dismiss COMLEX scores as part of the application process, please reach out to us at advocacy@nbome.org.

In a previous blog, we spoke to Jeremy Weleff, DO, a psychiatry resident now at Yale University, who launched several programs to address and improve mental health among residents. Research suggests that the pandemic has exacerbated the already high rates of anxiety, depression, and burnout among physicians in particular; fortunately, there are many resources that may help.

One such initiative, ACGME AWARE, is designed to promote well-being among residents, faculty members, and others in the GME community.

We recently interviewed Stuart Slavin, MD, MEd, the senior scholar for well-being at the Accreditation Council for Graduate Medical Education (ACGME), who launched ACGME AWARE based on his previous experience with medical students as associate dean for curriculum at St. Louis University.

The NBOME is exploring resources available in support of medical students, can you give us a little background on the ACGME AWARE initiative?

It is important to remember that while the environment is the primary driver [of stressors], there are other factors to consider, including individual susceptibilities and the persistent biases within healthcare against acknowledging stressors or seeking assistance.

When we say environment is the driver, we refer to stressors within the residency program which may include increased demands from what an intern experienced as a medical student. We also refer to global issues which impact physicians personally and professionally, such as the COVID-19 pandemic.

ACGME AWARE seeks to develop materials which can teach residents how to recognize stressors and reactivity to those stressors, and then manage those mindsets or thought processes that contribute to distress.

On the site, you give a lecture about Cognitive Skill-Building for Well-Being. Can you tell us about the skillset you describe and how it applies to medical students and residents?

Cognitive skill-building is fundamentally important for medical students. It comes from the world of cognitive psychology and cognitive restructuring is the main skill we teach in that video workshop and the associated podcasts and lectures. Cognitive restructuring forms the basis of cognitive behavioral therapy which is still gold standard treatment for anxiety and helpful for depression. The question is why do we withhold these techniques until one has a mental health problem and needs to see a therapist.  We believe that everyone can benefit from learning these techniques and that is the primary focus of the ACGME AWARE materials.  Cognitive restructuring can be very useful in dealing with common problematic mindsets like  imposter phenomenon, maladaptive perfectionism, or feelings of inadequacy and shame about performance.

While cognitive skill-building cannot banish those mindsets, it can give people the tools to recognize when they experience those thoughts and emotions, know when those mindsets are occurring, and learn how to not be so harsh on themselves.

Not only are these excellent life skills, they are wonderful for physicians who tend to be very hard on themselves. A great example would be how the maladaptive perfectionism mindset, which can occur during licensure assessment, interprets performance as identity, so, thinking “I didn’t just get this Level 2 score, I AM this Level 2 score.” When performance is not ideal, it can be much more distressing when one views your performance as who you are rather than how you have performed.

Because patient care, exposure to mortality, and the demands of education and assessment require a lot of mental fortitude, the inherent mental health challenges can be substantial hurdles to overcome. One of the best ways we can support physicians is by providing practical skills and resources to help manage their mental health.

What is Psychological First Aid and how does it apply to medical students and residents as caregivers?

I started to learn more about psychological first-aid at the beginning of the pandemic health care providers were experiencing huge amounts of stress.  It was clear that there are not enough psychologists to embed them in clinical settings to help the healthcare workers.

Psychological First Aid is a tool that was developed jointly by the National Child Traumatic Stress Network and the National Center for PTSD, which is a branch of Veteran’s Affairs, and was designed to provide psychological support to first responders. These same principles can be used in any traumatic setting.

The tools are set up as guidelines, essentially do’s and don’ts, which can help providers as they assist colleagues to navigate stressful situations. Psychological First Aid teaches physicians how to listen empathically to their colleagues without succumbing to the natural impulse to try and solve the problem for that person or assume the role of a counselor. The goal is to teach physicians how to provide the correct type of support for other physicians in a moment of need without trying to directly solve the problem.

What are some of the key areas of need you are seeing in medical students as they transition from UME to GME?

The transition to residency is an incredibly challenging and stressful experiences. Interns are very psychologically vulnerable, particularly to imposter syndrome early in their training. The huge leap in responsibility can present significant challenges. Studies indicate that the highest suicide rate in residency is within the first three months of residency, and I worry that impostor phenomenon may play a role in some of these tragic events.

It would be incredibly beneficial if every medical student going into residency was aware of both imposter syndrome and the mental health resources available to them. It is vitally important that both medical students and residents have a network of support. We should work to make sure these resources are abundant, available, and not stigmatized. If a physician is struggling, they never should hesitate to reach out and get the support they need.

For more on ACGME AWARE and other resources, visit the NBOME’s Mental Health and Wellness Toolkit.

Andrea Velazquez, OMS-III, is currently enrolled at Marian University College of Osteopathic Medicine in Indianapolis. She’s also a mom of two who believes she can find a successful path through medical school that doesn’t involve sacrificing time with her family.

In 2020, her husband Matt made the selfless decision to leave his career so she could answer her call to medicine. Here, both Matt and Andrea offer tips about how loved ones can care for their DO as they prepare for COMLEX-USA.

Matt, you recently tweeted about how proud you were of Andrea for passing COMLEX-USA Level 1. How can loved ones support their DO as they prepare for COMLEX?

MV: I think the biggest thing is trusting your DO knows what they need and understanding what a successful day looks like for them. Knowing how to support them is often more important than offering your own idea of what support looks like.

Sometimes studying for their COMLEX exam will mean really long hours and really long days, and at times they’re going to be gone a lot. Other times, they’re going to want to stay home, sleep in, or go to bed early. There might even be times they decide to attend an event they’d previously said no to because they’ve gotten further along in their studying than they expected they would—or they just need a break!

The last thing they need is for you to say they should study instead—that they shouldn’t go. If they believe that they’re at a good spot and need a break, you should trust and support them.

Do you think some people need to have that push to study?

MV: I think there’s a time and a place for that. If you see your DO is obviously neglecting study and is doing it for an extended period of time, there is a gentle way to approach it. Ask them what their ideal version of support looks like and what you can do to help them get into a position where they can study more effectively. Let them steer the conversation so you can work through their doubts, concerns, or issues together. You never want to be accusatory by saying, “You’re not studying X amount, or you’re not doing enough.”

That’s reacting to only a fraction of the whole picture. Maybe they’re never studying when you see them, but studying is all they do when you’re not with them. Maybe they need the break of spending time with you to study more effectively!

Here’s an example: Our daughters had a softball game, and Andrea had her COMLEX exam the next day. People asked her, “What are you doing here when you have an exam tomorrow?” And her answer was, “What else am I going to study? I need to be calm and feel like I’m taking care of myself, too.” That’s not the time to be cramming and stressing; it’s the time to get yourself in the right frame of mind.

Did you ever have a moment where you didn’t know what you could do to help? How did you overcome that?

MV: All the time. There were times when I tried to offer support, but it wasn’t exactly the support she needed. Sometimes she had to tell me that my attempts weren’t helping—that she needed to talk to a classmate or call one of her mentors or go out to lunch with a friend who was further along in training. At those times, I needed to provide her the space to lean into her community. I always want her to get the help she needs, even if it’s not from me.

Part of trusting your DO is knowing that you’re not always the person who is going to be able to help them the best. I’ve never taken COMLEX; I’ve never gone to medical school; I don’t understand the challenges that my wife faced and still faces.

There are other times where I had to let Andrea be on her own to process her feelings so we could regroup later. It’s important to acknowledge their frustration, but remind them that they’re doing great and are doing everything they need to be doing. They’ve been working for months to prepare for their exam. In those moments, you just need to tell them to keep doing what they’re doing and they’re going to be fine—and then slowly back out of the room with the promise of ice cream later.

Andrea, how was Matt helpful while you were preparing for COMLEX?

AV: Matt is a good planner, and we have constant communication about what’s going on. We regularly check in and make adjustments as needed. We’re able to have a high level of flexibility, which is essential when there are all these variables.

If the kids had a bad day and I planned on doing a lot of studying, sometimes I’d need to shift things around. It’s a constant conversation, and we prioritize our marriage and our family over everything. For us, medical school is a family commitment. We even talk to our girls about med school, and I tell them that I couldn’t do it without them. I think that kind of language for families and partners—emphasizing that this is our commitment—is helpful because it keeps everyone focused and willing to do what it takes to stay dedicated to each other and to that common goal.

What was it like to balance family life with the demands of medical school and studying for COMLEX? What are some of your tips?

AV: I see a lot of my peers struggle with relationships and with balancing. And I get a lot of questions about how I can possibly do this with two kids. I actually think that having a family helps keep you focused rather than taking away from your studying. I want to be able to tell people that it’s possible, and you can do it.

There was a time when I thought being a mom wouldn’t make me a good candidate for med school, and that it would be too hard. But here I am, as a mom and a medical student! So hopefully, this message comes across. All kinds of people can and do become good doctors; there’s no box that everybody has to fit into.

MV: Andrea intentionally scheduled her COMLEX exam for the day after our kids’ last day of school so she could study while they were not at home. She would study until around 3:30 p.m. when the kids would get home from school, and then she would take a break and spend time with us until the kids went to bed. Things shifted slightly toward a heavier studying load in the last month before the exam, but her emphasis on being around for at least a few pre-bedtime hours didn’t waver. Being present for them was important to her, so she made balancing her time a priority. She’s also able to lead our girls by example so our kids can see that, if you want something, you can make it happen. She’s showing them that it’s possible to achieve your dreams.

AV: I think the best advice is to be disciplined, but also be flexible. Being disciplined doesn’t solely mean locking in on doing the maximum number of test questions, because you should also want to keep all the best parts of your life and who you are as a person during this time of studying. Structure time for breaks. I made sure I was doing an afternoon walk with our dog, made time for family dinners, and if the kids were only going to be home and awake with us during a certain time, I made sure I was a part of it. Your schedule doesn’t have to look like anyone else’s.

I think sometimes when you don’t do as well on studying or you’re a little behind, there’s a temptation to cut something from your life to make even more room for studying. I tried really hard to limit that as much as possible; I believe you have to protect those other things as much as you protect your study time.

Sometimes an adjustment of expectations is necessary. I am not top of my class, and I had to let that go in order to do what I needed to do as a wife and mom. Be realistic about what’s possible for any single human. You shouldn’t let go of the parts of you that are really amazing so you can measure up to other people. Within the parameters of a passing score for exams like Level 1, there is a lot of wiggle room. What you can do is enough.

If you’re not sleeping, eating, and nourishing your relationships—your mental, emotional, and spiritual needs—you’re not only going to have a hard time showing up for your exam, but also for your life as well as you should be.

I don’t think students trust that, but I have seen over and over again that it is true. Just believe that it is possible to make time for things. I was home for the majority of family dinners, sports practices, and even coached while studying for COMLEX. It’s possible with discipline and planning. Sometimes you have to be creative about creating time for the things you care about instead of giving them up. You want those relationships to be there after COMLEX, and you don’t want to get a certain score at the expense of the people who love and support you.

To say Dominic J. Gigliotti, OMS-III, is accomplished would be an understatement; he was elected vice president of his class at the Alabama College of Osteopathic Medicine (ACOM) and also served as the Council of Osteopathic Student Government Presidents (COSGP) National Medical Education Chair during the 2021-2022 academic year. He also just completed service on the NBOME’s Special Commission on Osteopathic Medical Licensure Assessment.

Here, he shares his thoughts on leadership, advocacy, and education, as well as his own experience on the Road to DO Licensure.

Why did you decide to choose osteopathic medicine as a profession?

I knew I wanted to go to medical school, except only allopathic medicine was pushed by advisors and student groups so I wasn’t aware of osteopathic medicine at first.

It wasn’t until I decided to look up some medical examiners in my area while I was studying for the MCAT that I learned about DOs. I was scrolling through a list and came upon a doctor that had the DO credential after their name. I looked up what a DO was and found osteopathic medicine (or maybe it found me).

As someone who wants to become a forensic pathologist, I saw this doctor and thought if they got to where they are in their life, that’s exactly where I want to be too. After three days of research, I became firm in my decision. It felt good—osteopathic medicine felt right to me, which is an important feeling to have before you put hundreds of dollars into application fees. I also found out that the communication between myself and the COMs was also extremely professional and quick.

I really enjoy the profession—it’s such a close-knit community. I didn’t realize how close until I started going to conferences and meeting people. It feels like a family. Now, I feel very happy that I took the time to research and ended up going to an osteopathic school.

How did it feel to be the COSGP Medical Education Representative and how did you get there?

Being the medical education representative of COSGP was one of the most rewarding experiences of my career so far, especially because I was looking at medical education as a potential future career for myself.

This year I participated in ACOM’s Academic Scholars program rather than going right into my third year for clinical rotations. Through this program, medical students can earn a Master in Adult Education degree and learn more about medical education by teaching 1st and 2nd year students. I decided to do this year because I believed that at some point in my career, I would transition into medical education. Working to change education for the future is something I’ve always been passionate about. Advocacy is essential; you need people willing to make change by asking the right questions, such as, “What do we teach at our COMs? How often are we teaching these concepts? What are some areas that we can improve education?”

That was my whole year: figuring out what some of the gaps are in our education and how we can improve the profession moving forward—not just for our future doctors, but for our patients.

Having taken COMLEX-USA, how do osteopathic principles stand out to you personally?

This past year, I taught anatomy to first- and second-year medical students, and I told them that as DOs, we have an innate ability to use our hands to help patients who are chronically ill, or have had these problems for years.

I think what COMLEX-USA does is remind students that, “Hey, you are a DO and you have the ability to do this and make changes that are positive for your patients. So don’t be afraid to.”

I also took Step, and I could tell there was a significant difference in the way the questions were constructed. I think it’s how the people wrote the comments, questions, and their approach to medicine that made it change.

COMLEX questions were very open-ended that made you think critically and assess the patient. A question wasn’t just a bunch of facts and buzzwords; it was a whole patient case that was relative to real life where you had to determine the big differentials and ask yourself if this was a case where OMT was warranted or a case where it wasn’t.  Instead of prescribing the answer, COMLEX took the approach from the perspective of assessing the patient.

How did you prepare for COMLEX, and what advice do you have for others about to take the exam?

I started prepping for my board exams about six months out in January, and trust me, you can never do enough practice questions. Taking your preparation in chunks over a long period of time is better than cramming it in a month before your boards.

It’s also important to try and learn the information right the first time at your COM before going into dedicated study. COMLEX pushes students to not just regurgitate what they learned in school, but rather apply it, so if you just memorized the information without understanding it, you might end up struggling more in the exam. When you look at a question, you will want to be able to recognize what it’s asking and only brush up on some of the details you may have forgotten, so make sure you are comprehending rather than just absorbing.

What are you looking forward to the most in the next stage of your journey?

Taking that year to teach students helped remind me that I do love seeing patients. As much as I also enjoy medical education, and will eventually end up in it at some point in time, I just really love medicine. And for right now, medicine is my focus; helping patients and being the best physician I can be for my patients is what I care about. I’m looking forward to getting back into the swing of things this upcoming third year.

On this GME Professional’s Day, we’re highlighting the incredible accomplishments of Laura T. Adams, MNO, GME coordinator for the Cleveland Clinic Foundation/South Pointe Hospital Surgery Program, which has osteopathic recognition.

Adams has been in her current role for three years, and has more than two decades of experience in medical education and healthcare. Here, the NBOME spoke with her about her career and about the importance of osteopathic distinction in GME.

What is your background, and how long have you been a GME program coordinator?

I have worked in medical education since 1989.

I started as a medical secretary and then was an education coordinator for multiple residency and fellowship programs in Neurology. Later I became the GME manager at a hospital that, unfortunately, no longer exists.

I worked for nearly five years as an assistant registrar at a medical school.  After completing my master’s degree in Nonprofit Organizations, I returned to GME as an academic program administrator.  I became a clinical administrator for a short time, but quickly realized my passion was in working with residents, fellows, and medical students, so I made the move back to GME and my current role as program manager and team lead. It feels like I am back home!

Tell us about your volunteer work in healthcare.

My family has had experience with children with disabilities so it seemed like a natural thing to volunteer with Special Olympics Ohio. The athletes are so appreciative of everything you do for them. I joined in 2000 and participated in fundraising events, worked cycling events during the Summer Games and served briefly as an area director.  I volunteer at local events as much as possible.

Volunteering with Fieldstone Farm Therapeutic Riding gives me another opportunity to work with people with disabilities as well as the animals that I love.

Previously I volunteered as a member of the Hospital Emergency Response Team and on various committees within the hospital. At South Pointe I help with our monthly mobile food distribution.

How does Osteopathic Recognition (OR) set your program apart?

I’ve been a coordinator for other ACGME programs in the past but this is my first role in an osteopathic program and there is a noticeable difference in the way patients are treated here at South Pointe. The residents and faculty incorporate the tenets of osteopathic medicine into every aspect of patient care, and it shows. There is more care given to the patient as a whole person and not just about their disease or the procedure. The environment feels more personal, more like family.

What changes in residency recruitment has your program embraced in the wake of the pandemic?

In my opinion, the biggest impact the pandemic has had is the loss of personal interactions between candidates and staff. Let’s face it–staring at a computer monitor is not the same as talking with someone sitting a few feet from you. You don’t get a true sense of how the candidate is interacting with everyone. We also lose that energy of a day filled with dark-suited candidates walking through the halls, and having all of your faculty and residents together for the day.

We do value the opportunity for more candidates to interview with our program, however. And you can get a sense of how someone handles interruptions or stress when they experience connectivity problems, equipment failure, or wandering pets and children.

COMLEX-USA Level 1 recently went to pass/fail—how will that affect your applicant review process?

Our program has always taken a holistic approach to reviewing applications and selecting candidates to interview, so changing COMLEX Level 1 to pass/fail won’t affect us. We look at candidates as a complete person and focus on what makes them a good fit for our program. Our own program director didn’t have the best exam scores, and look where she is now!

What key attributes does your program director look for to determine whether a candidate is a good fit for surgery?

Whether or not a candidate has grit! She also considers a candidate’s extracurricular activities, national leadership experiences, volunteer experiences, culturally diverse background, whether they are a team player, and if they have a growth mindset. She also wants to know what the candidate will do with their knowledge and skills after training.

What is some advice you would give to DO students who plan to apply to a surgery program?

You really need to have a passion for surgery to be successful. During interviews, ask questions that will help you understand the expectations of the program and the challenges of the specialty. Be yourself, and don’t forget to have fun too!

What do you most enjoy about being a program coordinator and working with residents?

The thing I enjoy most about being a program coordinator is working with some very brilliant people who are engaged in their training programs and are passionate about GME. I enjoy working with the residents because I feel like a part of their development, from young trainees to successful practicing physicians. I am both proud and sad at the end of the academic year, but re-energized at the start of each recruitment season.

Anything else you’d like to share about being a PC?

I am blessed to work in a community hospital where the residents, faculty, and staff are dedicated to osteopathic education and patient care. Our GME team is amazing, and my program director is undoubtedly the best I have ever worked with. I am motivated every day to be at the top of my game.

NBOME continues efforts to educate and advocate for DOs and their credentials

As the NBOME continues to partner with other osteopathic organizations to identify and address biases towards DOs and their licensing credentials, we often find that institutional leaders are open to having a conversation about why prohibitive policies exist and what they can do to improve for students and programs alike.

Earlier this year, we heard concerns about the clinical rotation requirements for USMLE (Step 1) at the University of Colorado Anschutz Medical Campus (CU Anschutz).

In June, the NBOME and AACOM reached out to CU Anschutz Senior Dean for Education, Shanta Zimmer, MD who explained they would be happy to accept COMLEX-USA scores for visiting osteopathic students and  implemented the change immediately.

While there continue to be concerns around higher clinical rotation fees for osteopathic students, CU Anschutz indicated they are willing to engage in a discussion over alternative funding structures.

“We thank CU Anschutz for their responsiveness and strong support for osteopathic medical students and all medical students. They are indeed the future of our two profession’s abilities to rise to the challenges of providing just, equitable and high quality health care to all patients in all communities,” said John Gimpel, DO MEd, NBOME President and CEO.

Like residency programs, clinical rotations that state a preference or requirement for USMLE scores over COMLEX cause more stress and additional financial burdens for osteopathic applicants who are trying to remain competitive. What’s more, exclusionary language can also make some osteopathic students feel as though they are unwelcome in a program—even if that is not the case. Sometimes, all this requires is reaching out to clear up a misunderstanding or misstatement.

The NBOME will continue its efforts to advocate for reduced bias against osteopathic students and residents, and to engage leaders in academic healthcare to create institutional change.

We can best do that through collaboration with student groups and other interested parties. If you are aware of any residency programs that appear to dismiss COMLEX scores as part of the application process, please reach out to us at advocacy@nbome.org.

Every test question that appears on a COMLEX-USA examination goes through a rigorous item writing and review process based on industry standards and best practices.

Item is the term we use to refer to a multiple-choice test question with a single best answer. Here is a summary of what makes our items distinct to osteopathic medicine as well as the main stages of item development (item writing, item review, pretesting, and periodic review).

OSTEOPATHIC DISTINCTIVENESS
COMLEX-USA is the only osteopathic medical licensure assessment series, and the evidence-based examinations created by the NBOME are unique in that they integrate the principles of osteopathic medicine—starting with the philosophy that every person is a unit of body, mind, and spirit. In other words, the COMLEX-USA examinations are distinct to the osteopathic profession and align with osteopathic medical education and comprehensive, evidence-based osteopathic medical patient care.

ITEM WRITING
The items on our examinations are written by members of our National Faculty, which numbers more than 700 active, engaged medical professionals with expertise across all osteopathic health professions and specialties. Item writers are assigned questions based on the COMLEX-USA blueprint, which integrates the osteopathic tenets throughout its competency domains and clinical presentations. Whole-patient care is reflected in the clinical scenarios, which often include structural examination findings and information on lifestyle and environmental factors that may impact patient wellbeing.  To confirm the accuracy of item content, every item is prepared with a supporting reference from an up-to-date medical textbook, journal, or website.

ITEM REVIEW
Items are reviewed multiple times throughout their development by National Faculty committee members. Committees review test questions for accuracy, currency, fairness, and test-wise clues (i.e., are there hints within the item as to which answer options are correct or incorrect?).

NBOME editors review test questions to make sure that the test content is clear and the medical terminology adheres to the organization’s preferred usage and style. In addition, DOs are involved throughout the review process, whether the test question topic concerns basic sciences, communication, or patient care.

Evaluating test questions for bias is an important priority for the NBOME. Committee members evaluate test questions with the goal of ensuring person-centered language and a lack of biased content. The NBOME strives to ensure diversity of skin tones in photographs and videos throughout the exams. Diversity, equity, and inclusion were identified as key themes in the Special Commission on Osteopathic Medical Licensure Assessment Recommendations.

PRETESTING
Before a question is counted as part of candidates’ scores, it appears on examinations as a pretest item. A pretest item means that the item appears on an examination, but it is not used in the final calculation of the student’s score. Candidates do not know the difference between pretest and scorable questions, but the NBOME pays close attention to how candidates answer and comment on pretest items to determine whether they are appropriate to score in the future. So if you see an item that doesn’t make sense to you, you should comment about it to help us evaluate pretest items for future examinations.

PERIODIC REVIEW
After an item has been pretested, the review doesn’t stop. Test questions are routinely reviewed for accuracy, currency, and fairness. Candidate comments, examination statistics, and periodic review by National Faculty members ensure the validity of COMLEX-USA examinations. Items are removed from examinations if a review committee determines that the content is inaccurate, no longer reflects current medical practices, or exhibits bias in terminology.

On his first attempt at COMLEX Level 1, John Ukadike, DO, failed. He was devastated.

“I would be eating breakfast with tears streaming down my face,” he said. “It’s such a high-stakes exam, and there’s a culmination of all these expectations and factors. It can be overwhelming.”

When Ukadike took the exam again just three weeks later, he was able to improve his score by more than 100 points—enabling him to pass and graduate on time. What felt like a monumental problem at the time turned out to be a small bump in the road.

Here, Ukadike offers his tips for how to overcome initial feelings of disappointment and make an action plan for moving forward.

Talk to someone.

After Ukadike did poorly on his first go-around, he reached out to people on his campus to see if others were in a similar situation, and he also reached out to the top performers in his class and spoke with a counselor.

“For those who didn’t do well, it helps to have an accountability buddy, someone who you can check in with, laugh and cry with if you need to,” he said. “And for those who did do well, it helps to find out what they did to prepare so you can model that.”

Reframe your thinking.

Ukadike said his counselor helped him see the bigger picture.

“She explained how this was one point in time,” he said. “She helped me see that I was in a place where everyone is smart and high performing, and it’s an accomplishment just to get this far. That I had what it takes, I just had to focus. She also told me not to be afraid to ask for help, and I think there’s still a bit of a taboo when it comes to underperforming on COMLEX.”

It was this last part that led Ukadike to create a YouTube video to help others who were in a similar situation.

Recognize that you are more than just your board scores.

While important, Ukadike says that they don’t define who you ultimately become as an osteopathic physician.

“I can restart a heart, read advanced imaging, interpret labs without breaking a sweat, but the thing that matters most is how you treat your patients,” he said. “Be affable, answer the phone, and listen. Those things will make you great. The rest is icing on the cake.”

Nourish your body, as well as your mind.

It might seem like a small thing, but Ukadike says on test day, it’s incredibly important to pace yourself, and don’t skip breaks.

“You need to have the energy to recall all that information, especially towards the end,” Ukadike said. “By the end of my first test I was so exhausted I couldn’t recall anything, I just forgot the last 20 minutes. You have to take those breaks. Bring a snack or some Gatorade. Take the time to reset and it will put you in a better mindset for the rest of the exam.”

Ultimately, Ukadike was able to graduate on time, and land a residency in the Department of Family and Preventive Medicine at the University of Arkansas for Medical Sciences.

“Getting this residency was the best thing that ever happened to me,” he said. “I’ve had access to every specialty, and been given every opportunity to learn. My skills have been bolstered from this experience.”

*The NBOME does not endorse any particular test prep company or the study concepts named in Dr. Ukadike’s video.

The Board of Directors of the National Board of Osteopathic Medical Examiners (NBOME) has accepted the Report of the Special Commission on Osteopathic Medical Licensure Assessment.

The Board appreciates the work of the Commissioners for over 16 months on this important task. Based on this report, and as a follow-up on two of the four themes, the Board has made the following statements and endorsed specific action items:

Theme 1:  Long-term solutions to assess clinical skills competencies for osteopathic medicine in the COMLEX-USA program: Class of 2024 and beyond

Recommendation 1: Establish COM-based COMLEX-USA national standardized assessment which includes an in-person, hands-on evaluation of fundamental osteopathic clinical skills including interpersonal and communications skills and OMT, with quality assurance.

1. The NBOME will extend the enhanced attestation guidelines for Level 3 eligibility through the Class of 2025. Graduates in the classes of 2024 and 2025 (similar to the classes of 2022 and 2023) will need to have their college of osteopathic medicine (COM) dean provide attestation that the graduate has demonstrated competency in osteopathic clinical skills necessary for graduation.

2. The NBOME has approved closure of the NBOME’s two National Centers for Clinical Skills Testing and the formal discontinuation of the centrally administered COMLEX-USA Level 2-PE. We have committed funding and resources to develop and pilot a core competency capstone for osteopathic medical students. This project will include funding for partner colleges of osteopathic medicine that are interested in participating in this initiative to deliver a new clinical skills exam on campuses at the COMs. We anticipate a request for proposal (RFP) period to begin no earlier than September 30, 2022, with further details regarding the core competency capstone available at that time. The prototype in development will assess patient-physician communication skills and hands-on physical exam and OMT skills in a multi-station OSCE model using standardized patients that is designed for entry into residency program level. The model would be competency based, in that a candidate could have multiple opportunities to successfully complete the assessment. Only the final achievement of competency would be recorded on a transcript. Finally, minimizing overall costs to candidates will remain a key consideration.

3. The NBOME will also create a task force, comprising individuals from across the osteopathic medical education and licensure spectrum, to advise on the pilot project and resulting capstone assessment. These task force members will be selected based on their expertise in developing, administering, and validating performance assessments of clinical skills. There will be representatives from organizations including the American Osteopathic Association, the American Association of Colleges of Osteopathic Medicine, and the American Association of Osteopathic Examiners.

Theme 2: Diversity, Equity, and Inclusion in Assessment (DEI)

• The NBOME Board appreciates the tone of inclusivity in Theme 2, and would like to commend the commission for their recommendations for equity for and inclusivity of all persons, including those specifically mentioned in the report and individuals with disabilities.

“The mission of the NBOME is to protect the public by assessing the competencies of osteopathic physicians,” said NBOME Board Chair Richard J. LaBaere, II, DO, MPH. “Osteopathic clinical skills are important competencies for our patients and our profession. Through the work of the Special Commission, we have taken feedback from multiple stakeholders, and intend to develop a method of supporting a standardized, profession-wide assessment delivered in a distributed administration model. We believe that this will take advantage of the gains made over the past 17 years of national osteopathic clinical skills assessment, but also provide a trustworthy benchmark for use in medical licensure for DOs. We believe this path forward also takes into consideration stakeholder concerns about the previous assessment model and addresses the public concerns that all individuals demonstrate minimal competence.”

“We listened to everyone: patients and patient safety advocates, students and residents, educators including deans, residency program directors and faculty, and those in the licensure, accreditation and medical regulation community,” said NBOME President and CEO John R. Gimpel, DO, MEd. “What we heard was that each of those constituents believe that assessing fundamental osteopathic clinical skills is essential for our patients. Many shared that this could be done on COM campuses, which would help reduce travel and financial burdens for students.”

He added, “I believe the Special Commission’s guidance and the NBOME Board’s decision will allow us to do just that, and will allow the NBOME to maintain the licensure community’s trust, by ensuring our COMLEX-USA exam series continues to help protect the public. This underscores our profession’s emphasis on the patient and patient safety.”

READ THE FULL REPORT

PHILADELPHIA, PA— The National Board of Osteopathic Medical Examiners (NBOME), an independent, not-for-profit organization that provides competency assessments for osteopathic medical licensure and related health care professions, honored the following individuals at its midyear Board meeting:

Santucci Award

The Santucci Award is the highest honor the NBOME bestows. It is given to members of its Board, staff, or committees for outstanding contributions to the mission of the NBOME, and requires a minimum of ten years of service to the organization.

This year’s recipient, Eugene A. Oliveri, DO, has been a tireless supporter of the NBOME and of COMLEX-USA for decades. He served the NBOME on its Board of Directors from 2000-2009, and in numerous leadership roles including Membership/Nominating, Product, and Executive Committees.

In 2000, as President of the American Osteopathic Association (AOA), Oliveri was the Dr. Bryant L. Galusha Lecturer at the Annual Meeting of the Federation of State Medicals Boards, and described the importance of osteopathically distinctive licensure assessment and COMLEX-USA in protecting the public.

He also advocated for Louisiana’s acceptance of COMLEX-USA, the last state to do so, in 2005. Oliveri gave the A.T. Still Memorial Lecture at the AOA’s House of Delegates in 2009, focusing the address on the 75th anniversary of NBOME and the importance of the NBOME and osteopathically distinctive assessment as “the weaving tapestry that connects the profession together.”

Oliveri is certified in addiction medicine and is a fellow in both the American College of Osteopathic Internists (ACOI) and the American College of Gastroenterology. He led a practice in Farmington Hills, Mich., for 30 years and was professor of osteopathic surgical specialties and assistant to the dean at Michigan State University College of Osteopathic Medicine (MSU-COM). He also served as associate program director of the gastroenterology residency program at Botsford Hospital (now Beaumont Hospital – Farmington Hills).

He has served as past president of the American Osteopathic Association (AOA) and the ACOI; as past chair of the American Osteopathic Foundation and the Michigan Osteopathic College Foundation; and on the boards of the University of Pikeville-Kentucky College of Osteopathic Medicine, and the University of New England College of Osteopathic Medicine. He has been honored for his service from several organizations such as the AOA and from many colleges of osteopathic medicine.

“Having spent time on many boards and committees, I realize that being on the board of the NBOME was a very different experience,” said Oliveri. “Our examination means that we are qualified, we are trained and we are outstanding physicians that take care of the public. I would like to say how proud I am to be here. I am truly humbled and I thank you.”

John E. Thornburg, DO, PhD, National Faculty Leadership Award

This year we announce the inaugural John E. Thornburg DO, PhD, National Faculty Leadership Award. This award will be bestowed periodically to National Faculty leadership who have distinguished themselves by their longstanding contributions to examination development, committee work, or related activities. It was presented at the meeting to John E. Thornburg, DO, PhD.

John E. Thornburg, DO, PhD, has diligently served the NBOME in numerous capacities for four decades.

He began as an NBOME National Faculty member in 1982 and during his tenure served as an exam reviewer; National Faculty Chair for Biomedical Sciences; Chair of the NBOME Pharmacology Test Construction Committee and the Level 1 Exam and Advisory Committee; on the NBOME Blue Ribbon Panel; as COMLEX-USA Level 1 Coordinator.

Thornburg was elected to the NBOME Board in 2001, and served as its chair from 2009-2011. In 2014, he was honored with the Santucci Award in 2014 for his remarkable tenure with the NBOME. After completing his service on the Board, Dr. Thornburg reconnected with his test development activities, serving as National Faculty Chair for Foundational Biomedical Sciences and the COMLEX-USA Level 1 Exam Chair from 2013-2020.

He has mentored countless of current NBOME National Faculty members, and many—including current members of the NBOME Board—credit Dr. Thornburg as the reason they got involved with the NBOME.

Thornburg is professor emeritus of pharmacology and toxicology at Michigan State University (MSU). He has served that institution for nearly 45 years in numerous educational, clinical, and leadership roles and authored 57 publications and given 61 lectures on various topics related to pharmacology. In 2012, the American Osteopathic Association awarded him the Distinguished Service Certificate for his dedication to the profession, and MSU-COM honored him for distinguished teaching.

“My long experience with the NBOME has been such a great experience the whole way around,” said Thornburg. “I am very appreciative of and honored by this award.”

Meritorious Service Award

The NBOME bestows Meritorious Service awards to individuals, either within the osteopathic profession or outside of it, who have made outstanding contributions to the NBOME mission.

Anthony L. Cossetti, CPA, has served on the NBOME Finance Committee since 2015, and also on its Audit Committee. He also played an important role in the prudent stewardship of the organization’s financial resources.

Cossetti currently serves as executive vice president, chief accounting officer and controller at Fulton Financial Corporation.

He has more than 27 years of financial, banking, and accounting experience. Some of his prior posts include director of finance at Title Alliance Ltd and as senior vice president, corporate treasurer for Beneficial Bancorp Inc. He has also held senior finance roles at Unity Bancorp Inc., Sovereign Bank, and MBNA America, N.A., and served as an advisory board member to the Federal Home Loan Bank of Pittsburgh.

“I am humbled to be honored alongside two men who have meant a lot to the profession and the organization,” said Cossetti. “It’s been a pleasure to serve and I’ve been so grateful to help in any way I can.”

How the NBOME works to educate and advocate for DOs and their credentials

The NBOME regularly works in collaboration with other osteopathic organizations to identify and address biases towards DOs and their licensing credentials. The latest example of this effective partnering was with the Oregon Health & Science University (OHSU).

In May 2022, we learned that the website for the OHSU Department of Psychiatry’s Adult Psychiatry residency program seemed to indicate a preference for USMLE scores over COMLEX scores.

After reaching out to the program director, we quickly determined that they do indeed support DO residents and also DO applicants. The program’s website was then updated to make it clearer that the program does accept COMLEX-USA scores as part of its application process.

“We commend the leadership at OHSU for acting quickly to make this change and for supporting osteopathic candidates on their Road to DO Licensure,” said Melissa Turner, associate vice president for strategy & quality initiatives. “We also hope that we can inspire other programs to reassess their language and follow suit with clear wording that shows a support for osteopathically distinctive licensing credentials.”

Residency programs that state a preference or requirement for USMLE scores over COMLEX cause more stress and additional financial burdens for DO applicants who are trying to remain competitive. What’s more, exclusionary language can also make some DO applicants feel as though they are unwelcome in a program—even if that is not the case.

The NBOME will continue its advocacy and education efforts to help reduce biases against DOs, to help level the GME playing field for DOs, and to show what an asset DOs can be to residency program directors.

We can best do that through collaboration with student groups and other interested parties. If you are aware of any residency programs that appear to dismiss COMLEX scores as part of the application process, please reach out to us at clientservices@nbome.org.

Sometimes, all this requires is reaching out to clear up a misunderstanding or misstatement.

The NBOME believes that examinations designed to protect the public should reflect the makeup of the patient population that osteopathic physicians will serve. This means ensuring there is representation for the lesbian, gay, transgender, queer, and asexual (LGBTQIA+) community in the way we write and edit our test items.

The importance of diversity is a Core Value of the NBOME, and rooted in the Master COMLEX-USA blueprint. That document specifies, “The osteopathic physician must demonstrate sensitivity, respect, and responsiveness to a diverse and heterogeneous patient population, including but not limited to diversity in culture, religion, age, gender, sexual orientation, socioeconomic circumstances, mental and physical disabilities, and military personnel and their families.”

Diversity, equity, and inclusion is also one of the themes in the recommendations from the Special Commission on Osteopathic Medical Licensure Assessment.

This emphasis is essential as many in the LGBTQIA+ community have felt discrimination and bias from healthcare providers. According to a 2019 study, roughly 16 percent of LGBTQIA+ adults have reported facing discrimination, and as a result, avoided seeing their provider altogether. In an effort to combat this discrimination, the osteopathic medical profession is using several strategies to foster inclusive care.

One example is the American Osteopathic Foundation’s LGBTQ+ Health Equity and Inclusion Campaign, designed to undertake the work of better understanding and addressing the healthcare needs of the LGBTQIA+ communities. Several colleges of osteopathic medicine are working to emphasize inclusion and allyship in osteopathic medicine as well:

• https://com.msu.edu/events/2022/diversity-week-2022-gender-and-lgbtq-medicine
• https://tourocom.touro.edu/news–events/events/list/health-professions-seminar—-improving-lgbt-healthcare.php
• https://www.wvsom.edu/students/diversity/allyship-training
• https://www.statpearls.com/physician/cme/activity/34541/?deg=DO

The NBOME is doing its part to combat stigma and discrimination by ensuring that its test questions accurately address the health needs of the LGBTQIA+ population, and are fair and free from bias. The NBOME Item Development Style Guide’s section on LGBTQIA+ terminology offers specific guidance on up-to-date language for editors and item writers.

“This has been a focus of ours for a long time,” explains Marie Fleury, DO, associate vice president for test development. “For each test question, we conduct a review that includes looking for bias and stereotypes related to gender and sexual orientation. We also review candidate comments and flag any that indicate an item has problematic terminology or outdated content.”

The NBOME has also held item writing workshops dedicated to transgender patient care. At these sessions, the NBOME’s National Faculty shared resources, brainstormed exam content, and wrote and reviewed test questions together.

“It is important to address and assess heath care needs of patients from all backgrounds,” said Obstetrics-Gynecology National Faculty Chair, Stephanie Zeszutek, DO. “The LGBTQIA+ population has unique but also overlooked needs that often contribute to health disparities.”

In a recent item writing workshop, Zeszutek added, “The NBOME team was extremely collaborative and supportive in the item writing workshop. We found it helpful to utilize real-life patient-interaction scenarios as a stepping-stone to exam question development. Our goal was to create timely and timeless items that address stigma, increase awareness, and promote wellness.”

Evelyn Ronkowski, associate director for test development also says, “We have referenced the GLMA Provider Directory to find National Faculty members who may be well-suited to write and review topics related to LGBTQIA+ health, but this does remain a high-needs area for us.”

In addition, the NBOME Item Development Style Guide has a section on LGBTQIA+ preferred terminology, which is regularly updated as new guidance emerges on best practices. Two resources for this section include the GLMA Guidelines for Care of Lesbian, Gay, Bisexual, and Transgender Patients and the GLAAD Media Reference Guide.

“Information can change so quickly, so as the organization responsible for assessing if a DO is fit to practice, it’s important that we remain nimble, and continually ask ourselves: ‘What are we doing now? What info do we want to provide item writers and reviewers? What can we change in our items right now? What do we need to remove?’” says Fleury.

If you are interested in writing questions related to LGBTQ health, please email nationalfaculty@nbome.org.

The 2022 Match cycle was an unprecedented one for DO seniors and graduates; more than 7,048 osteopathic applicants matched in March 2022, and DO seniors achieved a 91.3 percent NRMP match rate—the highest on record.

As you look ahead to another hotly anticipated Match cycle, remember that every journey on the Road to DO Licensure is unique. Over the next nine months, the NBOME will be here to help you on that journey by providing information, education, and other valuable resources as you embark on one of the greatest transitions in your life.

In the meantime, here’s what you need to know as you start the Match process for 2023. Good luck!

2023 MATCH TIMELINE

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June – August 2022 | On Your Mark…

Once your COM has approved you to enter the upcoming residency match, you can begin working on your applications in MyERAS. Check out the NRMP Intro to the Match page to learn about what’s new for this upcoming application cycle.

• June 8: ERAS 2023 season opens
• June TBD: Urology Match
• July 1: Ophthalmology SF Match applicant registration
• August 1: Supplemental ERAS application opens for the 16 participating specialties

Military students are automatically registered for the Military Match.

September | Get Ready…

Now’s the time to start submitting applications. The AAMC’s Residency Explorer Tool can help you find programs that fit you, if you decide to expand your search.

• September 7: Start applying to their residency programs of choice through ERAS
• September 15: Registration opens for the NRMP 2023 Match Cycle
• September 16: Supplemental ERAS application submission deadline
• September TBD: Plastic Surgery SF Match applicant registration opens
• September 28: Residency programs begin reviewing applications and MSPEs through ERAS

October – January 2023 | Get Set…

It’s time for interviews! Many residency programs have gone back to in-person interviews, but some still hold them virtually—be sure to check the websites for any programs you’ve applied to for more information.  If it’s a virtual interview, these tips can help make sure you’re ready to ace your virtual interview.

• October 1: Medical schools can begin uploading rising seniors
  • Interviews begin
• October 31 – December 23: Ophthalmology SF Match interviews
• December: Military Match announced
• January 3: Ophthalmology SF Match program rank list submission deadline
• January 20: Ophthalmology SF Match applicant rank list submission deadline
• January 31: NRMP 2023 Match registration deadline (late registration will now incur a $50 fee)
  • Program withdrawal and/or SOAP participation status deadlines

February 2023 | …And GO!

If you’ve registered with the NRMP, now’s the time to submit your Rank Order Lists.

• February: Urology Match announced
• February 1: Rank order list entry opens
  • Medical schools can begin verifying student graduation credentials
  • Ophthalmology SF Match announced

March 2023 | Crossing the Finish Line

It’s the moment you’ve all been waiting for!

• March 1: Rank order list deadline (9pm ET)

Medical school student graduation credential verification deadline

• March 13: Match Week Begins! Get notified that you matched.

SOAP-eligible applicants can send applications to unfilled match programs

• March 17: Match Day! Find out which residency matched to you.

May 2023

• May: Plastic Surgery SF Match announced
• May 31: End of the ERAS 2023 season

Please see this statement from NBOME President and CEO, John R. Gimpel, DO, MEd:

Our hearts are broken over the loss of Stephanie Husen, DO, Preston Phillips, MD, William Love, and Amanda Glenn, and we send our deepest condolences to their families.

The violence in Tulsa compounds what has already been an incredibly difficult time for frontline healthcare workers over the past two years. And yet, we continue our unwavering commitment to caring for patients’ body, mind, and spirit.

The NBOME grieves for those who have been lost, and stands with the communities who have been affected by these tragedies.

Jeremy Weleff, DO, is a fourth-year psychiatry resident at the Cleveland Clinic. During his time there, he has launched many interventions to improve resident wellness. His work in this area has garnered him several awards including the Accreditation Council for Graduate Medical Education David C. Leach Award and the Cleveland Clinic Bruce Hubbard Stewart Award for Humanistic Medicine.

Here, Dr. Weleff shares some of his insights into the importance of mental health and wellness in graduate medical education (GME), how it can be better approached, and how he was able to affect change at his own institution. 

The Maslach Burnout Inventory was published for the first time more than 40 years ago with the goal of measuring and assessing occupational burnout. Yet the struggle continues to effectively address medical student, resident, and physician burnout.

As osteopathic physicians, we know that structure informs function, and we see that playing out in the realm of mental health and burnout in medical education; that is, the current structures are producing undesirable results for our medical students and trainees.

Across the country, GME departments are inheriting medical students with already high levels of burnout (up to 45 percent according to some studies) and are placed in a situation of playing “catch up” to effectively support their trainees.

Thinking structurally about physician wellness means addressing the root causes of these outcomes. In a practical sense, this means each individual training program, each GME, and each employer should be cataloguing and addressing these factors in a deliberate and sustainable way—beyond token gestures and wellness modules. If they cannot, they should become advocates for changes at other levels, such as institutional policies that positively affect workflow, trainee reimbursement, and benefits. Institutions must maintain a fine balance between top-down and bottom-up approaches to resident wellness.

Starting at the top, leadership must be willing to not only accept the current state of their trainees’ mental health, but also to make change through deliberate action. GME leaders must be willing to go beyond the minimum requirements for resident wellness, to set a higher bar and require that their program lead by example. There are many existing frameworks and strategies to do this, but leadership must be willing to create an environment where these activities are encouraged, without putting additional burdens on residents to fix the problem.

From the bottom-up, these initiatives should reflect the culture and needs of that specific institution. At the Cleveland Clinic, we did this by first documenting all current wellness programming available to trainees in GME and within the institution. Enabled by our leadership, a dedicated staff member had created an online app to host these resources.

Out of this came the need to found the Wellness Council, a group of representatives from each training program tasked with coordinating efforts to improve trainee wellness across all of our training programs. We created an anonymous outlet for resident feedback, and that led to swift action on many issues over the pandemic, including ensuring that incoming residents were well supported, and concerns over prioritization of the COVID-19 vaccinations. GME leadership responded promptly and with open communication for action to proceed unhindered.

Our council also created the Interspecialty Mentorship Program as the result of resident orientation going virtual due to the pandemic—there was a fear that residents would feel disconnected from their institution. The mentorship program provided an additional opportunity to foster camaraderie and collaboration among the specialties, to gain a better understanding each department, to bond, and to transcend traditional departmental boundaries.

We were also able to secure a funding stream for grants allowing for reimbursement to residents for wellness-related expenses. This program was funded through GME and provided low-barrier funds to support trainees. Many used it for home fitness, literature, art supplies, and other health and wellness-supporting equipment or supplies.

Moving towards a sustainable structure of medical training and practice means deliberately planning sustainable initiatives that target the factors that influence burnout and wellbeing. The system we have inherited, which seems so unmanageably large and unchangeable, is very clearly mendable – and it is our responsibility to do so.

As of May 10, 2022, candidates who take COMLEX-USA Level 1 will no longer receive a 3-digit numeric score and will receive a pass/fail designation with a formative performance profile. The Level 1 examination’s validity, reliability, and fairness are not impacted.

Misconception: Without a score, I won’t know how I performed in subject areas.

Candidates will be able to access a formative performance profile in addition to their Level 1 pass/fail result. This profile will provide information on a candidate’s performance in the content areas of the COMLEX-USA blueprint (Competency Domains and Clinical Presentations) as compared with the national mean performance of candidates who have taken Level 1 for the first time. This information is provided for the purposes of continuous professional development and lifelong learning for the candidate. We have gathered feedback from student stakeholder groups and undergraduate medical educators who wanted to have this information for professional development; however, this information is not shared with residency program directors or on candidate transcripts.

Myth: COMLEX-USA Level 2-CE numeric scores will be more impactful to residency applications than Level 1 pass/fail designations.

Test scores should be just one component of an osteopathic medical student’s residency application. The NBOME supports holistic review of residency applicants as recommended by The Coalition for Physician Accountability Undergraduate Medical Education-Graduate Medical Education Review Committee. Things like MSPE (“dean’s letters”), letters of recommendation, commitment to specialty, professionalism and ethics, leadership qualities, other professional and research experiences, and performance on audition rotations all are highly regarded by program directors and are important for well-rounded application and holistic evaluation.

Misconception: The difficulty of COMLEX-USA Level 1 will change because of the transition to pass/fail score reporting.

The score required to pass the Level 1 examination will not change with pass/fail score reporting. There have been no changes to the examination blueprint, timing, or score needed to pass.

The passing standard for Level 1 is set through a process called Standard Setting. The Level 1 passing standard has not been changed this year, and is scheduled for review in 2024.

Myth: I don’t need to prepare as much for COMLEX-USA Level 1 because score reporting has transitioned to pass/fail.

COMLEX-USA Level 1 continues to be a high-stakes licensure examination that assesses competency in the foundational biomedical sciences and osteopathic principles necessary for osteopathic medical care of patients. We encourage candidates to ensure preparedness prior to taking the examination by following their COM’s curriculum and guidance, fully engaging in the COM’s curricular program leading to the DO degree. Use of the practice exams provided on the NBOME website, along with WelCOM and COMSAE, may also be useful.

Myth: COMLEX-USA Level 1 score reporting transitioned to pass/fail because USMLE Step 1 score reporting did.

We contemplated this transition for many years and actively participated in review and debate across the house of medicine on holistic review and student and resident wellness and opportunities to improve the system.  We conducted research and a literature review to inform this change and also considered input from various stakeholders–including organizations representing the medical licensure community, undergraduate and medical education organizations, accreditation authorities, and students and residents.

Transitioning Level 1 score reporting to pass/fail was thought by most to be an effective way to reduce student stress, especially during residency application. A study published in Medical Education Online found that performance pressure on examinations was one of the greatest stressors reported by participants. Interestingly, stress levels often peaked during the second year of medical school, which is the year in which Level 1 is typically taken. The study concludes that changing to a pass/fail grading system has demonstrated improvements in student wellbeing, as also shown by other studies.

For any other questions related to pass/fail, please see our list of FAQs, or email clientservices@nbome.org.

May is Mental Health Awareness Month, and for many medical students and residents, their mental health can often take a backseat to the demands of studying, rotations, family, and numerous other obligations; studies have shown that levels of anxiety, burnout, and depression are often higher among medical students than in the general population.

We spoke with Ryan Smith, DO, PhD, MBA, MSEd, who heads the NBOME National Faculty department for psychiatry, neurology and clinical neurosciences, about the importance of wellness and mental health in medical education.

As the clerkship director of psychiatry and an associate clinical professor of psychiatry at PCOM Georgia and PCOM South Georgia, he provided some valuable insight into the resources he uses to guide students at his campuses.

In your roles at PCOM Georgia and South Georgia, and also as associate professor and chief of psychiatry at UNECOM, what has been the most effective method to guide students through the stress of medical education, particularly during a pandemic?

The pandemic has shown us that remote/distance learning has a place in medical education. But it is important to not lose sight, being behind a computer screen, of why you went into osteopathic medicine in the first place: patient care.  Always keep your eye on that prize and work through the numerous modules knowing that the time spent learning foundational basic and clinical sciences will not only pay off on your COMLEX-USA result, but also once you hit the medical floors and start interacting with patients.

What do you think the main barriers are for students in getting help with their mental health?

There is a fair amount of misinformation about the effect mental health has on the ability of medical students, interns, residents, fellows, and attendings to practice medicine.  Some of this was based on older medical practice guidelines. I’ve talked with many students who fear getting psychotherapy or pharmacotherapy out of fear that it may impair their ability to get a medical license. This is just not the case any longer.

Many state medical boards have changed how they ask licensing questions to be more inclusive, and now ask questions such as, “Do you currently have a mental condition which can directly impair your practice of medicine?” versus “Have you ever had a mental health diagnosis?”  This is an effort to encourage all licensees to get the help they need to stave off a worsening mental health diagnosis as it propagates untreated for fear of licensing difficulties.

As a physician who has served on a State Board of Licensure, it is important to know that different states will have different laws and guidance around medical professionals who have mental health difficulties.  By and large, most state boards are in place to protect the public, and simply want to ensure that any mental health difficulty a candidate might have will not directly impede their practice of medicine.

What is some advice you provide to students about managing stress around assessments?

First: you are not alone – we all have experienced stress around assessment.

However, some students and residents may develop a pathologic level of stress which may develop into one of many conditions such as major depressive disorder. We know that it is important to try to rectify the situation as early in its development as possible, so speaking to counseling services, the academic success center, or a director/dean of student affairs or student success at your medical school may be a good first step.

Also, talking to colleagues about how they handle stress can help you see that you are not alone and others are likely in a similar boat as you.  Medications may also be helpful if a diagnosis is made, and not being afraid to be seen by student health or an off-campus mental health professional is essential to prevent the situation from ballooning into something that could be a hindrance further down the line.

What are some resources you would recommend to support mental health and wellness for osteopathic medical students?

AACOM has a Mental Health Awareness Task Force that is very active which I refer students to frequently. And this interview with a DO about mental health helps to de-stigmatize the topic greatly.

In addition, check in with your student government or student affairs office to see what resources may be available.  All osteopathic medical schools, at a minimum, must provide 24-hr access to mental health services as a condition of accreditation.

Also, know that many others before you have been diagnosed with a mental health condition and successfully made it through their medical education program to residency and onto clinical practice.  These diagnoses are nothing to be ashamed of, but they do need to be identified and treated as soon as possible to get you back to your highest level of functioning, so you can excel in medical school, residency, and in clinical practice as an attending.

Without defining ourselves, we run the risk of being defined by others, and the status of distinction we enjoy will devolve to extinction.

The NBOME works to accelerate research focusing on the validity and fairness of the COMLEX-USA series, and how it can evolve to meet the changing needs of the profession. At Educating Leaders 2022, the annual conference of the American Association of Colleges of Osteopathic Medicine, NBOME staff will present on some of this research:

A Validity Study of COMLEX-USA Level 3 with the New Test Design
April 26, 6 pm MDT

This presentation, led by Xia Mao, PhD, director for psychometrics and research, will highlight findings from analyses conducted by the NBOME to support the validity of the COMLEX-USA Level 3 following the format change in September 2018.

COMLEX-USA Level 3  is a two-day computer-based examination with two components; a multiple-choice question (MCQ) component with single best answer and a Clinical Decision-Making (CDM) case component with Extended Multiple-Choice (EMC) questions and Short Answer (SA) questions, the latter being scored by physicians. This study used Kane’s framework to investigate content, reliability, score associations, and subgroup comparisons of the COMLEX-USA Level 3.  Validation of COMLEX-USA Level 3 under the new design is vital to the appropriate interpretation and use of the test scores.

Assessing the Clinical Skills of Osteopathic Medical Students/Graduates without a National Licensing Examination
April 28, 2:15 pm MDT

This presentation, given by John R. Boulet, PhD, senior research consultant; Jeanne M. Sandella, DO, vice president of professional development initiatives and communications; and Amy Lorion, MA, senior director for professional development initiatives, will review the results of the Evidence for Clinical Skills Activities inventory, a survey of current practices at COMs for assessing osteopathic clinical skills. The researchers note that these findings will help the osteopathic profession develop effective, alternate strategies for assessing these critical skills in DO students moving forward.

Defining Professionalism: Lessons learned from COMLEX-USA Level 2-PE
April 28, 1:45 pm MDT

This session will be led by Sandella and Lorion and developed with contributions of Anthony Errichetti PhD, international expert in physician-patient communication and former director for doctor-patient communication for the NBOME. They will discuss lessons learned during the 17-year history of the COMLEX-USA Level 2-PE in evaluating professionalism. Through a recreated video, this session aims to give participants a better understanding of how to identify observable behaviors related to professionalism competency.

Assessment Matters: NBOME Update
April 29, 9:45 am MDT

NBOME President and CEO John R. Gimpel, DO, MEd and NBOME Board Chair Richard J. LaBaere II, DO, MPH will provide updates on several developments at the organization, including the transition to pass/fail score reporting for COMLEX-USA Level 1; the progress of the Special Commission on Osteopathic Medical Licensure Assessment; the transition to Pearson administration of the COMLEX-USA series; and much more.

We encourage you to attend these sessions, or view them virtually, during EL 2022. For more information, visit: aacom.org/educatingleaders2022.

An RPD provides advice to fourth-years awaiting residency

By now, most DO students have learned where they will be going for their residencies, and have just a few weeks left until graduation. They have just a few weeks more until they begin the next phase of their careers.

What should osteopathic medical students do during this time to prepare for July 1?

Heather Sankey, MD, MEd, Ronald T. Burkman Endowed Chair and interim ob-gyn residency program director at UMass Chan Medical School—Baystate, says first and foremost, take some time for yourself and enjoy the achievement of graduating from osteopathic medical school and matching to a residency.

“It’s good to take a little time off to refresh and have fun,” she says.

As residency draws near, Sankey says students should brush up on their basic skills, such as knot-tying, catch up on the latest readings in their specialty (for example, from the American College of Osteopathic Obstetricians if one is going into ob/gyn), take a skills course for residency (if one is available), and get all of their training, prep, and paperwork done early.

She also says to consider things like finding resources for pet care, getting preventive health checkups, and working on a plan to fit in exercise and healthy eating.

“These students are about to transition into a profession with huge responsibilities for patient lives that will be very intense for 4 years,” she says. “They need to get ready.”

Tactics such as these will help DO students hit the ground running when they begin their residencies.

Once DOs begin their residencies, the NBOME recommends waiting at least six months to take Level 3. For more information, visit https://www.nbome.org/assessments/comlex-usa/comlex-usa-level-3/.

The NBOME and Rowan University School of Osteopathic Medicine (RowanSOM) recently partnered to develop 30 multiple-choice questions assessing substance use disorder for the COMLEX-USA examination series. This event is part of the Expansion of Osteopathic Medicine Practitioner Education on Substance Use Disorders, a grant administered through the Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA).

To fulfill the grant, NBOME National Faculty members at RowanSOM, including Philip Collins, DO, Suzanna Hosein, DO, MS, Joanna Petrides, PsyD, and Alexander Kowalski, DO, met with NBOME staff for virtual item-writing workshops focused on substance use disorder. These productive sessions included individual and group item writing and review.

We recently spoke with Kowalski and Petrides about the experience.

Q: Why do you think substance use is critical to assess in COMLEX-USA?

A Joanna Petrides (JP): Substance use has traditionally been a touchy topic in the medical setting with either the provider being uncomfortable bringing it up, the patient being uncomfortable, or both. As more evidence presents in addressing the needs of patients seeking support towards sobriety, it is obvious that a strong source of support comes from the relationships patients have with their healthcare providers.

Q: Why did you want to partner with the NBOME on this grant?

A (JP): We wanted to incorporate item writing as part of our grant work because we knew substance use is and will continue to be a focus in providing effective primary care to patients, and assessing learner knowledge is important to being clinically effective with patients. Partnering with NBOME was a great step in allowing us to reach learners and prepare them for the future of medical practice.

Q: Anything else you would like to share about this process?

A Alexander Kowalski (AK): Having attended in-person item writing in the past, I was amazed at how smoothly it transitioned to the virtual setting. The team from NBOME was great to work with, and we are all so proud of how this project turned out!

For more information on partnering with the NBOME on item writing, please reach out to nationalfaculty@nbome.org.

We’re so DO Proud of the more than 7,049 DO seniors and graduates matched into PGY-1 positions in this year’s National Resident Matching Program Main Match.

The NBOME applauds the extraordinary success of DO seniors who achieved a 91.3% match rate – a 2.2 percent increase over 2021 and the highest NRMP match rate on record.

Congratulations to all who matched and best wishes for continued success on the Road to DO Licensure!

7,049 of DO seniors/grads matched

339 more DO seniors matched than 2021; a 5.4% increase

87% increase of total DO match over the last 5 years

Largest DO senior Match increases by specialty:

• Internal Medicine (+120)
• Pediatrics (+61)
• Psychiatry (+55)
• Family Medicine (+54)
• Transitional (+36)

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In the February edition of the Journal of Graduate Medical Education, we published an article showing concordance between scores for USMLE and COMLEX-USA.

To help students make rational test-taking decisions, it is important for those who are advising DO students to be able to interpret the results of the study.

Most residency programs understand that COMLEX-USA and USMLE are administered to make licensure decisions and that DOs take COMLEX-USA and MDs take USMLE. Although the scores for these examinations were never meant to guide residency selection, there are ways for programs to compare exam performance for MD and DO applicants for use in holistic review of applicants. This study was designed to give program directors another way to understand COMLEX-USA scores.

Let’s say a program director is not very familiar with DO applicants, but they know that the average USMLE Step 2 score for residents previously accepted into their program was between 210 and 230. In their holistic review of all applicants, they can look at the Concordance Table and see, with some degree of error, what that score range would look like for COMLEX-USA.

While the COMLEX-USA and USMLE series measure overlapping constructs, the concorded scores provide some “ballpark estimates” of how DO candidates would perform on USMLE.  It should be noted, however, that DOs are required to take COMLEX-USA, and their scores reflect their performance on examinations that were specifically designed for the assessment of their competencies for osteopathic medical practice. As such, the concorded scores, and any associated pass/fail inferences, are not perfect.

Here is a run-down of some of the myths we’ve seen, and the corresponding truth:

MYTH 1:  The fact that a COMLEX-USA score goes up when a USMLE score goes up means that the examinations are interchangeable.

It has been argued that both examinations are not necessary because concordance means similarity, therefore redundancy. There are a number of problems with this. First, the content of the examinations is not the same. While Level 1 and Step 1 measure overlapping constructs, as do Level 2 and Step 2, they are not the same assessments.  Blueprints for USMLE and COMLEX-USA both include the content and competencies as taught and required in the curricular programs leading to the separate degree programs, DO and MD.

To protect the public, licensing boards want to assure that physicians, whether DO or MD, have demonstrated competencies necessary for safe practice in their respective professions. Similarly, patients want to know that DOs have demonstrated competencies for practice as DOs. This would be the same expectation for MDs to practice as MDs, for podiatrists to practice podiatric medicine, or for optometrists to practice optometry.

Second, one could argue that any measure of application of knowledge and related competencies will show a positive correlation – good test-takers tend to perform well on tests.  This does not mean that COMLEX-USA and USMLE are interchangeable. It just means that they measure overlapping constructs.

MYTH 2: The Pass/Fail standards do not align in this table, so USMLE is a more “rigorous” test.

The purpose of the study was to develop more accurate concordance tables, not to predict USMLE Step Pass or Fail status from COMLEX-USA scores.  Given that the passing rates on COMLEX-USA and USMLE are quite high (most candidates score well above the cut-scores), predicting passing status on Step 1 from Level 1 (or Step 2 from Level 2) is error-prone, and not appropriate.

COMLEX-USA is designed for licensure for osteopathic medical students and graduates. Passing Level 1 and 2 indicates that they have demonstrated the competencies needed for licensure and  ntry into supervised residency practice at accredited GME programs. Standards are set with reference to the expected performance and competence of the candidates who are eligible to take the respective examinations.

Osteopathic medical students are not meant to take USMLE – it was never designed for them. USMLE was introduced in the early 1990s to take the place of the three previous MD licensing exams (NBME, FLEX, FMGEMs) used for MD students from US-LCME-accredited medical schools and IMGs. It is not surprising that DOs perform differently than MD students on USMLE Step 1 and Step 2. We might expect the same if MD students took COMLEX-USA.

From the concordance analyses, the passing standards from COMLEX-USA and USMLE do not map 1:1.  Given that: 1.) the concordance analyses were based on a sample of osteopathic students, 2.) the exams measure different but overlapping constructs, 3.) the standard-setting procedures for COMLEX-USA and USMLE differ, and 4.) there is no data for US MD students taking COMLEX-USA, this is not surprising. With this in mind, it makes sense that DO students perform better on examinations such as COMLEX-USA that are specifically constructed to measure their competencies required for osteopathic medical education and practice. More important, one must acknowledge that any concorded score is not a perfect predicted measure of performance on the other examination, including those at or near the respective pass/fail cut-points.

MYTH 3: This data will make DO students feel they have to take USMLE.

While we can’t predict what would make a DO applicant feel more competitive as a GME candidate, let’s talk about why they shouldn’t feel they have to take USMLE in the first place. We need to do a better job informing program directors about the way DOs are educated and trained, including what COMLEX-USA scores mean, to help collectively foster inclusion and reduce bias. This is why relying on USMLE performance for osteopathic graduates is not consistent with holistic review and not appropriate.

Similarly, to further promote a more holistic selection process, the reliance on real (or mapped) USMLE scores for DOs and MDs should wane. A passing performance on COMLEX-USA Level 1 and 2 indicates that the applicant is competent in the foundational biomedical and clinical sciences necessary for licensure at the level of entry into supervised GME training.

The results from the concordance study will allow program directors to determine a more accurate “predicted” USMLE score for those DO applicants who did not take USMLE. There have been numerous concordance studies published with the exact same purpose. The reliance on USMLE should decrease with the transition to Pass/Fail for Step 1 and Level 1, but only if DO advocates, faculty, advisors, and learners also stand up for the profession, its learners, and its distinct educational pathway to help to make that happen.

Noted author and psychologist Adam Grant wrote recently, “The simplest way to be a good friend is to be a loyal fan.  You root for their happiness like you rooted for Jim & Pam, Arya Stark, or Harrry, Hermione, & Ron.  You cheer for their success like you cheer for your favorite sports team. And you keep showing up.”

In the single GME era, with a better understanding of osteopathic medicine and the qualifications of  DO graduates, most residency program directors have already changed their selection practices and have been more inclusive of DO applicants, using more holistic review processes. As a result, the DO match rates for residency and fellowship programs have been very strong since the first uniform NRMP Match in 2020.

MYTH 4: The results of this study won’t change program requirements so I should advise DO students to take USMLE.

As advocates for our students and our profession, we need to continue to fight for the equality of DO applicants in residency and fellowship selection. The perceived need to take USMLE creates additional stress for DO students, both financial and emotional, and–to be fair–should not weigh heavily in any selection decisions. The increasing acceptance of DOs in residencies and fellowships across the US, combined with the transition to Pass/Fail for both USMLE Step 1 and COMLEX-USA Level 1, should reduce the notion that DO students must take Step 1 moving forward.

Some advisors at the COMs have told us that a passing performance on Step 1 will help some DOs in certain instances in the selection process. This opinion ignores the fact that passing performance on Level 1 provides the same screening information for program directors who use licensing exams to determine readiness to enter a GME program. COMLEX-USA is the tool to assess competencies for a DO. This is the message that needs to get out, and we are hopeful that COM advisors and faculty can help us to do that.

While licensure examinations and their associated scores will likely continue to be used as a part of the residency application process, particularly in more competitive specialties, the current debate around whether DO applicants can be fairly considered with their COMLEX-USA scores provides an opportunity to develop a more holistic–and arguably fairer–review process for residency applications.

Our profession must come together to address biases against DOs in GME to foster more equity and inclusion. We should take pride in the fact that we provide a distinctive, interconnected “body, mind, and spirit” approach to partner with patients to restore and maintain their health.  When we do, it will benefit not only applicants and residency programs but perhaps most importantly, the patients we have the privilege to serve.

The osteopathic profession has been an advocate of female physicians ever since its founding in 1892 when Andrew Taylor Still admitted six women into the first class of his new medical school. Today, women make up nearly half of all DOs in active practice and constitute a majority of first-year osteopathic medical students.

This Women’s History Month, we’re highlighting the work and contributions of Geraldine O’Shea, DO, the NBOME’s immediate-past Board chair, who has been a leading voice in the osteopathic profession for more than 20 years.

Her path to leadership began as a student at the College of Osteopathic Medicine of the Pacific. While editor of the school’s magazine, The Student DO, then-Dean Donald Krpan, DO, recognized her as a leader immediately.

“He invited me to meetings of the Osteopathic Physicians and Surgeons of California (OPSC), to AOA House of Delegate meetings,” she said. “He saw potential in me and wanted me to experience all these things. And once you get a taste of the AOA, you’re hooked.”

Indeed, O’Shea—who also runs the Foothills Women’s Medical Center in Jackson, Calif.,–has served the AOA in numerous capacities, including as a trustee, as chair of its Strategic Planning Committee, and as vice-chair of its Bureau on Federal Health Programs and Council of Women’s Health Issues.

She has also served the profession as president of the Osteopathic Medical Board of California, the American Association of Osteopathic Examiners, the Federation of State Medical Boards, and the OPSC.

“Being a good leader means being a sponge,” she said. “Meet and listen to interesting people who are willing to stand for what they believe in—it’s a rising tide that carries all boats.”

Most recently, she completed her two-year term as the NBOME Board chair, appointed just a few months before COVID-19 took hold of the world.

“The hardest part of leading at that time was the shifting sands,” she said. “Easy decisions were scarce. We shared the information we could with our COMs, tried to support students through an incredibly stressful time, and looked at the safety of our community through every possible lens.”

O’Shea notes that her work at the helm of the Board would not have been possible without those around her.

“The NBOME brings in the best people,” she said. “Those who are so willing to be distinctive and different, and happy to bring that subset of talents into the mix. Richard LaBaere, who’s now the current Board chair, was a great resource for me.”

Even though the percentage of women practicing osteopathic medicine continues to grow, O’Shea hopes to see even more in positions of leadership. For those considering a leading role in their careers, she offers this advice:

“Listen first and speak second. Get a good mentor. And finally, be proud of who you are. As women and as osteopathic physicians, we are in a unique position to be nimble enough to make change—and change always comes from the minority. You have a unique skill set you’ve honed over the years—use it to go as far and as high as you want.”

The last year of medical school is an exciting time, and even more so with the National Resident Matching Program (NRMP) Match Week right around the corner. Residency training will determine where you live and work for the next few years (and maybe longer), and also gives you the chance to practice in your dream specialty. But, while a majority of applicants place to their first or second program of choice, a small number may not.

First thing’s first – there is life after Match. In 2021, 50 percent of the 964 DO seniors who applied to the Supplemental Offer and Acceptance Program (SOAP) placed into residency programs, performing better than MDs (40 percent) and IMGs (3 percent).

Being successful in SOAP means planning ahead. We spoke with Director of Medical Student Success, Melva Landrum at the Texas College of Osteopathic Medicine, about the importance of planning for SOAP, and she shared her advice for developing a plan with your COM’s career office to prepare for that (small) possibility.

“If you’re looking to Match for 2022,” she says, “it’s important to be optimistic as well as realistic.” With your COM advisor, you can weigh the number of interviews obtained and programs ranked against the competitiveness of your desired specialty. If an applicant focused on only one specialty and only landed a few interviews, it may be helpful to have a SOAP strategy in place, just in case.

Landrum emphasizes that not every specialty will have available positions in SOAP, and frank consideration should be given to the most reachable specialties available via SOAP, especially for those candidates who had a strong application, but applied to a highly competitive specialty.

When preparing your SOAP strategy, remember to use the resources available to you:

• Take full advantage of the career advising resources at your COM
• Have a mentor review your application for areas that could be strengthened
• Review the American Association of Colleges of Osteopathic Medicine’s information on preparing for SOAP and beyond

If you’re eligible to participate in SOAP, you can access the List of Unfilled Programs in the NRMP R3 system starting Monday, March 14 at 9am ET. SOAP deadlines and offers take place on Thursday, March 17 prior to Match Day (see the full SOAP schedule for details). There are now four SOAP rounds available, created in response to an increased number of unfilled positions in recent years. During the process, contacting the SOAP programs or looking for other, external positions outside of SOAP is prohibited. Additional resources about the SOAP process can be found on the NRMP’s website.

If you are not able to find a placement through SOAP, Landrum recommends prioritizing positions in a clinical setting or obtaining additional education in the form of a research position or an additional degree or certification that aligns with your career goals. Unmatched DO graduates may also consider applying to take COMLEX-USA Level 3 under the alternate pathway attestation, which permits candidates to obtain eligibility with endorsement by their COM dean.

Most importantly, never lose sight of the fact that there are many paths which lead to success. In 2021, AACOM reported that the total post-Match Week placement rate for DO seniors was 99 percent, so your chance of finding a residency placement is extremely high. Take the opportunity now to consult with your COM advisor and develop a strategy that will allow you to face any obstacle on the Road to DO Licensure.

Maya Johnson has been the head of the NBOME’s HR department for over 8 years. This year, her role expanded; as of January 1, Johnson became the organization’s first-ever Chief Diversity Officer. Here, we speak to her about her new role and her plans for highlighting and strengthening the NBOME’s commitment to diversity, equity, and inclusion (DE&I).

When did conversations first begin about diversity efforts at the NBOME?
The NBOME has always supported diversity whether that is from a racial or ethnic standpoint, a gender standpoint, or a professional standpoint (such as DOs and MDs working together). But the events of summer 2020 really highlighted the fact that we as a society have much more work to do, and we have to be deliberate about that work. That’s when we as an organization gained momentum towards more tangible action.

We began by putting together small workgroups, facilitated by the HR department, to better understand the types of ideas, questions, and training needs staff have about cultivating an inclusive work environment.

That feedback was immensely helpful to us in planning several programs over the past two years that focus on the stories and perspectives of the different groups represented at the NBOME. For example, in 2021 we introduced our MLK Day of Reflection program to dedicate the workday to social awareness and personal reflection in honor of Dr. King’s legacy and hosted our first Juneteenth celebration to learn more about its history and traditions.  In response to “Stop AAPI Hate” efforts, we held employee group sessions to share experiences and show our support to each other.  We also promoted awareness of June as Pride Month, when the world’s LGBTQ communities come together and celebrate the freedom to be themselves.

The NBOME embarked on several organizational enhancements over the past year, and as this work continued, we saw a clear need emerging to have a formalized role helming this work at the senior leadership level.

Why put DE&I efforts under the purview of HR?
Through responsibilities such as EEO compliance, Title VII adherence, and others, HR already has a strong foundation to support those efforts. It’s something that is always top of mind for us, and our past work can translate over to our staff at large.

Do you have an idea of where you’d like to take the NBOME’s DE&I efforts?
Moving forward, we’ll be formalizing a DE&I Task Force structure to identify opportunities, further develop programs and outline specific deliverables in order to ensure our reach extends to our National Faculty, governance, and committee members.

Organizationally, our core values are being expanded to include a value statement solidifying our commitment to DE&I, and we have formed various workgroups across the organization that are implementing related initiatives.

Specific to HR, we are improving our processes related to employees’ abilities to self-identify personal demographic information. From a recruitment aspect, our talent sourcing strategy continues to evolve as we incorporate the use of new job posting sources and methods to widen our talent pool reach. We are also evaluating our benefit programs with our vendors to ensure we have a focus on relevancy and fair and equitable benefits offerings.

How do these DE&I efforts translate to our assessment products and services?
Our test development teams have gained a lot of momentum over the past several months in this area, working to ensure they are following best practices related to representation in test development. This is a part of the charge to the Special Commission on Osteopathic Medical Licensure Assessment. These efforts include evaluating test content for potential bias and expanding sources of test media in our assessments.

How do you feel being the organization’s very first chief diversity officer?

It is such an exciting opportunity to have a lead role in the ongoing development of our organizational DEI efforts. The NBOME has made great strides over the years to continue to be progressive in how we positively impact our staff, stakeholders, candidates, and the public in general.  The creation of a formal diversity-focused role is another demonstration of just how important these efforts are to the NBOME.

To learn more about NBOME’s DE&I efforts, or to suggest a program or topic, email MJohnson@nbome.org.

Many DO students report feeling compelled to take the USMLE exam series in addition to their required COMLEX-USA exams, which can result in an unnecessary expense of time, resources, and money on their part; taking the USMLE in addition to COMLEX-USA results in more than $5 million spent by DO students annually, despite the fact that COMLEX-USA is accepted—and in some cases, required—for DO licensure in all 50 states and in several international jurisdictions.

The reasons for this are myriad; DO students may be advised that they must take the USMLE to remain competitive; well-meaning individuals may share old, outdated, biased and/or incorrect information about COMLEX-USA; or DO students may be assessed on residency applications based on USMLE requirements that are not applicable to them.

For its part, the NBOME continues to publish research on the validity and fairness of the COMLEX-USA exam series, as well as on comparisons of COMLEX-USA performance to that of assessments such as the USMLE.

In a newly published paper in the ACGME’s Journal of Graduate Medical Education February 2022 edition, NBOME researchers analyzed the relationship of the scores of more than 3,500 DO students from five colleges of osteopathic medicine across the US who took USMLE Step 1 and Step 2-CE in addition to COMLEX-USA Level 1 and Level 2-CE.

The findings in the manuscript resulted in the development of the COMLEX-USA/USMLE Concordance Table, aimed providing an evidence-based tool for residency program directors and others in the GME sphere to provide some context to COMLEX-USA scores and better estimate a USMLE score (if desirable) based off of a provided COMLEX-USA Level 1 and/or Level 2-CE score.

Other tools available to assist in this effort include the NBOME Percentile Score Converter and the Residency Program Director Toolbox.

The NBOME continues to advocate for parity among DO students and physicians as they continue on their professional journeys, and promotes greater understanding of the COMLEX-USA credential. Recent examples include an article in the DO and the NBOME’s work with groups like the Coalition for Physician Accountability and its Undergraduate Medical Education to Graduation Medical Education Transition Review Committee.

“The NBOME has always advocated for and supported the holistic review of applicants, and encourages residency program directors to evaluate applicants based on consideration of applicants’ unique experiences, attributes, and competencies, without any disproportionate weighting of any one factor,” said John R. Gimpel, DO, MEd, president and CEO of the NBOME.

”However, so long these licensure exams are used as part of the residency application process,” he added, “a simple score concordance tool may help bring greater understanding of COMLEX-USA to GME personnel, and a broader understanding of the importance of a fair, equitable, and more holistic review of osteopathic medical students applying to residency programs.”

The National Resident Matching Program (NRMP) released the results of the 2021 Pediatric Specialties Match (PSM), for positions that will begin in 2022. The 2021 PSM once again surpassed the prior year to become the largest in history. For DOs, that meant an 81 percent match rate this year. Significant gains included a 24 percent increase in the number of active applicants and a 22 percent increase in the number of DOs that matched over 2020.

More information on the breakdown of DO performance can be found in the accompanying infographic.

The NRMP Results and Data Specialties Matching Service 2022 Appointment Year report will be released in February 2022 and will provide full details for all fellowship matches.

Visit the Navigating GME page to learn how the NBOME can help DOs navigate GME on the Road to DO Licensure.

PHILADELPHIA, PA—The National Board of Osteopathic Medical Examiners (NBOME), an independent, not-for-profit organization that provides competency assessments for osteopathic medical licensure and related health care professions, is proud to announce the following appointments to its National Faculty Chair positions for 2022:

 
National Faculty Clinical Department Chair – Internal Medicine, Geriatric Medicine, & Dermatology
Angela C. Cavanna, DO – Touro College of Osteopathic Medicine-Middletown

 
National Faculty Department of Foundational Biomedical Sciences Division Chair – Microbiology/Immunology
Balbina J. Plotkin, MEd, PhD – Chicago College of Osteopathic Medicine of Midwestern University

 
National Faculty Examination Chair – COMLEX-USA Level 2-CE
Wayne R. Carlsen, DO – Ohio University Heritage College of Osteopathic Medicine-Athens

Carlsen begins this position as he vacates his previous leadership position, as National Faculty Clinical Department Chair – Internal Medicine, Geriatric Medicine, & Dermatology.

“We welcome these new leaders, who represent subject matter experts from across disciplines and across the country, to help guide the NBOME and its assessments into the future,” said John R. Gimpel, president and CEO of the NBOME.

The NBOME, its staff, its Board of Directors, Board Chair Richard J. LaBaere II, DO, MPH, and Gimpel also extend appreciation to the outgoing National Faculty Chairs whose terms ended on December 31, 2021.

 

 
National Faculty Examination Chair – COMLEX-USA Level 2-CE
Charles A. Finch Jr., DO – Arizona College of Osteopathic Medicine of Midwestern University

 
National Faculty Department of Foundational Biomedical Sciences Division Chair – Microbiology/Immunology
Peter G. Gulick, DO – Michigan State University College of Osteopathic Medicine

 
National Faculty Examination Chair – COMLEX-USA Level 2-PE
David Kuo, DO – Philadelphia College of Osteopathic Medicine

Kuo concluded his tenure as Examination Chair – COMLEX-USA Level 2-PE in June 2021 and continues to serve the NBOME as a co-vice-chair of the Special Commission on Osteopathic Medical Licensure Assessment.

“The longstanding service and dedication of these individuals, who volunteer their time freely, ensure the quality, validity, and fairness of our test items, cases, and rationales,” said Gimpel. “We are so grateful for their contributions.” Visit the National Faculty page to learn more about members of the National Faculty and their integral role at the NBOME.

PHILADELPHIA, PA—The National Board of Osteopathic Medical Examiners (NBOME), an independent, not-for-profit organization that provides competency assessments for osteopathic medical licensure and related health care professions, is pleased to recognize the 2021 Item Writer and Case Author of the Year award winners from its distinguished National Faculty. Throughout the year, this group of individuals graciously volunteered their time and expertise to contribute to the COMLEX-USA and COMAT examination programs.

Each year, the NBOME selects the best-in-class item writers and case authors from a large group of contributors whose work supports our mission to protect the public through osteopathic competency assessment. Congratulations to these esteemed awardees for their exemplary commitment to producing valid and high-quality exam content.

COMLEX-USA Level 1 Item Writer of the Year
Kristie Grove Bridges, PhD

Dr. Bridges is a professor and chair of the biomedical sciences department at the West Virginia School of Osteopathic Medicine. She has been a member of the National Faculty since 2014 and has contributed considerable time to the COMLEX-USA Level 1 examination.

COMLEX-USA Level 2-CE Item Writer of the Year
Megan Thomas, DO

Dr. Thomas is an internist and pediatrician at the Community Health Center of the New River Valley, a FQHC in Christiansburg, Va. She also supervises residents in the Internal Medicine Continuity Clinic at LewisGale Hospital Montgomery in Blacksburg, Va. She has been a contributor across COMLEX-USA as well as the Point-of-Care Knowledge, Education, and Testing (POCKET) workgroup.

COMLEX-USA Level 3 Item Writer of the Year
Helga V. Toriello, PhD

Dr. Toriello is a professor at the Michigan State University College of Human Medicine with a specialty in genetics. She has been a member of the National Faculty for eight years and has invested a considerable amount of time into the COMLEX-USA Level 3 examination.

Clinical Decision-Making (CDM) Case Writer of the Year
Brett S. Stecker, DO

Dr. Stecker is a primary care physician with the Steward Medical Group in Raynham, Massachusetts. He has been involved with the COMLEX-USA Level 3 for six years, serving on the Clinical Decision Making Subcommittee as well as Vice Chair of the COMLEX-USA Level 3 Advisory Committee.

Osteopathic Principles and Practice (OPP) Item Writer of the Year
Catherine M. Fusco, DO

Dr. Fusco is a board-certified family medicine and osteopathic neuromusculoskeletal medicine physician at Suburban Community Hospital’s Medical Group in Norristown, Pa., and is a clinical faculty member in the Osteopathic Manipulative Medicine department at Philadelphia College of Osteopathic Medicine. She previously assisted with osteopathic manipulative treatment standard setting for the COMLEX-USA Level 2-PE.

Preventive Medicine and Health Promotion (PHMP) Item Writer of the Year:
Jason T. Eberl, PhD

Dr. Eberl is a professor of health care ethics and philosophy and the director of the Albert Gnaegi Center for Health Care Ethic at Saint Louis University. He has contributed to the NBOME since 2015, assisting with standard setting for the humanistic domain of the COMLEX-USA Level 2-PE.

COMAT Clinical Item Writer of the Year
Rita Malhotra, DO

Dr. Malhotra is a physician actively practicing medicine and surgery, founder of the national telemedicine platform DrRitaM.com, and an instructor at New York Institute of Technology College of Osteopathic Medicine-Old Westbury. She is a significant contributor to COMAT Clinical and is the first surgeon to receive this award.

COMAT Foundational Biomedical Sciences Item Writer of the Year
Amber Eade, PhD

Dr. Eade is an assistant professor of biology at Slippery Rock University. She has been involved with the NBOME since 2013, serving as an examination contributor for COMLEX-USA Level 1 and 2-CE and COMAT FBS, participating in activities from item writing to item and blueprint review.

On December 1, the National Resident Matching Program® (NRMP) Medicine Specialties Matching Program (MSMP), the NRMP’s largest Fellowship Match comprised primarily of Internal Medicine subspecialties, released results for medicine fellowship positions that begin in July 2022.

This year’s MSMP Match was the largest on record, with 7,435 active applicants. The match showed that more DOs are going into medical subspecialties than ever before; the number of active DO graduate applicants increased more than 21 percent over last year for a total of 1,040—the largest growth among applicant types.

Learn more about how DOs performed in the MSMP in the infographic on the right.

Read the full 2021 MSMP Match Results Statistics Report on the NRMP website for additional findings and key data on Internal Medicine fellowship appointments.

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We dive into his experience taking COMLEX, and share his advice on how to address challenges—and how to grow and prosper from them—on the Road to DO Licensure.

 

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How did you prepare for COMLEX, and what advice do you have for others about to take the exam?

For Level 1, I started by picking out resources to use. I booked out my schedule per blocks and listed what subject each block would cover. For example, 8 AM to 9 AM would be 1-2 chapters in pathology, 9 AM to 11 AM would be 100 practice questions, 11 AM to 12 PM was question review for those I got wrong, etc. I also added a full-length practice exam at the beginning, middle, and end of dedicated. I don’t really like taking breaks every hour on the hour and instead held them over for longer breaks at points in the day. I was done studying by 9 PM every night and in bed by 10 PM, with one day off a week for rest. This was a very efficient system—until I deviated from it.

It was a few weeks into board prep, and I was not seeing my score really climb on practice tests. I started feeling overwhelmed and critical of myself. This led me to cut more breaks and I stopped taking my one day off a week. There came a time when waking up day-in-and-day-out to sit behind a screen started to really take a toll on my mental health and my ability to engage with the study material. My scores started to decrease, my mental health quickly tanked, and soon I realized I couldn’t keep that up. I went back to following my original schedule, reached out to loved ones for support, and when necessary, took impromptu time off when I really didn’t think I could keep going. My mental health started to improve, and scores started to increase, at first small jumps, and then later into dedicated, large jumps. I guess a lesson of what not to do and the importance of trusting the process.

First, as I’ve outlined from my lessons learned—have faith in the process and your plan. Create a dedicated study schedule as detailed as you can and include within the schedule regular breaks and additional open blocks where you can either catch up on study material or take additional needed time off. Usually, this schedule can be made over 6 weeks but varies from person to person. Even then, most schedules have a lot to fit into one day. Combat overwhelming your schedule by using as few trusted study resources as possible and to be generous when mapping out time for each block of material. Finally, be kind to yourself and give grace through the growth process. Do not allow scores to determine your self-worth or how you see yourself as a student. Especially when taking a practice test in the beginning of your dedicated block. Try your best to shake off the bad and celebrate every piece of the good.

What are some challenges you faced, and how did you overcome them?

Like many med students, I tend to keep working until my fumes are out. I think what it comes down to is identifying when you need downtime—or when you need additional resources and assistance and then acting on that. For example, I often check in with my loved ones. They help me gauge where I’m at. Pulling on support structures helped to remind me that I wasn’t taking on the challenge of dedicated alone—I had people in my corner. I have also sought school-provided resources for support as well. It’s okay to break away from a routine that is not serving you well and it’s okay to admit when you’re not okay and need help.

What are you looking forward to the most in the next stage of your journey?

I am pursuing internal medicine and looking forward to taking care of patients, but also advocating for patients. I believe my interests in care for patient populations, advocacy, and non-profit involvement are reflective of my time growing up in a small Southern town. My childhood instilled in me an ongoing love for Southern communities and respect for the barriers those communities overcome. Some of those barriers are caused by undertones that remained in the wake of years of slow progression in the sphere of civic policy.

As an LPN, I saw first-hand how those undertones and barriers could aid in poor outcomes for underserved patient populations. I wanted to do something about that. I wanted to help change the environment for communities like the one I grew up in. That desire followed me to medical school and has steered my involvement ever since. I look forward to matching into a residency that will help further build my skills as both a physician and advocate for underserved patient populations; I want to improve lives for those in communities similar to the one I grew up in.

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PHILADELPHIA, PA—The National Board of Osteopathic Medical Examiners (NBOME), an independent, not-for-profit organization that provides competency assessments for osteopathic medical licensure and related health care professions, honored J. Michael Wieting, DO, MEd, with the 2021 NBOME Clark Award for Patient Advocacy at its annual Board of Directors Meeting on December 11.

The Clark Award recognizes those who have demonstrated outstanding commitment to patient safety, patient protection, and quality of care.

Wieting currently serves on the Special Commission on Osteopathic Medical Licensure Assessment for the NBOME and is a member of the NBOME National Faculty, serving on the Test Accommodations and Liaison Committees as well as the COMAT FBS Body Systems Task Force.

He has served the osteopathic profession in numerous capacities, including in many positions with the American Association of Osteopathic Examiners, of which he is the immediate past president, the Advocates for the American Osteopathic Association, the American Osteopathic Association, and the Federation of State Medical Boards—among many others.
Wieting is currently senior associate dean at Lincoln Memorial University – DeBusk College of Osteopathic Medicine in Harrogate, Tenn. and has been a dedicated educator and advocate for both patients and for the osteopathic profession for more than 30 years.

“Michael has been an incredible advocate for patient care and for the osteopathic profession throughout his career, which makes him the ideal recipient of this award,” said John R. Gimpel, DO, MEd, president and CEO of the NBOME.

Wieting received his osteopathic medicine degree from the Oklahoma State University – College of Osteopathic Medicine and his master’s in education from Central State University in Edmund, Okla.

PHILADELPHIA, PA—The National Board of Osteopathic Medical Examiners (NBOME), an independent, not-for-profit organization that provides competency assessments for osteopathic medical licensure and related health care professions, honored Ronald R. Burns, DO, MS, with the NBOME Santucci Award at its recent Board of Directors meeting.

The Santucci Award is the highest honor the NBOME bestows, given to members of its Board, staff, or committees for outstanding contributions to the mission of the NBOME and requires a minimum of ten years of service to the organization.

Dr. Burns served for nine years on the NBOME Board, where he was nominated via the American Osteopathic Association (AOA) Board of Trustees. On the Board, Dr. Burns served in numerous leadership roles, including as chair of the Nominating Committee and Board representative on the Level 3 Advisory Committee.

Dr. Burns served as president of the AOA from 2019-2020 and has served on the AOA Board of Trustees since 2007. He has also been active with the Florida Board of Osteopathic Medicine (FOMA) for more than three decades and served as president of the organization from 2004-2005.

In 2002, FOMA named Dr. Burns Physician of the Year, and in 2007 the organization presented him with a Distinguished Service Award. Ohio University awarded Burns the Alumni Medal of Merit in 2018. He and his wife, Janet, maintain a family medicine practice in Orlando, Fla.

“Ron has been an invaluable resource to the NBOME, and we have benefitted greatly from his professionalism and his years of experience in licensure, governmental affairs, and professional advocacy,” said John R. Gimpel, DO, MEd, president and CEO of the NBOME.

Burns received his osteopathic medical degree from the Ohio University Heritage College of Osteopathic Medicine in Athens, Ohio.

PHILADELPHIA, PA—The National Board of Osteopathic Medical Examiners (NBOME), an independent, not-for-profit organization that provides competency assessments for osteopathic medical licensure and related health care professions, is proud to announce the following updates to our Board membership and leadership:

The NBOME Elects New Board Officers

The following officers have been elected to serve the Board for two-year terms:

Chair – Richard J. LaBaere II, DO, MPH, Ortonville, Mich.

An osteopathic family physician, LaBaere previously served as Board vice-chair and also serves the NBOME as chair of the COMLEX-USA Composite Examination Committee and the Special Commission on Osteopathic Medical Licensure Assessment. He is the associate dean for graduate medical education at A.T. Still University–Kirksville College of Osteopathic Medicine in Kirksville, Mo., where he also provides leadership to the National Center for Osteopathic Principles and Practice Education.

LaBaere has served as regional assistant dean for the Michigan region at Ascension Genesys in Grand Blanc, Mich., where he began his career in 1993 in private practice and graduate medical education. For nearly 30 years, he has served in various medical training and educational roles such as family medicine residency program director, director of medical education, and as the designated institutional official for Still OPTI, an accredited sponsoring institution.

LaBaere was named the 2006 Osteopathic Family Physician of the Year by the Michigan Association of Osteopathic Family Physicians, was inducted into the American Osteopathic Association’s Mentor Hall of Fame and was named a fellow in the collegium of fellows of the Association of Osteopathic Directors and Medical Educators.

Vice-Chair – Lori A. Kemper, DO, MS, Glendale, Ariz.

Kemper was previously Board secretary-treasurer, and also serves on the NBOME Finance and Awards committees. An osteopathic family physician, she is dean of Midwestern University, Arizona College of Osteopathic Medicine and is chair of the Data Committee for the American Osteopathic Association’s Commission on Osteopathic College Accreditation.

She also is past chair of the Board of Deans of the American Association of Colleges of Osteopathic Medicine and past president of the Arizona Osteopathic Medical Association (AOMA). She continues to serve the profession as chair of AOMA’s Professional Committee and as a Fellow of the American College of Osteopathic Family Physicians.

Secretary-Treasurer – John L. Goudreau, DO, PhD, East Lansing, Mich.


Goudreau was first elected as a member of the NBOME Board in December 2014. He has formerly served in COMLEX-USA Level 2-CE and Level 1 Coordinator roles, and as chair of the Clinical Decision-making Subcommittee for the COMLEX-USA Level 3. He is also a member of the COMLEX-USA Level 3 Advisory Committee.

Goudreau is a professor of neurology and pharmacology-toxicology at the Michigan State University College of Osteopathic Medicine (MSUCOM), where his research focuses on Parkinson’s disease and other movement disorders.

In 2019, he was appointed as the associate dean for research at MSUCOM, and as co-director of the school’s DO-PhD training program. He also directs the MSU Clinical & Translational Science Institute, which facilitates university-wide clinical/translational research infrastructure.

Immediate Past Chair – Geraldine T. O’Shea, DO, Jackson, Calif.

O’Shea was installed as chair in December 2019 and due to COVID-19, served almost the entirety of her tenure in a virtual environment.  She was recognized for her tireless commitment to serving NBOME and all of its stakeholders, most notably the patients for whom we have the privilege to care. She will maintain a vital leadership role within the Board as its immediate past chair.

O’Shea joined the Board in December 2009 and has served on numerous committees over the years, including the Graduate Medical Education Outreach Task Force, and as Liaison Committee Chair. She currently is a member of the NBOME Executive Committee and the Compensation Subcommittee.  She is a trustee of the American Osteopathic Association and served as its chair of the Strategic Planning Committee, the Bureau of Membership, and the Membership Value Task Force.

An osteopathic internist, O’Shea and her husband, Mark Eastman, DO, have served the community in their practice, the Foothills Women’s Medical Center, for more than 20 years.

The NBOME Welcomes New Public Board Member

Sheri L. Clarke, PhD, East Lansing, Mich.

Clarke has 22 years of experience in graduate medical education and medical school clerkship oversight and serves as the designated institutional official/director of medical education at Ascension Macomb Oakland Hospital, Lansing, Mich., a two-campus hospital with 235 residents and 50 base medical students. She is a past president and treasurer of the Michigan Association for Medical Education.

Clarke co-authored the Physician Career Guidebooks and launched a corresponding YouTube channel to help medical students and young physicians prepare for the next step in their careers. She has served on the boards of several medical education groups, and helped develop the Training Administrator of Graduate Medical Education certification.

The NBOME Thanks Outgoing Board Members

The NBOME also recognized three outgoing board members with an Outstanding Service Award, which recognizes those who have made significant contributions to the NBOME.

Dana C. Shaffer, DO, Des Moines, Iowa

Shaffer has served as Board secretary-treasurer and vice-chair, and as Board chair from 2017-2019. Over the past 14 years, he has served the NBOME as a member of the Test Accommodations Committee, chair of the Finance and Liaison Committees, a member of the Executive Committee and Compensation Subcommittee, and as chair of the Board’s Independent Review Committee.

For more than two decades, Shaffer practiced the complete spectrum of rural osteopathic family medicine in Exira, Iowa. He has served on the state medical licensing boards in Iowa and Kentucky. After serving as in associate dean roles at both Des Moines University College of Osteopathic Medicine and the University of Pikeville- Kentucky College of Osteopathic Medicine, Shaffer served as dean of the Kentucky College of Osteopathic Medicine from 2018-2021.

 
Susan I. Belanger, PhD, MA, RN, Lewiston, Maine

In October 2010, Belanger joined the NBOME Board as a public member. She served twice as an Executive Committee member. She chairs the Standard and Assurances Committee and was a member of the Awards Committee. She is also a public member of the American Osteopathic Association’s Commission on College Accreditation. She has served as a hospital vice president, nursing school professor, and clinical ethics consultant.

Belanger is currently the senior vice president for mission integration and the system ethicist at Covenant Health System in Lewiston, Maine. She is also an adjunct professor at Georgetown University School of Nursing and Health Studies in Washington, DC.

 
Anita L. Showalter, DO, Yakima, Wash.

Showalter joined the NBOME Board in 2012 and served on the Executive Committee, the COMLEX-USA Composite Examination Committee, and the Nominating Committee.

She is associate dean for clinical education, chair of the department of clinical medicine, and the chief and professor of women’s health at the Pacific Northwest University of Health Sciences in Yakima, Wash. She has practiced as an osteopathic obstetrician-gynecologist in Ohio and Kirksville and hopes to complete her career where she began, starting a new private osteopathic OB-GYN practice in her community in Yakima.

There are as many opinions about social media as there are on social media. They range from viewing these virtual networks as avoidable distractions to being so enthusiastic that they can’t get out from under their flood of notifications.

Both sides of the spectrum can give social media a bad rep—but if you think that’s all there is, you’re missing out. A common misconception is that the use of social media is disruptive, draining, and time-consuming—and it can be if used incorrectly, especially while preparing for high-stakes examinations like COMLEX-USA.

That said, osteopathic medical students can use social media to build relationships, network with others who have been through what they are going through, and even converse directly with residency program directors before applying. These are just a few examples of how social media can be helpful rather than becoming a hindrance:

During the COVID-19 lockdown, many of us relied on social media to stay emotionally connected with one another, even while socially distanced physically. This ability to transcend isolation by maintaining contact with others enabled us to combat feelings of loneliness and solitude in a world that was otherwise shutdown. An article published by Harvard found that

“Having a strong social network is associated with positive mental health and well-being. Routine social media use may compensate for diminishing face-to-face social interactions in people’s busy lives. Social media may provide individuals with a platform that overcomes barriers of distance and time, allowing them to connect and reconnect with others and thereby expand and strengthen their in-person networks and interactions.”

Even pre-COVID, social media was still valuable in allowing medical students to build up their self-confidence and establish connections they otherwise wouldn’t have had. In-person interactions are incredibly beneficial to mental health and wellness, but social media can also provide continuous and boundless conversations that can enrich anyone’s life.

Keeping up that connection and “using social media as part of [an] everyday routine and responding to content that others share—is positively associated with [social well-being, positive mental health, and self-rated health],” according to the Harvard article.

As with most indulgences, moderation is key. You wouldn’t eat ice cream for breakfast, lunch, and dinner, would you? (Don’t answer that). It’s important to regulate frequency—and that goes for social media usage as well. At the same time, keeping that balance doesn’t require you to ‘go dark’ unless it’s a personal choice. Everyone is different, and for some who have more trouble regulating themselves, there are always other options to maintain that balance.

On top of that, there is a lot of misinformation that can be shared and spread widely online so it is essential to use your best judgment and verify what you see. Always remember, we are here as a source to help you. If you question the validity of anything related to licensure or COMLEX, don’t hesitate to tag us!

You can safely and productively utilize social media to maintain your mental hygiene in ways you may not even be aware of. It can be a viable tool in preparation for COMLEX-USA by tapping into your osteopathic community to seek out accurate advice, take brain breaks, and reset before diving into the next section.

Some may see social media as rife with distractions, but it also provides a great opportunity for support and advocacy. Internet friends are important, and community built through social media can provide a support system to help you on your Road to DO Licensure.

He is a dog-parent of three raring pups and an avid advocator of osteopathic distinction and LGBTQ+ rights. Nic is focused on becoming the change that he wants to see in his community and we were so excited to hear about his personal journey on his Road to DO Licensure.

 

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Why did you decide to choose osteopathic medicine as a profession?

It was my experience in military that inspired me to become a DO. Honestly, I didn’t think I could become a physician initially. I hadn’t met many people with my background—or at least didn’t know many people with similar backgrounds who had become physicians. I’d started part-time courses on a nursing track while in Afghanistan to become a registered nurse—little did I know at the time, most of the physicians I worked under were DOs.

I gravitated to them because they placed a great deal of emphasis on the whole patient and challenged me. One night, a man by the name of Col. Francis saw me studying at the clinic late (it was the only place that had Wi-Fi). He took the time to explain how he became a physician and the principles of osteopathic medicine. For the first time, I thought, “Wow, this sounds like me—this sounds like something I want to do.” I changed my major a few weeks later. Funny enough, I would go on to primarily work with DOs until I transitioned to the reserves. Those mentors I gained while on deployment and after returning to the states are also the ones who wrote my letters of recommendation for medical school.

What really inspired me to choose osteopathic medicine was my exposure through my mentors far before I ever knew I wanted to become a physician. That’s one of the reasons I push for pre-medicine programs like pre-SOMA. I think DOs are made far before they ever walk the halls of our academic institutions.

Tell us more about your experience in the military.

I grew up in a small rural town in southern Louisiana and started living on my own at 17. I worked full-time through high school, and after graduating, I started a local licensed practical nursing program. When I got out, I wanted to continue with my education, so I talked to my brother about his experience in the military, which inspired me to join the US Army as a medic.

I met my husband shortly before deploying to Afghanistan in 2013, in support of Operation Enduring Freedom. On the very night I came back to the states, he surprised me with a proposal. We were lucky to be able to get married in Illinois right before the repeal of the Defense of Marriage Act.

The following year was interesting with balancing newlywed life and a military schedule, but after making it through deployment, a hectic schedule was really nothing. This also helped prepare me for managing my time in medical school. But before then in 2015, I left active duty and joined the reserves in order to start full-time at Austin Peay State University (near Fort Campbell). I also continued nursing part-time and served as a noncommissioned officer leading small teams focused on medical training for the unit.

I had a great experience leading up to medical school that made me able to appreciate the challenges of medical leadership and administration. I was activated to stand up a 30-personnel clinic for an 8,000-soldier training mission.

Following that, I continued in the reserves in my first year of medical school, and eventually transitioned to the inactive ready reserves where I am now.

How does it feel to be the National SOMA president and how did you get here?

I have a background in service, but I’d promised myself that I would place emphasis on medical school and not get involved with anything until after I graduated. Just like most students, I was afraid school would be overwhelming. Don’t get me wrong, it has been—especially that first year. I didn’t end up keeping that promise to myself. I saw all the good things that SOMA was doing for the community and I was hooked.

I became invested in SOMA at the national level; I wanted to continue helping my peers make an impact on the communities our chapters serve. I campaigned to become a region trustee so I could help other students lead their chapters. After a lot of deliberation, I decided to run for president.

Being the SOMA president is amazing. I get to advocate for and serve our members—medical students from various backgrounds—on a multitude of different issues. I get to work alongside an amazing leadership team to push for real change. While I advocate for more than 15,000 members on the national stage, I am also answerable to those I serve. That and our amazing 51-year legacy can, at times, come with pressure. Still, I couldn’t imagine myself doing anything else. I am very, very thankful for the confidence others have given me to serve them in our organization.

From a holistic viewpoint, having taken COMLEX-USA, how does osteopathic medicine stand out to you personally?

You know, this is a great question. What is osteopathic medicine? How do we give ourselves, as students, an identity and how do we own that?

At present day, I believe osteopathic medical education emphasizes patient-centered care through a collective view of factors that impact those we care for. Our institutions focus on the whole person, and that influences our education from the first day we enter school. This includes mind, body, and spirit, but also the interrelatedness of systems in the body; social, environmental, and behavioral health determinants; accessibility to care; as well as physician-patient relationships. We pair this amazing emphasis on medical education with approaches to care that allow the body to better heal and ensure our students are well-equipped for modern care practices within clinical environments. Osteopathic medicine stands out because of our approach and emphasis within medicine, and I think that is evident when DO students work with patients and clinical staff.

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The NBOME’s vision is to be the global leader in assessment of osteopathic medicine and related health care professions. DOs and DO students are generally able to provide the COMLEX-USA licensure series as a credential that is recognized across the continuum by stakeholders to help them to realize their professional goals.

While its primary and intended purpose is for use in applying for medical licensure for DOs, COMLEX-USA is widely regarded as the valid and reliable assessment for other secondary uses for osteopathic students and physicians. So it’s disappointing when we occasionally hear students or others say or write, “COMLEX isn’t as good of an exam as USMLE,” or “We should only take the USMLE.”

The more than 100,000 professionals who choose to study and practice osteopathic medicine are unique; they are more likely to choose career paths in primary care (roughly 56 percent of DO graduates practice in specialties that comprise primary care) and historically tend to practice in areas of greatest need. Not only that, global recognition of osteopathic medicine continues to grow.

DO students learn to integrate the unique osteopathic principles and practice of medicine. DOs assess each patient through their osteopathic lens, which is developed through mentoring, assessment, practice, and an integrated curricular program leading to the DO degree.

Unique individuals learning a traditionally unique way to provide care for patients should have a unique way to measure those skills.

Nursing students are shaped and assessed by the nursing examinations, law students take the bar exams, and optometry students sit for national board exams in their unique field. So too are MD students, in part, credentialed by the USMLE exam, and DO students by COMLEX-USA.

And this is why numerous authorities across the medical profession recognize the substantial body of evidence for the validity, reliability and quality of COMLEX-USA. For example:

The Federation of State Medical Board’s House of Delegates’ official policy is that the evidence for the validity of COMLEX-USA is exemplary, and every state licensure board uses (and a number require) COMLEX-USA for medical licensure of DOs.  The editor-In-chief of the FSMB’s Journal of Medical Regulation, complements the NBOME in her forward (October 1, 2018): “COMLEX-USA…provides a good example of how medical examiners can update their assessment systems to stay ahead of the curve of change [and] help medical regulators make sound, balanced decisions as they continue their work in protecting the public and ensuring quality in medical practice, keeping our patients safe.”

In November 2018, the American Medical Association’s House of Delegates adopted a new policy to promote equal acceptance of the USMLE and COMLEX at all US residency programs. The AMA also called for education of residency directors to better understand and use COMLEX scores.

The Graduate Medical Education community also endorses COMLEX-USA, as the ACGME accepts COMLEX-USA and USMLE equivalently. In August, the Undergraduate Medical Education to Graduate Medical Education Review Committee (UGRC) of the Coalition for Physician Accountability released a series of recommendations for improving the transition to residency, and calling for the mitigation of bias in all forms—specifically against DO students and their COMLEX-USA credential, which the committee called a “comparable examination with a different scale.”

Kenneth B. Simons, MD, senior associate dean for GME and accreditation at the Medical College of Wisconsin, is another passionate advocate for DO students and for COMLEX-USA. Dr. Simons serves as chair of the Federation of State Medical Boards and is a former leader of the National Resident Matching Program and the ACGME.

“The AMA says [COMLEX] is equivalent, the ACGME says it’s equivalent, the FSMB says it’s equivalent,” he says in this video from 2019.

“I would tell program directors who are uncomfortable with DO students or with COMLEX that they need to get comfortable with both. These young men and women are under tremendous debt and they don’t need additional debt placed on them because a program director doesn’t know how to interpret COMLEX.”

Internationally, the COMLEX-USA series is also highly regarded. Most recently, in September 2020 the Medical Board of Australia established a new competent authority pathway for licensure in that country, which includes COMLEX-USA for US-trained DOs. This decision was based on a recommendation from the Australian Medical Council, its accreditation authority, who performed a comprehensive, two-year review of the COMLEX-USA program and found the exam series to be a valid and reliable assessment for licensure/registration to practice medicine in Australia.

While most international jurisdictions require their own country’s national standardized assessments for physician licensure, COMLEX-USA was the first such physician licensure assessment program in over 15 years to receive this designation in Australia, another seal of approval for U.S. DOs and COMLEX-USA.

Leaders across the house of medicine endorse COMLEX-USA as a valid, rigorous, and trustworthy method of assessing competencies for osteopathic medical practice. What’s more, our profession and its distinctiveness continue to gain popularity; the number of practicing DOs has grown by more than 80 percent over the past decade, and roughly 25 percent of current medical students in the US are enrolled at a college of osteopathic medicine.

Patients like the osteopathic approach to care; a 2019 study found that osteopathic physicians were perceived significantly more favorably by their patients on the measures of interpersonal manner and empathy. An aligned assessment program, linked to this unique education pathway and practice, contributes to high-quality osteopathic medical care for patients and communities.

Robert Frost’s famous poem, “The Road Not Taken,” celebrates seeing things from a different perspective. Today, highlighting the value of different paths traveled and different viewpoints is more important and perhaps more relevant than ever.

While some both inside and external to the profession may struggle to reconcile the uniqueness, spirit, and competencies of osteopathic medicine with their need to assimilate in a number of ways, the fact is that DOs, MDs and IMGs each have their own rigorous and valid pathways to becoming a physician in the U.S.

In diversity there is strength—and a diversity of pathways interacting together helps to broaden the educational milieu in the GME learning environment–and ultimately strengthen health care in the U.S.

For our part, the NBOME, along with the AOA and AACOM, continues to work to educate program directors and other stakeholders to increase their understanding of COMLEX-USA, what is measures, how to interpret its scores. We will continue to advocate for the inclusion of the COMLEX-USA credential when assessment for DOs is considered. We also support the U.S. Department of Education-recognition of COCA accreditation of US DO-granting medical schools, and almost universal acceptance of AOA board certification in 27 different medical and surgical specialties.

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In celebration of GME Professionals Day, we recognize the GME coordinators, managers, and administrators who work tirelessly to make residency programs a success. We took this opportunity to highlight the incredible accomplishments of Philadelphia College of Osteopathic Medicine (PCOM)’s GME Coordinator, Brenda Hoffman. Hoffman has been with PCOM for three years and is the coordinator for Hospice and Palliative Medicine and Geriatric Medicine. During that time, she was instrumental in getting both programs certified with the ACGME for Osteopathic Recognition. We had the chance to sit down with her to discuss her accomplishments and talk more about the importance of osteopathic distinction in GME.

What changes did you notice during the shift to ACGME’s single accreditation system?

I actually started working at PCOM right at the start of the application process for ACGME accreditation for the two fellowship programs for which I am the program coordinator: geriatric medicine and hospice and palliative medicine. It was a whirlwind of learning ACGME guidelines at the same time everyone else was, while also learning my new job! In the end, it was beneficial for me to not have a ‘before’ reference. The application process was actually a great opportunity to learn the ins and outs of both programs.

Does your program rely on score reporting for filtering applicants or are you adopting more holistic reviewing processes in anticipation of COMLEX-USA Level 1 going Pass/Fail?

Our program has always had a more holistic approach to reviewing applications in that we strongly consider many other attributes in candidates.

What other key attributes do your program directors look for to determine whether a candidate is a  good fit for the program?

My program directors focus highly on the personal statements, letters of recommendation, activities, and volunteer work. There is an emphasis on service to older patients that goes beyond merely treating their medical complaints, so fellows must embody the characteristics of compassion and care.

How early in single accreditation did your program gain ACGME Osteopathic Recognition (OR)?

The programs became ACGME accredited in 2019 for the 2018-2019 academic year and received OR in 2021.

How does OR set your program apart from others in this specialty?

Most geriatricians and palliative medicine physicians who are trained osteopathically apply OMM principles throughout their entire assessment. It gives a more integrated approach to patient care. While osteopathic manipulative treatment is not appropriate for every patient, seeing the body as a self-regulating unit is a key OR principle seen in both geriatric and palliative medicine.

What is some advice you would give to COM students who plan to apply to an OR program?

You already have all the tools and knowledge that you need to succeed in any OR program! When interviewing for any program, make sure you are interviewing the program as well as letting them interview you.  And most importantly, be extra nice to the program coordinator! They have more say in things than you might think.

What do you most enjoy about your role as a Program Coordinator?

Because I work with much smaller programs, I love that I get to work with each fellow very closely.  We have the opportunity to cater the program to meet the needs and wants of each fellow, within reason. I enjoy helping to maintain a meaningful and impactful experience for every doctor that decides to spend a year in our fellowship programs.

Anything else you’d like to share about being a PC?

Program coordinators are such a key element to any residency or fellowship program. There is so much behind-the-scenes that goes into it to make sure programs are running as smoothly as possible and it could potentially go unrecognized. I am fortunate to feel appreciated in my programs and I work with an incredible team at PCOM! Go thank your PC today!

We have been a tireless advocate for reducing unnecessary barriers and increasing awareness of osteopathic students and their qualifications.

You watched the incredible resilience of the Class of 2021 as they navigated a match cycle during the pandemic. Everything they had been told to expect, changed. And now you find yourself in a similar position as the process continues to shift. While your Match season will be fundamentally different, rest assured that the community has come together to provide plenty of resources and support to help you navigate one of the most important transitions of your academic and professional careers.

You have overcome incredible challenges to get here, and we have great resources to help you as you take your next step on The Road to DO Licensure.

2022 Match Timeline

June 2021 | Open for Business

ERAS opened in June, and if you have been approved by your COM to enter the upcoming Match, you can access  MyERAS, and begin working on your applications. Check out the NRMP Intro to Main Residency Match page to learn about what’s new for this upcoming application cycle.

As a reminder, the following key Match dates occurred in June and July:

• June 1: Central Application Service (CAS) for the San Francisco (SF) Match for Ophthalmology and Plastic Surgery
• June 9: ERAS 2022
• June 23: Urology Match
• July 1: SF Ophthalmology applicant registration (SF Match)

Military students automatically registered for Army/Navy/Air Force Match

September 2021 | Off to the Races

Keep in mind that you do not need to submit all of your applications on September 1; you have plenty of time to complete and submit your applications. If you’re still researching programs, the AAMC’s Residency Explorer Tool can help you find programs that are a good fit for you.

• September 1:
  • Candidates can start applying to their residency programs of choice through ERAS
  • Dermatology, General Surgery and Internal Medicine applicants invited to participate in the supplemental ERAS application
• September 15: Registration opens for the NRMP 2022 Match
• September 20: Plastic Surgery applicant registration opens (SF Match)
• September 29: Residency programs can begin reviewing applications and MSPEs through ERAS

October 2021 | Putting Yourself Out There

Most residency program interviews will be held between October and December. Some specialties will continue to rely on virtual interviews. Double-check the websites for the programs you have applied to, and see what they have planned for this interview season. And make sure you’re ready to ace your virtual interview with these important tips.

• October 1:
  • Medical schools can begin uploading rising seniors
  • Interviews begin

December 2021

• December: Military Match announced

January 2022

• January 31:
  • NRMP 2022 Match registration deadline
    • Late registration will now incur a $50 fee
  • Program withdrawal and SOAP participation status deadlines

February 2022 | Ranking Opens

It’s that time – once you’ve registered with the NRMP, you can now submit your Rank Order Lists.

• February 1:
  • Rank order list entry opens
  • Medical schools can begin verifying student graduation credentials
  • Urology Match announced
• February 8: Ophthalmology SF Match announced

March 2022 | This Is It

*The 2022 SOAP schedule shown below is an estimate; the official schedule has not been posted yet.

• March 2:
  • Rank order list deadline (9pm ET)
  • Applicant late registration deadline
  • Medical school student graduation credential verification deadline
• March 14:
  • Match Week Begins; students notified if they matched
  • SOAP-eligible applicants can send applications to unfilled match programs*
• March 18: Match Day

May 2022

• May 10: Plastic Surgery SF Match announced
• May 31: End of the ERAS 2022 season

For osteopathic med students getting ready to participate in the 2022 Match cycle or those who have not started their 4^th year yet and want to prepare early, there are a number of key resources available. The following is a brief rundown of the latest Match resources crucial to crafting a successful application strategy.

The American Association of Colleges of Osteopathic Medicine (AACOM) has put together a Match Resource Center to help COM students as they embark on the UME to GME transition. It includes interviews with key leaders, tips on interviewing and managing social media during the application cycle, and help for those who don’t match. With over 5,000 students attending the last Virtual Residency Fair, it has proven to be a great resource for applicants seeking to learn more about residency and fellowship programs—and it’s free! Best of all, AACOM has launched a new site which provides residency programs with a platform to share available positions with COM students. Check out Available Residency Positions here.

Alongside AACOM, the Assembly of Osteopathic Graduate Medical Educators (AOGME) have great transition resources. Available webinars can provide key insights into understanding residency contracts or optimizing the transition from a COM student to a PGY-1. Connect on the AOGME Membership Discussion Forums to share perspectives and get guidance from other colleagues in GME.

As the gatekeepers of ERAS, the Association of American Medical Colleges (AAMC) offers a number of in-depth resources like the AAMC T2R Tools for a Successful Residency Application webinar. Though the session went live in June, the recording is freely available, and provides an overview for the application process itself, helping to facilitate application strategies. The webinar includes an overview of the Careers in Medicine microsite, Diminishing Returns data, the Residency Explorer research tool, and ERAS guidelines.

Careers in Medicine is a multi-resource deep-dive into physician career options, tips on preparing for residency, and insight into 135 specialties and subspecialties. The Specialty Insights section is especially useful for COM students who want to see how their COMLEX-USA scores stack up against those who have already matched.

Apply Smart for Residency provides data and resources which helps candidates shape their application strategy and cover topics, such as managing finances, interviewing, and understanding the application process. In addition, COM students who are looking to enter Internal Medicine, Dermatology, and General Surgery can find details on the supplemental ERAS application specific to these three specialties. The supplemental application spotlights candidates’ prior experience, interests, and indicate their program preferences.

Residency Explorer is a tool that allows applicants to review and compare programs in 23 specialties. The platform can weigh student’s profiles with other applicants who have successfully matched. Users can also compare using metrics like applicant type, standardized exam scores, peer-reviewed publications and research, and volunteer and work experiences. Residency Explorer is supported by verified data which includes contact and demographic information, such as the number of filled resident positions, program characteristics, application requirements and trends, program selectivity, and resident opportunities. Users should be very aware that some elements depend on program input (e.g. if a program has failed to update their application requirements, candidates may find conflicting information on the program website).

As we gear up for the 2022 Match cycle, it is important to know that there is a wide-range of knowledge available for COM students. The application process is stressful, but finding the right resources can help reduce that stress.

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