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Why osteopathic assessment is important throughout the career of an osteopathic physician and to our patients.

The 4 tenets of osteopathic medicine underlie the osteopathic philosophy of health and medical care. The body, mind, and spirit approach; the connectedness of the body’s structure and function; and consideration of other factors, such as social determinants of health and partnership with patients in overall wellness all contribute to this approach. DOs are trained to integrate these osteopathic principles and osteopathic manipulative treatment (OMT) into patient care.

If you look at an assessment as a milestone for what has been learned and a framework for what is required, then the assessment tools used should align both with the curricular program (what is taught and learned) and what is practiced (what patients expect). If that assessment is further used as part of a profession’s responsibility for self-regulation (i.e. licensure exam), then it is all the more important.

Examinations are developed by a profession, or entity (think driver’s tests or teacher certification) to assess whether a candidate has the knowledge, skills, and attitudes to perform in that profession. The COMLEX-USA licensure examination series is designed to assess the competencies required for the practice of osteopathic medicine. It reflects how DOs approach a patient, and the foundational abilities needed to provide osteopathic medical care, which remain distinctive for DOs.

COMLEX-USA is the only licensing examination that is aligned with the practice of osteopathic medicine, and it is gaining recognition across the globe. It is the only licensing exam accepted in all 50 states and other US licensing jurisdictions for osteopathic physicians. In 2020, the Medical Board of Australia recognized the NBOME/COMLEX-USA as a competent authority pathway for registration (licensure) for comprehensive medical practice in Australia!

Specifically, then, how is COMLEX-USA osteopathically distinctive?

  1. Examination series: The COMLEX-USA series is aligned to be taken at certain developmental times in the osteopathic medical student and residents’ progression toward licensure. Content is designed to be developmentally appropriate and aligned with the osteopathic medical educational programs. COMLEX-USA is endorsed by the AOA’s Commission on Osteopathic College Accreditation (COCA) with graduation standards that include COMLEX-USA examinations. COCA is the recognized accreditation authority by the US Department of Education for osteopathic medical schools.

  2. Blueprint design: The COMLEX-USA examination blueprint includes two integrated dimensions: osteopathic competency domains and clinical presentations. The competency domains define the unique knowledge, skills, experience, attitudes, values, behaviors, and established professional standards of osteopathic medicine. The clinical presentations represent the manner in which a particular patient, group of patients, or a community presents for osteopathic medical care. These are both informed by an evidence-based design for the practice of osteopathic medicine, including the review of national databases of what DOs do and see in practice. 1-2

  3. Inclusion of the Competency Domain “Osteopathic Principles, Practice and Manipulative Treatment”: COMLEX-USA includes this as a competency domain, and it is important to osteopathic medical education and practice. However, osteopathic principles are also integrated with the other competencies in the assessment. For example, questions classified or “coded” to this competency domain may also be assessing another competency domain or skill. This aligns with practice—osteopathic physicians bring all of their competencies to the care of a patient, at the same time.

  4. Examination construction: Once the blueprint has been designed and the items written, the test is assembled according to specifications for each level (as in, how many of each kind of question goes into an examination, among other considerations). This provides an assessment form that is fair, valid, and aligned with the practice of osteopathic medicine. Because the specifications are so aligned, changing a few items will necessarily change the whole examination. The test specifications are based on DO practice data including that from the National Ambulatory Health Care Surveys, which is actually distinctive from practice data for other physicians. 3

  5. Test question and case construction: Down to the item level, the NBOME uses an osteopathically distinctive approach to developing multiple-choice questions and clinical cases. Interdisciplinary groups of DOs and other professional colleagues collaborate to develop patient scenarios and associated questions based on high-frequency, high-impact clinical presentations. This results in items that address whole patient care—not just assessment of basic recall of scientific facts. COMLEX-USA test items and cases are built to assess the application of knowledge and other competencies—not just knowledge itself. The unique clinical decision-making (CDM) cases in the Level 3 examination are designed to assess a candidate’s ability to think beyond multiple-choice questions. CDM forces candidates to think holistically about the patient’s scenario—whether that means determining the diagnosis based on the available findings or selecting management steps for a patient in an extended multiple-choice question. CDM items are particularly relevant to patient safety and differentiation at the minimal competency threshold.

    To help ensure alignment across national standards taught at all of the colleges of osteopathic medicine, the NBOME collaborates with Educational Council on Osteopathic Principles (ECOP) to establish testable concepts and standardized nomenclature related to osteopathic manipulative medicine (OMM). In the Level 2-PE, before that exam was suspended in the pandemic, candidates had the opportunity to perform hands-on diagnostic physical exam maneuvers, and perform OMT as appropriate to the diagnosis and within certain parameters.

On the residency program/GME front, we work at the grassroots-level to help provide information to elective clinical rotation sites and program directors about COMLEX-USA, helping to contribute to the steady increase in DOs being accepted with their own distinctive credentials into ACGME-accredited residency programs.

  • We have worked with the American Association of Medical Colleges (AAMC) to provide data for the Report on Residents, which for the first time in 2020 included COMLEX-USA scores.

  • Our partnership with the Electronic Residency Application Service (ERAS®) assists residency program directors by demonstrating parity in the application dashboard for DO and MD applicants, including a COMLEX-USA percentile score converter and similar transcript presentations and notations to those available for licensing exams for MD applicants.

  • We serve on the National Resident Matching Program®’s (NRMP®) Research Advisory Committee to ensure that the osteopathic voice is represented and that inclusive nomenclature is used for DO stakeholders in NRMP® publications, presentations, and other Match® initiatives.

Even those less familiar with DOs and COMLEX-USA prior to the Single GME Accreditation System (2015-2020) have learned that DOs take COMLEX-USA. The NBOME has historically advocated for DO students and their credentials, including the DO degree, COMLEX-USA, and AOA board certification both nationally and internationally.

Other examples of osteopathically distinctive assessments deemed to be valid for their purposes include COMAT examinations used by almost every DO medical school campus in the US, AOA board certification assessments in 16 specialties, and numerous residency in-training/in-service assessments designed by osteopathic specialty societies and used by hundreds of residency programs in specialties such as family medicine (ACOFP), internal medicine (ACOI) and surgery (ACOS).

Assessments should be aligned with the educational programs, outcomes, and practice of the profession. A profession must self-regulate and set standards to continue to earn public trust. COMLEX-USA is targeted to the distinct practice of osteopathic medicine to protect that trust. This, along with rigorous standards and continuous quality improvement, has helped COMLEX-USA to be the gold standard licensure examination for osteopathic physicians since the NBOME was founded in 1934. Having a robust, distinctive portfolio of assessments will help DOs to be well positioned to continue to grow and thrive across the United States and the world.


  1. Gimpel JR, Horber D, Sandella JM, Knebl JA, Thornburg JE. Evidence-based redesign of the COMLEX-USA series. Journal of the American Osteopathic Association. 2017;117(4): 253-261.
  2. Horber D, Gimpel JR. Enhancing COMLEX-USA: Evidence-based redesign of the osteopathic medical licensure examination program. Journal of Medical Regulation. 2018;104(3):11-18.
  3. Boulet JR, Gimpel JR, Errichetti AM, Meoli FG. Using National Medical Care Survey data to validate examination content on a performance-based clinical skills assessment for osteopathic physicians. JAOA: 2003; 103(5):225-31.
Original Publication Date: April 19, 2021.

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The Board of Directors is pleased to announce that the NBOME will change from reporting three-digit numeric scores to reporting only “Pass” or “Fail” for COMLEX-USA Level 1 examinations administered after May 1, 2022.

Update: COMLEX-USA Level 1 Transition to Pass/Fail Reporting

As previously announced, COMLEX-USA Level 1 (Level 1) reporting will transition from a three-digit numeric score to “Pass” or “Fail” outcomes for Level 1 beginning on or after May 10, 2022.

To receive a three-digit numeric score, candidates must take their Level 1 before May 10, 2022.


Dates for Level 1 Transition to Pass/Fail Only:

Level 1 Test before May 10, 2022 Test on or after May 10, 2022
Score Reports Numeric score AND pass/fail Pass/fail only
Transcript Numeric score AND pass/fail Pass/fail only


Level 1 Candidate Score Report

All candidates will receive their performance information as it relates to the national mean performance of those who have taken COMLEX-USA Level 1 for the first time. This feedback (Low/Average/High) identifies areas of strength and weakness and may be useful to guide a study plan for failing candidates. The minimum blueprint percentage allocated to the competency domains and clinical presentations will also be presented. Discipline scores will no longer be included in either candidate or school reports.

View Sample New Score Report here.

Frequently Asked Questions
1. Q: When will changes to COMLEX-USA Level 1 score reports go into effect?

A: Changes will go into effect for any administrations taken on or after May 10, 2022. Click here to see the sample Score Report.

2. Q: Will COM deans receive the candidate score reports?

A: Yes. COMs will still get up-to-date student performance on COMLEX-USA Level 1 with pass/fail (P/F) and performance profiles by clicking “View Score Report” on their dean’s page.

The NBOME cautions against use of these performance profiles for purposes other than providing candidates with an understanding of their relative strengths and weaknesses in the COMLEX-USA blueprint.

3. Q: Will discipline scores still be available to COM deans?

A: No. Beginning May 10, 2022 administrations, the Level 1 discipline scores will no longer be available for the candidate score reports, Dean’s Page, and aggregate school report. Only performance as it relates to the blueprint competency domains and clinical presentations as seen in the candidate score report will be available to COM deans. This information will be accessible under the “View Score Report” on the Dean’s Page. Click here to see the sample Score Report.

4. Q: What performance data will COMs see?

A: COM deans will be able to view how many of their students have taken the exam for the first time, and performance pass rates for their students who are first-time test-takers as compared to the national pass rate for first-time test-takers. They will see performance as it relates to the blueprint competency domains and clinical presentations as seen in the candidate score report.

5. Q: Will COM deans still get an annual report?

A: Yes, an annual report of school performance will be available to deans in September 2023.

6. Q: What do program directors see in ERAS for candidates who test on or after May 10, 2022?

A: Program directors will only see a pass or fail result in ERAS for candidates who take Level 1 after that date. The minimum passing score of 400 will also be shown in the ERAS transcript, but no numerical scores for candidates will be reported for candidates who test on or after May 10, 2022.

We will continue updating this document with answers to additional questions as we receive them. If your question is not answered here, please email clientservices@nbome.org.

7. Q: How can a student determine if they are prepared to take COMLEX-USA Level 1?

A: Because the COMLEX-USA Level 1 examination is highly integrative, students should review all content areas, especially if they are retaking the examination. The COMLEX-USA Level 1 blueprint is a good place to start.

The NBOME offers self-assessment tools that osteopathic medical students may use prior to sitting for the COMLEX-USA Level 1 examination: COMSAE and WelCOM. These tools are used to gauge students’ knowledge base and abilities, reinforce medical knowledge, and determine which content areas they are most adequately prepared for.

The COMSAE Phase 1 score report provides performance by discipline, competency domain, and clinical presentation, which may be helpful for students as they prepare to take COMLEX-USA Level 1. Please see this article for additional information on the role of COMSAE Phase 1 in COMLEX-USA Level 1 preparation.

WelCOM provides additional learning resources to prepare students for both COMSAE Phase 1 and COMLEX-USA Level 1. After responding to each WelCOM question, candidates are shown the correct answer, the rationale for why that answer is correct, and are provided additional references for further study.

December 17, 2020

PHILADELPHIA, PA. The Board of Directors is pleased to announce that the NBOME will change from reporting three-digit numeric scores to reporting only “Pass” or “Fail” for COMLEX-USA Level 1 examinations administered effective May 1, 2022, aligning with the start of the 2022-2023 testing cycle. This decision was made after several years of analysis and considering input from across the education, training, and licensure continuum.

The NBOME recognizes that this score reporting modification for COMLEX-USA Level 1 (pass/fail only) will create new questions for osteopathic medical students, faculty and deans, state licensing board members, the GME community, and other stakeholders. More information and further specifics will be made available by July 2021 on the particulars and logistics of the new score reporting construct for candidates, and that for schools and other secondary users. Input was considered from stakeholder groups across the continuum, including the licensure community, osteopathic medical students and residents, those involved in undergraduate and graduate medical education, accreditation authorities, and numerous other professional organizations across the profession. Ultimately, the NBOME Board took this action in support of wellness across the continuum and in the interest of its mission to protect the public.

Frequently Asked Questions

These FAQs serve as a complement to the December 2020 announcement of the transition of score reporting for COMLEX-USA Level 1 examinations from reporting numeric scores to only reporting Pass/Fail results starting May 1, 2022. Note that additional information will be provided by July 2021 on the particulars and logistics of the new score reporting construct for candidates, schools and other secondary users.

How long have you been thinking about this decision? What went into making this decision? Did you just do this because USMLE announced the same in 2020?

While there had been considerable discussion and consideration of reporting only pass or fail rather than numeric scores for COMLEX-USA examinations with NBOME’s testing committees and Board of Directors since the first COMLEX-USA redesign in 1995, the concept of the elimination of numeric scores from COMLEX-USA Level 1 garnered considerable attention and analysis by NBOME’s Blue Ribbon Panel for Enhancing COMLEX-USA, which was commissioned in 2009 and published an initial report in March 2012.

At the time, with the secondary use of licensing examination scores by Program Directors and the beginning of discussions regarding a potential transition to a Single Accreditation System for Graduate Medical Education, the decision was to continue to report numeric scores. NBOME continued to engage the medical licensure, regulatory, assessment and education communities on this topic, including inviting input from osteopathic medical students and residents. NBOME has presented on this topic at national meetings including those within the licensure community, but many expressed concerns about change. Students, residents and their advisors in particular cautioned against the unintended consequences of discontinuing reporting of COMLEX-USA Level 1 numeric scores, primarily related to concerns about application for residency programs. While other concerns were cited, the principle apprehension was that DO candidates with a COMLEX-USA score that reported as pass/fail only would not be able to be compared to applicants from MD-granting schools and international medical graduates who applied producing numeric scores. Upon USMLE’s announcement earlier in 2020 that they would discontinue reporting “Step 1” numeric scores beginning in 2022, this concern was mitigated, and stakeholder input changed.

This December 2020 decision was ultimately made after several years of analysis and considering input from across the education, training, and licensure continuum, and in the interest of wellness across the continuum and supporting NBOME’s mission of protecting the public through assessment. The comprehensive analysis included research, surveys of individuals, and solicitation of stakeholder position statements, including those from organizations representing the medical licensure community, undergraduate and graduate medical education, accreditation authorities, and students and residents.

Why May 2022 and not January 2022? Why doesn’t NBOME make this transition sooner?

Our COMLEX-USA test cycles align with the cohorts of students who take the examination and their anticipated graduation year and are established with input from colleges of osteopathic medicine and other stakeholders. This change to the score reporting for COMLEX-USA Level 1 examinations needs to align with the test cycle change, therefore we will make this change in May 2022 (a time when the Class of 2024 begins to take this examination). To make this change earlier would compromise both the psychometric integrity of the examination results of the 2021-2022 test cycle, and would potentially result in half of a graduating cohort having numeric scores, and half having only Pass/Fail results. In addition, this provides stakeholders appropriate notice to prepare for the transition. USMLE has reported that their “Step 1” exam, which is often compared to COMLEX-USA Level 1, will make the change to Pass/Fail reporting as early as January 2022, which is the start of their test cycle. Historically, students at some MD-granting schools and international graduates take Step 1 of USMLE earlier in the calendar year than DO students begin taking COMLEX-USA Level 1, who do not start taking Level 1 until May.

Will candidates or COMs get additional information on candidate performance as part of the COMLEX-USA Level 1 score reports after May 1, 2022?

It is anticipated that comprehensive score reports provided to candidates and available to schools for COMLEX-USA Level 1 examinations taken on or after May 1, 2022 will still include individual candidate performance profiles as they currently do. These demonstrate individual areas of strength and weakness within the examination blueprint for the benefit of continuous professional development, and, when relevant, to use as part of remediation and to enhance potential for success. These reports will likely continue to be generated for candidates and available to COM deans in their secure NBOME Portal accounts. However, it is anticipated that this information will NOT be reported in examination transcripts provided for residency program applications in ERAS or to state medical and osteopathic medical licensing boards. Particulars and logistics of the new score reporting construct for candidates as well and schools and other secondary users will be made available by July 2021.

Will score reports for COMLEX-USA Level 1 examinations administered prior to this transition look any different?

No. If you take/took your COMLEX-USA Level 1 examination on or prior to April 30, 2022, NBOME will continue to report numeric scores AND pass/fail result. Your numeric score will remain on your COMLEX-USA transcript and will be reported in ERAS and to state licensing boards as such. It will not change or update with this transition. Reports for Level 1 examinations starting May 1, 2022 will no longer report numeric scores.



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We met Courtney Cox, MA, a fourth-year medical student from Arizona College of Osteopathic Medicine (AZCOM), on Twitter after she tweeted to encourage other students that they can match using only COMLEX-USA scores.

We met Courtney Cox, MA, a fourth-year medical student from Arizona College of Osteopathic Medicine (AZCOM), on Twitter after she tweeted to encourage other students that they can match using only COMLEX-USA scores. Courtney shared that she was able to match into her dream specialty: Emergency Medicine, where she will complete her training at OhioHealth Doctors Hospital Emergency Medicine Residency Program.


Tell us what inspired you to become a DO, specifically.

I was first introduced to osteopathic medicine when I was a patient in the emergency department during my sophomore year of college. At the time, I was already on the path to go to medical school, but I didn’t know the difference between an MD and a DO. While I was at the ER, I had a strong impression of the doctor treating me there, who I later found out was a DO. That discovery was what triggered me to research more about what osteopathic medicine was. After that, I found out that I strongly believed in the core foundations of osteopathic medicine—our body is a unit composed of the body, mind, and spirit—all of which are vital to assess in each of our patients.

Prior to medical school, I watched my grandmother battle cancer. Initially, her physical body was deteriorating, but her mind remained sharp and her spirit uplifted. Witnessing this is what allowed me to truly realize that her body, mind, and spirit each played a role in her overall health. And when I thought about my view of healthcare—how I wanted to treat my patients, I knew that pursuing osteopathic medicine was ultimately the right path for me.

Congratulations on your Match into Emergency Medicine! How did you choose this specialty?

I’d known I wanted to be a physician since high school, but I was first introduced to the exciting field of Emergency Medicine while I was a scribe during my gap year in the emergency department. I chose to scribe for a full year, then did a one-year master's program for my Masters of Arts in Biomedical Science at Midwestern University, going then to their medical school directly after that.

Everyone always told me that I would find my specialty when I found my people, and it was literally less than 15 minutes on the first day of my emergency medicine rotation during my third year of medical school that I knew this was the best specialty for me. I love the diverse medical pathology that presents every day, along with the ability to treat patients within the community from all different walks of life, while using our knowledge and skills to address a variety of emergencies.

We understand you only used COMLEX-USA scores when applying to residency—what prompted that decision, and what advice would you give students who are thinking of doing the same?

I was initially scheduled to take COMLEX-USA Level 1 and USMLE Step 1 five days apart from each other. I did this because it seemed like it was what everyone else was doing—so many people told me that I also needed to take USMLE because I was planning on applying to a competitive specialty. However, during my first dedicated board study period, I realized preparing for both exams was like trying to run two completely different marathons. The exams are very different, and studying for both of them simultaneously posed a challenge for myself. That was why I ultimately decided to focus my efforts on only COMLEX-USA Level 1, and cancelled my USMLE Step 1. And when it came time for the next round of boards, I only scheduled the COMLEX-USA Level 2. But because I’d made that decision, it was so much less stressful—I felt I had more focus and could maintain a positive and optimistic attitude since there was only one exam I had to focus on.

DOs take COMLEX-USA because we are osteopathic students and it is aligned with our curriculum. A large part of what we are tested on is if we understand the osteopathic foundation—if we understand the tenets of what a DO physician is. Also, osteopathic manipulative treatment—none of that would be on USMLE. COMLEX-USA could ask some very specific pathology but might weave in osteopathic foundation into the question as well. Ultimately, USMLE and COMLEX-USA are very different exams.

I was actually, and thankfully, in the position where I was able to decline several residency interview invites because I had sufficient COMLEX-USA scores, despite not having a USMLE Step 1 score. This isn't talked about very much, and I want to bring attention to it, with the hope that our profession can have more osteopathic students matching into competitive specialties with just COMLEX-USA. At first, I felt embarrassed that I didn’t have a USMLE score when applying to a competitive specialty—I felt like I was navigating uncharted territory as an applicant, and it really shouldn’t be the case. I want to be a voice for the students coming after me to know that they can do this with just COMLEX-USA scores.

I also ultimately decided that what I wanted in a residency program was for them to respect my licensing exams as they do the MD examination. DO students shouldn’t have to pay for and take double the amount of board exams to be on an even playing field. Why should residency programs require me as a DO to take both? I am really proud of my osteopathic education and I want residency program directors to acknowledge and respect the decision each of us make to become a DO.

I do think that we are heading in the right direction towards eliminating DO bias, but we still have a long way to go. I hope to see continued acceptance of DOs in graduate medical education across the country, which hopefully allows a greater number of students to match into competitive specialties with only COMLEX-USA scores.

We often hear the phrase ‘osteopathic distinctiveness’ used across the profession. What does that phrase mean to you personally?

Our osteopathic training allows me to have a larger understanding of the structure and function within the body, and I think it's so important to be able to have this foundation because it can drastically change someone's life by recognizing that they might not have a disease or a diagnosis that has to only be fixed with medication. I might have a patient that comes into the emergency department with back pain, and I've ruled out all of the other acute pathologies. If I think it’s musculoskeletal, they could really benefit from osteopathic manipulative treatment—such as myofascial release—and walk out of the emergency department feeling a lot better. I want to use osteopathic manipulative treatment when I can to be able to aid the body in healing itself, and I'm so proud to be a DO.

Looking back at how you prepared for your most recent level of COMLEX-USA, would you have taken a different approach to studying? What advice do you have for other COM students who are preparing for COMLEX-USA?

My most recent COMLEX-USA exam was Level 2-CE, and I plan to take the same approach when studying for Level 3. I learned from a lot of mistakes I’d made when prepping for Level 1, and did much better on Level 2 because I’d fixed my approach to studying.

My level one preparation period was focused on passive learning—reading a lot of material versus active learning, such as using practice questions or flashcards, which utilize spaced repetition. You’re not going to be able to read the same textbook five times, but you’ll be able to use a variety of practice questions to ingrain the same principles from them. On top of that, it can be easy to have a resource overload—so be sure to focus on only two to three. That said, I took the active learning approach for Level 2 during a much shorter time period, and it was a huge improvement.

The Road to DO Licensure has many unexpected challenges that I’m sure you’ve experienced, including burnout, stress, and anxiety. Tell me some of the major challenges you’ve faced while taking COMLEX-USA and some advice on how you personally overcame them.

The first time I took COMLEX-USA, it was a challenge being able to focus for the length of the exam while also operating under the time constraints. These exams are timed, and it’s necessary, so we as students need to figure out how we can do our best under these constraints and focus our practice efforts towards preparing for that. I would take four-hour practice exams, and if I could maintain my focus for that amount of time, I knew I could likely extend it the rest of the way. For example, when someone is preparing to run a marathon, they don't practice by running all 26 miles; if they can make it to mile 16, they're likely going to have the stamina to be able to endure until the end.

The dedicated board prep periods are so challenging; they're full of anxiety; they're full of stress. During them, I had the inclination to say ‘no’ to my family and friends if I got a dinner invite. But during my Level 2 prep period, I decided to start saying ‘yes’ instead, and I had better balance because of it. I think that balance allowed me to enter into my exam with a much healthier outlook. My performance also reflected this.

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

There are so many things I'm looking forward to because I'm finally going to be a resident physician! I would say, ultimately, I am excited to finally apply all of these years of hard work. As an emergency medicine resident physician, I'm looking forward to being able to connect with my patients of all different backgrounds and cultures while treating and advocating for them in their most vulnerable moments.


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Merwan Faraj, ENS, MC, USNR, is a second year med student at Edward Via College of Osteopathic Medicine-Carolinas campus and the American College of Osteopathic Family Physicians-Carolinas Chapter President.

Merwan Faraj, ENS, MC, USNR, is a second year med student at Edward Via College of Osteopathic Medicine-Carolinas campus and the American College of Osteopathic Family Physicians-Carolinas Chapter President. He has been a huge advocate for the wellness of his colleagues, has published a previous article on practicing gratitude, and continues to promote the use of body, mind, and spirit in osteopathic medicine on his road to DO Licensure. Coming from a background as a cardiovascular ICU nurse, Merwan has a lot of insight into how one can learn to cope with the stressors of being in the field. Read on to see his thoughts and advice!


You were an ICU nurse before you decided to become a doctor—what inspired you to become a DO, specifically?

I was inspired by the osteopathic tenets of mind, body, and spirit being applied to the treatment of patients. This was similar to what I’d already learned during nursing school—you don’t take care of a patient; you take care of a whole person. This is was what I wanted to do at a much higher level, but because I am so big on spending time with my patients and I enjoy being there for them, I didn’t want to lose that in my decision to become a doctor. I felt that by choosing to become a DO, I would be able to maintain that same practice for my patients—that I would always be there for them.

On top of that, DOs also learn OMM. When I discovered this, I thought it was a more hands-on way to take care of somebody without having to rely heavily on medications. Just being able to use your hands to diagnose and treat someone is amazing. Just touching a patient can go a long way. This also aligns with my ideas of prevention because DOs do our duty to avoid prescribing meds if we don’t have to, or if we do, making sure to offer and incorporate non-pharmacologic treatments. OMM is a great way to take care of people that can improve their quality of life with minimal risks and expenses. I wanted to learn that skill so I could become a more well-rounded physician and help patients to the best of my ability.

What mental challenges are you facing as a 2nd-year osteopathic medical student as you prepare for your first level of COMLEX-USA and how are you addressing them?

The sheer amount of information that we need to know can easily be overwhelming—just looking at the big picture. What I realized I needed to do was to break down all of that information into chunks a little bit at a time. I need to understand the bigger concepts before digging down to the smaller details, and then I need to recognize where my weaknesses are so I can go after them. I’ll spend more time on those weaknesses than I will on the things I already know, prioritizing my study time. Also, doing tons of questions—they will show you what’s important and how your brain works—how you’re thinking and if you know why you got something right or why you got it wrong. If you think you’re going to memorize nine text books of medical knowledge, then good luck, but take comfort in realizing that you don’t have to know everything; you just need to know enough. What will make you one of the best doctors is being compassionate with your patients. No matter what anyone does for a living, I think you need to recognize that you are interacting with another human. Empathy should be everywhere—it will make the world a better place.

Also, setting goals is important. I set a daily goal for the number of questions I will do that day. Once I hit that number, it’s over—I’m clocking out! You have to have those breaks in between and not try and do it all in one sitting. Do a set of questions and then take a break to just relax or do something you enjoy. Then, do another batch, and before you know it, you’ll have reached your goal and it wouldn’t have been that tolling.

Although it varies from person to person, what do you feel is most important to a medical student’s mental well-being and why?

You need to do things for yourself. And that may sound selfish, but from what I experienced, taking care of yourself might actually be one of the most unselfish things you can do. Because when you’re in a better place, you’re more able to be there for others. I think if you take care of yourself by making time to exercise on this day at this time or decide that at seven o’clock, you’re going to meditate for 10 minutes no matter what, you’ll keep burnout at bay and find yourself thriving. It’s easy to get caught up with grades and other worries, but I think if people realize that taking these little timeouts for themselves is not going to negatively affect their scores; bur rather improve them, they would be much more likely to do them on a regular basis. There’s a myth that more studying equals better performance, but that may only be true to a certain degree. I believe in quality over quantity, and performing better because you physically and mentally feel better. I think taking some pressure off yourself, especially when you’re always feeling you have to achieve at such a high level, is extremely important.

I hope students can carry this mindset into their practice as physicians. If you adopt—that sure there is school, there is work, but there is also me, my friends, my family, and my life—you will be happier and better for it. I have both witnessed and been someone who just works all the time and is always under this certain level of stress…it’s not exactly the recipe for providing excellent patient care. You’ll find yourself being fatigued, not as sympathetic or compassionate, and even may not be as cognitively present. It becomes easy to miss things that otherwise you would have caught when you’re burned out. It’s a valuable practice to take time for yourself, and I hope it carries over to every facet of your life.

VCOM featured you in an article about practicing gratitude and its positive impact on mental health. What other practices, both mental and physical, do you find helpful for improving wellness while preparing for COMLEX-USA? What advice would you give to other COM students?

For your physical health, you definitely need to be making healthy food choices, drinking lots of water, and you absolutely should be exercising. You don’t have to do them 100% of the time, but if you can pull them off on a regular basis you will still reap the rewards.

As for your mental health, I recommend some form of meditation. And don’t worry about whether or not you’re doing it right— I love the quote: “Meditation, if you're doing it, you're doing it right.” But, especially when you first start out, I think it's easy to get frustrated if your mind wanders off or you internally feel like you're messing up. I would tell anyone that they should expect for this to happen as part of their progression in learning about themselves. You’re only human and it’s natural. Don’t judge yourself when that happens, and instead, use it as a tool to practice self-acceptance and bring yourself back to the present moment.

The goal of meditation isn’t about not having thoughts—the goal isn’t about not having your mind wander; the goal is just to be present in the moment and to be able to let go. Just be there. There is so much time in our day where we are bogged down by work or distracted with other things. I think meditation is an opportunity to practice awareness and “be here now.”

One of the most important things you can do is give yourself permission to relax. A friend of mine, at one point, was constantly quizzing himself so much that he couldn’t sleep. When he came to me with this issue I told him, “Man, you already study for 13 hours a day. It’s okay to go to bed, but you gotta give yourself permission to not think about school.” If you’ve studied 12 hours a day for X number of days for your exam, you’ve already put in the work. Being able to let go and give yourself permission to relax comes from trusting yourself, trusting your work, and trust that you’ve put in enough time.

For me, I anticipate my success on the exam because I know I busted my butt. Now I can relax—now I’m going in to get the reward for all my hard work. And if you’re not succeeding, know you need to go get help. I always believe in asking for help, guidance, advice, or coaching no matter what. From there, you can reformulate how you study.

Work-life-balance is important for every field, how do you recommend osteopathic medical students start now to be sure that they maintain this throughout their career?

This is definitely tough because we do have a lot of pressure. We have school, we get involved in organizations, we do volunteer work, etc. Work-life-balance was definitely something I struggled with, also because I hadn’t gotten involved in many things until going into med school. I wasn’t used to juggling everything.

The best thing you can do is maintain your relationships and stick to your hobbies or find new ones. For me, it’s exercising, hanging out with friends, meditating, learning a new language, NASA/space, and I even had a guitar that I hadn’t touched in 12 years that I just picked back up. I know others who jumped on instruments too. I feel like no matter what you’re passionate about, you need to make time for those things. It’s so important to your mental health and well-being. If you just make time to study for 13 hours a day, then that’s all you’re doing. Having those personal aspects to your life will allow you to succeed more in school and clinically (especially for connecting with patients), but also enjoy yourself and stay who you are.


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Amir Khiabani, MS, OMS-III, was recently appointed to the Special Commission for Osteopathic Medical Licensure Assessment as the Student Osteopathic Medical Association (SOMA) representative, and we wanted to get to know him better by featuring him in our latest installment of the Stories from the Road series.

Amir Khiabani, MS, OMS-III, was recently appointed to the Special Commission for Osteopathic Medical Licensure Assessment as the Student Osteopathic Medical Association (SOMA) representative, and we wanted to get to know him better by featuring him in our latest installment of the Stories from the Road series. Alabama College of Osteopathic Medicine (ACOM) student doctor Khiabani is actively involved with SOMA as Region II Trustee and was recently reelected to be part of the senior board as National Treasurer. To him, SOMA is family-oriented in the same way osteopathic medicine is—in that he sees his experience as more than just something to put on paper, but rather something to live. Amir also enjoys being a producer of the D.O. or DO Not Podcast, which you can listen to here.


What inspired you to become a DO, specifically? Tell us your story.

I was a chemist before going into medical school. I’d finished my undergraduate degree at the University of Florida, and I worked for a company in Savannah, Georgia. I was very unhappy, all over the place, and didn’t know what I wanted to do. I dabbled in many things, including being a high school teacher—loved mentoring kids or anything with a group of people—but I hadn’t found my calling. I even earned my Master's degree in molecular medicine. A couple of my friends were in medical school—they were learning pharmacology and I was looking at their material and found myself interested, even enjoying studying the topics with them. That is when they said to me, “Why don’t you go to med school.” I’d never even thought of that. I like people. I like science. I like mentoring. That’s what a physician is and should be—it made sense, so I decided to apply to medical school.

We often hear the phrase ‘osteopathic distinctiveness’ used across the profession. What does that phrase mean to you personally?

I was a scribe in the emergency room and met four amazing DO physicians. When I worked with them, I felt like I wanted to be like them. They sat down on the bed of the patient, they held their hand—didn’t even take their computers inside the room. The patient would always laugh, smile, cry—they would tell us things that would help us diagnose them. In just the way those DOs would connect with their patients—I was inspired to go into osteopathic medicine. That’s the main reason why I only applied to DO schools.

Looking back at how you prepared for your most recent level of COMLEX-USA, would you have taken a different approach to studying? What advice do you have for other COM students who are preparing for COMLEX-USA?

COMLEX-USA questions include a lot more detail, are more person-oriented, and have answer choices that are very non-invasive. Every answer choice on every question still tested my scientific knowledge, but I feel as though COMLEX-USA also tests the concept of patient-centered osteopathic medicine in a way that 2nd years can understand.

I was actually surprised by how well I scored. The only regret I really had was inundating myself with too many study resources. I think if I just stuck with two or three and not listened to everyone saying, “This is better than this and that’s better than that,” then I would’ve been more selectively driven. Therefore, I would say to try and find those two or three study resources that work for you and stick with them. Also, do a lot of questions and practice exams. I did a lot because I'm a very anxious test-taker; I don't like taking exams. There’s a lot of pressure.

My best piece of advice is to try to remember that it’s just a test. If you’ve put in all the work prior to taking it and you give it your all, the results will come. You really just need to focus on what you're doing while you're studying—focus on that test, and be as relaxed as possible. I approached each question like I’d treat a patient. Because they are patients; they’re vignettes. I don’t want to misdiagnose my patient so I’m not going to get this question wrong. It’s true!

My final piece of advice I'd give students is, when you're taking practice tests or practice questions, you need to simulate the environment of where you're going to take your exam. Go into a quiet room, have a desk, take it with a similar keyboard, similar mouse, and sit with good posture. Get a chair that's similar to what they have in Prometric testing centers and sit in it as if you're taking the real test every single time, every question. With the right body language, you self-perceive yourself as more confident.

The Road to DO Licensure has many unexpected challenges that I’m sure you’ve experienced, including burnout, stress, and anxiety. Tell me some of the major challenges you’ve faced while taking COMLEX-USA and some advice on how you personally overcame them.

My first two years of school were rough. I was a non-traditional student- I was out of school for three years prior to coming in. I didn't have that study routine down my first year, but I didn’t let that stop me from being who I was. I still joined SOMA. I engaged in extracurricular activities, and I still do—that's what gives me life. It was a struggle to find that rhythm my first year, and there were tears, there were long nights, there were times where I had to tell family, “I can't talk to you today.”

There was a lot of sacrifice—I even had to miss my niece being born. I had to shut people down at the time and ask for forgiveness later. My family knows I love them, but they struggled to see the path I had to take. I’m a 1st generation; my mom came from Mexico and my dad came from Iran. They didn’t go to college—I’m the first. Because of this, I had to be very self-motivated and I had to work my own way through college with four jobs. I worked as a shoe salesman, a waiter at a Mexican restaurant, a barista and a chemistry tutor. My mornings started at four in the morning, working at a coffee shop in the atrium of Shands Hospital, University of Florida. This was all while still being a full-time student.

I also encountered a great deal of financial strain during my first year, almost requiring me to pull out of medical school, but members of my community helped me. I regularly go to the gym to help with stress, and friends there noticed how I was struggling. Without a word to me, they collected donations from community members. They told me I was surrounded by friends: lawyers, dentists, and DO physicians who wanted to help and encourage me. They told me, “We don’t want this paid back. You’re helping our community, and we know what you as a DO physician are doing. We see a light in you and we want to keep that on.” It gives me chills thinking about it. I have been blessed to encounter so many wonderful people on my journey.

I also took my board exams during the roughest period of the pandemic in June, 2020. COVID was messing up all the schedules. The stress level, anxiety, and the trauma of repeatedly having to be rescheduled was extremely high. My exam was pushed back from June to July to the end of July—the day after my birthday. It was stressful, but I looked at it and said to myself that it was more time to study. That extra month gave me the composure to be able to sit down and say this is just a test.

Have you encountered other mentors that have helped get you to where you are today?

One mentor I had was Mr. Timothy Wall, in eighth grade. I was getting C’s and D’s the grade before, but he took one look at me and told me that I could do more. Meanwhile, I couldn’t read because I was a product of immigrants, and learned only broken English. I know four languages. He took me under his wing and guided me. He turned me from a C and D student who started in ESL courses to an honors student who graduated as valedictorian of my eighth grade class.

I want to continue mentoring because of the effect that my mentors have had in my life. I want to continue to give back in the same way.

You were appointed to the Special Commission after your nomination by SOMA—tell us what this means to you.

My involvement with National SOMA began with my desire to contribute to my profession and ensure the student voice will be heard. As I have progressed through my years in medical school, I have witnessed many events that have affected osteopathic schools, students, and the profession as a whole. This appointment grants me the opportunity to ensure that the perspectives of the osteopathic student body are represented during discussions that will impact their future. Moving forward, this appointment will aid in providing me the experience and resources to be an osteopathic physician who confidently advocates for our profession.

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

My patients. I can’t wait! Every time I think about my future, I think about my patients and the people I’m going to meet—the minds and the hearts that I’m going to touch and change. Hopefully, sharing my story will show others that there is light at the end of a very long tunnel.


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Match Day success stories from the past as well as new stories from this year’s Match.

MATCH 2022

MATCH 2021

MATCH 2021

Melinda Kizziah
I matched Emergency Medicine at The Ohio State University and could not be more excited to have years of hard work culminate in this achievement. I hope my fellow DO students always remember that they are amazing, smart, and capable of anything they set their mind to!
Melinda Kizziah, West Virginia School of Osteopathic Medicine
Emergency Medicine at The Ohio State University

Asia Colen
I matched at my #1 UAMS South Central! God’s plan never fails! I am beyond grateful! I get to serve my home! The very place I was born, where it all began for me, Pine Bluff, AR. I am overwhelmed and honored to serve my hometown. I promise to do my best to make everyone DO proud!
Asia Colen, New York Institute of Technology College of Osteopathic Medicine
Family Medicine at UAMS South Central

Andriana Saric
I'm so thrilled to have matched in Emergency Medicine at Trident Medical Center in Charleston, SC! Participating in the 2020-2021 Match cycle presented many unique challenges to an already stressful process. I'm extremely thankful to have my advisors and mentors by my side from audition rotations, to navigating applications, and troubleshooting virtual interviews! Onto the next big adventure!
Andriana Saric, Arizona College of Osteopathic Medicine
Emergency Medicine at Trident Medical Center

Evan Arbit
As a DO physician and future Physiatrist, I recognize the holistic approach plays a pivotal role in patient care, especially in the world of PM&R. Often times it’s the emotional and or psychosocial components of an individual that contributes and or worsens the physical ailments and vice versa. My osteopathic education has given me this perspective to help improve my patient’s quality of life and be at their best!
Evan Arbit, Michigan State University College of Osteopathic Medicine
Rush Physical Medicine and Rehabilitation

Alyka Glor Fernandez
Don't discount yourself from applying to programs even if they have only a few DO residents! You've worked hard and put in the work; you are equally as qualified as our MD counterparts. Show them what you've got!
Alyka Glor Fernandez, Kansas City University
Emergency Medicine at Emory University

Chi Chi Do-Nguyen
When there's a passion, there's a way. I am so incredibly honored and humbled to be the 1st PCOM student to match into cardiothoracic surgery, the only DO student to match into cardiothoracic surgery this year, and the 1st DO to match at the University of Michigan CT Surgery. I can't wait to apply my osteopathic medical training to treat patients holistically within the field of cardiothoracic surgery!
Chi Chi Do-Nguyen, Philadelphia College of Osteopathic Medicine
Cardiothoracic Surgery, University of Michigan


MATCH 2020

MATCH 2020

My Osteopathic education prepared me so well for a residency training in Physical Medicine and Rehabilitation. I could not be more grateful for my school and the physicians who mentored me along the way.
Nicolet Finger, UNTHSC-TCOM
Physical Medicine and Rehabilitation at UT Health San Antonio

The road to get here was surely a rough one, but nothing worth doing in life is meant to be easy. At the end of the day I had faith that my perseverance through the hard times would pay off, and today I found out that they did! To all the future physicians out there, NEVER GIVE UP. The world needs your healing.
Brynne Hunt, WCUCOM
Emergency Medicine at Newark Beth Israel-Newark

I matched to my number one spot! I’ll be a family medicine resident at Saint Joseph Health System in Mishawaka, Indiana. I am so blessed to be able to be a DO and serve the community that raised me! Here is a picture of my cat and me celebrating during quarantine lol. We had a dance party!
Jess Williams, KCOM
Family Medicine at Saint Joseph Health System

I am so grateful to have trained to become an osteopathic physician. I matched into my number one choice for residency in internal medicine! Thankful for all my friends I made along the way and the physicians who mentored me!
Jacob Baer, KCU-COM
Internal Medicine at University of Kansas

I am able to fulfill my dream of being an emergency medicine physician! I am thankful to my school for all the opportunities afforded to me and the people in my life for support! Looking forward to being a DO in the emergency department.
Michael Skaletsky, MU-COM
Emergency Medicine at Doctors Hospital Columbus, OH

With all the craziness that is going on right now, it was great to see how everyone rallied together to celebrate match day virtually. We have all worked so hard to get to this point and I love seeing all of our dreams become a reality.
Amber Hartman, KYCOM
Pediatrics at SIU - Springfield, IL

At Cook County Hospital there’s a plaque that says: 'One doesn’t ask of one who suffers, what is your country and what is your religion? One merely says you suffer. This is enough for me. You belong to me and I shall help you. - Louis Pasteur' This philosophy aligns perfectly with the values we learn at CCOM. Proud to be a part of #DoctorsthatDo and match at my top choice!

Palak Patel, CCOM
Internal Medicine at Cook County

My DO medical education introduced me to mentors, clinical experiences, and a revitalized passion to assist struggling rural locales like my own hometown. I am over the moon about matching into my top choice in family medicine at at NH-Dartmouth Family Medicine Residency in Concord, NH, which offers a rural track that I will carry with me for the entirety of my career in rural family medicine.
Clare O'Grady, NYIT-COM
NH-Dartmouth Family Medicine Residency

My osteopathic medical education provides a unique vantage point into mental health treatment. Residency program leadership also saw this as a valuable asset when assembling their incoming intern class. I am proud to be a DO and will utilize my experiences as a future research psychiatrist!
Grace Sydney Pham, UNTHSC-TCOM
Psychiatry/Research at Baylor College of Medicine

I am beyond thrilled to have matched into Internal Medicine and cannot wait to begin my career as a doctor! The knowledge gained, the experiences lived, and the relationships formed throughout medical school will stick with me as I continue to grow as a physician. To all of my 2020 peers, we made it!
Maxwell Horowitz, TouroCOM NY
Internal Medicine at Mt. Sinai Icahn SOM St. Luke's-West

I could not have picked a better medical school to grow and mature into a young doctor. I am thrilled to have matched into an OB/GYN residency at my top program, St. Luke's University Health Network. I look forward to continuing to pave the way for other DOs!
Kathleen Ackert, PCOM
OB/GYN at St. Luke’s University Hospital in Bethlehem

I think the key to getting a good residency is to go and audition at that location. If you can show programs a good work ethic, coupled with your unique osteopathic education, you might be surprised at how many doors can open up for you.
Phillip Bennett, RVU-COM
Pathology AP/CP at the University of Utah

Matching into my top choice residency is a dream come true! I am incredibly grateful for my medical school peers and physician mentors for helping me build self-confidence and supporting my intellectual, personal, and professional growth throughout this journey.
Priya Shah, CCOM
Emergency Medicine at Duke University

I have loved every moment of this crazy journey through medical school, and I am eager to use the knowledge I have gained as an osteopathic medical student. A quote I once heard was "if you work hard, you'll get lucky" and I am so lucky to have found a place among the amazing physicians who work in Family Medicine. I can definitely say they are my people! I matched at Wright State University in Dayton, Ohio and I can't wait to begin the next 3 years of training.
Megan Miller
Lincoln Memorial University-DeBusk College of Osteopathic Medicine
Family Medicine at Wright State University

Beyond excited to match at Detroit Receiving for Emergency Medicine. I am extremely excited to be a DO in the Emergency Department.
Rajiv Varandani, CCOM
Emergency Medicine at Detroit Receiving

Attending an osteopathic medical school has equipped me with a unique skill set and has provided a one of a kind training experience that will be invaluable to my future role as a physician. The journey was challenging, but with faith, dedication, and support, I made it through! Always remember, your darkest and most difficult moments are never wasted; they simply prepare you for your destiny. I cannot wait to apply all that I have learned to serve and make a positive impact on my patients- the osteopathic way
Anna-Kaye Brown, RowanSOM
Anesthesiology at Temple University Hospital

Incredibly humbled to be the only DO this year to match in Cardiothoracic Surgery I6. Prior to medical school, I worked as an LPN in Cardiac Surgery for 5 years ,while taking night classes dreaming of this day. Thank you very much to the AOA, AACOM, NBOME and WVSOM for all your support and giving this nurse an opportunity to realize his dreams
Jason Gilbert, WVSOM
University of Kentucky in Cardiothoracic Surgery


MATCH 2019

MATCH 2019

Don't think of time spent studying for COMLEX-USA and COMAT exams as time lost. It's an investment in your future career and in your ability to match into your specialty of choice.
Jason Rodriguez, DO
Kettering Health Grandview Medical Center, Anesthesiology

Match can be intimidating, but being an active learner through research, conferences, volunteering, and working hard in preparing for COMLEX-USA, truly pays off. I matched into my #1 choice!
Alexandra Digenakis, DO
University of North Carolina, Emergency Medicine

Medical school and residency applications can cause you to doubt your abilities. Remember that hard work pays off.  Have faith in your abilities and push through. You are amazing and can achieve your dreams.
Parth Gandhi, DO
Delaware Christiana Care Health System, Combined Emergency Medicine/Internal Medicine

I matched into my #1 choice! Don't be afraid to step out of your comfort zone and take advantage of new opportunities. Medical school is a time for personal and professional growth, and while grades are important, programs pay attention to other things too.
Jordan Hauck, DO
Medical College of Wisconsin Affiliate Hospitals, Obstetrics and Gynecology

I was able to match into my #1 program! I'm thrilled to be joining the Georgetown team and pursuing diagnostic radiology in Washington DC!
Matthew Bourne, DO
Georgetown University, Diagnostic Radiology

Work hard to shine during your sub-internships and interviews, but most importantly, be kind, positive, and a team player.
Pauline Terbio, DO
University of Nevada Las Vegas, Emergency Medicine

When it comes to residency, the most important thing is to find the right fit for you. Something I considered important was finding a place where I would be happy training. I found some programs more welcoming than others, and I loved the one I ended up in!
Tiffany Sinclair, DO
Franciscan Health Olympia Fields, General Surgery

Put 100% into everything you DO, and it will pay off. Studying hard and surrounding yourself with friends and family that support you is key -- and got me where I am today.
Khadija Farooq, DO
Presence St. Joseph Hospital, Family Medicine

I matched into my #1 choice! I was searching for a program that allowed me to incorporate my love for public health and community health. This one had it all!
Khyrista Valentine, DO
Authority Health Residency Program, Pediatrics

As DOs, we think holistically. As residency candidates, we have to be the same. Be well-rounded on every part of your application: COMLEX-USA, extra-curriculars, volunteer experience, and who you are as a person.
Kayla Prokopakis, DO
St. Elizabeth Boardman Health Center, Emergency Medicine

I wanted to be somewhere that allowed me to help the community, and would also make me the best doctor I could be. All my dreams came true and I matched at my #1 choice!
Hajiraj Ishaq, DO
Doctor's Hospital Ohio Health, Emergency Medicine

My fiance and I were both going for the same specialty in the same year. We couples-matched in pediatrics and will move from being classmates to being co-interns. All of my hard work was worth it!
Este Marks, DO
Oklahoma State University, Pediatrics

I'm very proud of my osteopathic medical training and COMLEX-USA best reflects this. It was important to me to find a program that valued my osteopathic roots as much as I do.
Victoria Starr, DO
Beaumont Hospital Obstetrics & Gynecology

Keep your mind open and trust the process. You might be surprised sometimes what you want initially changes when you stay open to possibilities and explore new things.
Joseph Schreiner, DO
Jefferson Health New Jersey Emergency Medicine


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Despite a year of many hardships, we are overjoyed to announce that this year’s NRMP Main Match was the largest on record, and 6,327 DO seniors matched to 33,353 filled first year positions across the US!

Those 6,327 DO seniors, and an additional 609 DO prior graduates, will carry their osteopathic distinction into their residency programs and specialties. The number of DO seniors who matched increased 6% from 2020, and over the last 5 years the number of DOs who matched has increased 125%!

Match rates for all groups dropped slightly in 2021, and the 1.9% decline for DOs is similar to the slight match rate decrease found in the US MD match rates, with a more significant match rate drop in the international medical graduate (IMG) match rates. But that is not the whole story- this does not take the Supplemental Offer and Acceptance Program (SOAP) (post-initial match rounds) into account, and we are excited to see the final Match data when it is released by the NRMP in May. Applicants who did not match to a residency position participated in the SOAP to obtain one of 1,892 positions available.

The three most popular specialty matches for DO seniors in 2021 are Internal Medicine, Family Medicine and Emergency Medicine with a 6.7%, 3.4% and 15.7% increase in the number of DO matches, respectively.

DO students and graduates have demonstrated extraordinary resilience in this year’s 2020-2021 residency application cycle, which was upended from the beginning by the COVID-19 pandemic. We recognize DO applicants for their journey to becoming osteopathic physicians and commitment to serving patients. John R. Gimpel, DO, MEd, NBOME President and CEO, shared a special congratulations with the students and graduates entering residency positions in July 2021:

“This year’s residency match is a milestone day in the lives of many future physicians, including a record number of DO applicants. We applaud your resilience and patience as you encountered numerous curve balls and obstacles related to training in a pandemic, and wish you all the best as you begin the next exciting chapter. Enjoy your celebration and upcoming graduation, and we look forward to welcoming you to the next stage of your journey as you start your career as an osteopathic physician.”


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In this section
For the 2021-2022 academic year, the NBOME offers three COMAT administration options to provide flexibility in location and proctoring to address your assessment needs.

For the 2021-2022 academic year, the NBOME offers three COMAT administration options to provide flexibility in location and proctoring to address your assessment needs.

The newest option, remote-proctoring, compliments in-person proctoring and self-proctoring administrations of all COMAT assessments. Remote-proctoring allows for Zoom-like virtual monitoring of students by COM proctors, balancing security and convenience. While most COMs prefer the in-person option, some are allowing students to test from remote settings.

With the implementation of these options, COMAT will no longer be administered at Prometric Testing Centers.

Option Features
In-person proctored Highest exam security with proctors on campus or at rotation sites
Remote-proctored Provides exam security by COM proctors monitoring remote administrations
Self-proctored Most flexible for location and timing but least secure

Contracts and pricing for the 2021-2022 academic year were distributed in April 2021. COMAT pricing for each COM is based on contractual usage and the proctoring option selected.

The NBOME is pleased to offer webinars to outline ways to register for and administer COMAT assessments through the various proctoring options. For assistance, contact our Client Services team or call 866-479-6828 Monday-Friday (excluding NBOME holidays) 8 am-5 pm CT.

NOVEMBER 3, 2020

To enable COM faculty and staff to effectively plan for COMAT administrations for the remainder of the current academic year, NBOME is pleased to confirm that remotely administered COMAT-SP (self-proctored) examinations will continue to be available through the current COMAT Clinical Subject examination cycle, which ends on June 26, 2020. We will determine the availability of this option for the 2021-2022 academic year as we monitor the limitation of on-campus activities resulting from the pandemic.

COMAT FBS examinations will also continue to be available for remote self-proctored administration as well as on-campus proctored administration through this academic year.

COMAT administrations at Prometric testing centers will continue to be unavailable this academic year. We expect to offer a remote proctoring feature for COMAT in the next academic year as an alternative for in-person proctored examinations.

Thank you, as always, for your support of the COMAT series and NBOME’s mission to protect the public.


JUNE 5, 2020

To enable COM faculty and staff to effectively plan for COMAT administrations in the next academic year, NBOME is pleased to share that COMAT-SP (self-proctored) will continue to be available at the start of the next COMAT Clinical subject examination cycle, on July 15, 2020. We will remain flexible with long-term availability of this option as we monitor the recovery of COMs from social distancing requirements. If we observe later in the academic year that all students are back on campus, we may revert to proctored on-campus administrations, as required previously.

COMAT administration at Prometric testing centers will continue to be unavailable. However, we are working with Prometric to develop a remote proctoring option for COMAT Clinical subject examinations as an alternative to the in-center Prometric administration.

COMAT FBS examinations -- both Comprehensive and Targeted -- will be available for selfproctored administration as well as on-campus proctored administration. Please note that the FBS Comprehensive exam will be shortened to 4 hours/200 questions beginning September 1, 2020.

Thank you, as always, for your continued support of the COMAT series and our mission to protect the public. If you have any questions, please don't hesitate to contact our Client Services team or call 866-479-6828 Monday-Friday from 7 AM to 7 PM ET for assistance.


APRIL 20, 2020

To enable College of Osteopathic Medicine faculty and students to continue their important work during this challenging time, the NBOME developed an alternative assessment delivery method for the COMAT examination series, launching these as COMAT Self-Proctored (COMAT-SP) exam forms.

NBOME has enabled COMs to deliver COMAT Subject Exams and FBS Exams to students in remote locations, including student residences. Note: Effective April 20, 2020 and until further notice, the Prometric Testing Center Option is unavailable.

At this time, the examination launch and administration do not involve high-security remote proctoring tools. Remote proctoring will be further studied but will not be available in this time frame. The integrity of these administrations rely on the honor system and codes of conduct of each educational institution, and schools will determine, as they do with other COMAT exam forms, how to interpret the scores and factor that into overall student evaluation. Further information about implications for scoring will be provided in the future.

NBOME is committed to supporting COMs and COM students using COMAT through this process. Please feel free to contact us with questions at clientservices@nbome.org.

For more information on other COMAT exams, please click here.


Read a joint statement from the NBOME, AACOM and the AOA in support of the suspension of COMLEX-USA Level 2-PE and continued osteopathic assessment.
American Association of Colleges of Osteopathic Medicine (AACOM) American Osteopathic Association (AOA) National Board of Osteopathic Medical Examiners (NBOME)

Joint statement from AACOM, AOA, NBOME – Support of Suspension of COMLEX-USA Level 2-PE and Continued Osteopathic Assessment

PHILADELPHIA, PA. The American Association of Colleges of Osteopathic Medicine (AACOM), American Osteopathic Association (AOA) with support from the Commission on Osteopathic College Accreditation (COCA), and the National Board of Osteopathic Medical Examiners (NBOME) have been working together on numerous challenges presented by the COVID-19 crisis. One such challenge is balancing the importance of appropriate testing and assessment of students with the safety of testing and travel to testing centers, including the COMLEX-USA examination series that is administered by the NBOME.

Today, our organizations stand together in support of NBOME’s decision to suspend COMLEX-USA Level 2-PE administrations indefinitely given the COVID-19 pandemic. We also stand united in the need for assessment of the unique aspects of osteopathic medical practice within the undergraduate medical education curriculum leading to the DO degree, as an important part of the eventual pathway leading to licensure.

The decision to suspend the COMLEX-USA Level 2-PE will help to address some of the undue burdens and multiple stressors placed upon our osteopathic medical students during the pandemic. We support the use of temporary alternative pathways to ensure that DO students and residents are not uniquely impacted on their progression to residency, or their ability to eventually seek licensure.

In addition, we support and look forward to participation in the Special Commission on Osteopathic Medical Licensure, as it will engage multiple and varied voices throughout the osteopathic medical community to assure that COMLEX-USA evolves in a manner that reflects the changing practice of osteopathic medicine and its physicians.

Together, our organizations remain committed to developing innovative ways to assess clinical skills and other fundamental competencies for the public good and to prepare osteopathic physicians of the future.


About AACOM

The American Association of Colleges of Osteopathic Medicine (AACOM) was founded in 1898 to lend support and assistance to the nation’s osteopathic medical schools, and to serve as a unifying voice for osteopathic medical education. The organization represents the administration, faculty, and students of all osteopathic medical colleges in the United States and is actively involved in all areas of osteopathic medical education, including graduate medical education. Visit AACOM.org for more information or ChooseDO.org for information about applying to osteopathic medical school.

About AOA

The American Osteopathic Association (AOA) represents more than 151,000 osteopathic physicians (DOs) and osteopathic medical students, promotes public health, encourages scientific research, and serves as the primary certifying body (specialty board certification) for DOs. To learn more about DOs and the osteopathic philosophy of medicine, visit Osteopathic.org.

About COCA

The AOA Commission on Osteopathic College Accreditation (COCA) is recognized by the U.S. Department of Education as the accreditor of colleges of osteopathic medicine. COCA accreditation signifies that a college has met or exceeded the Commission’s standards for educational quality. COCA is a division of the AOA, but operates independently to serve its role of accrediting colleges of osteopathic medicine.

About NBOME

The National Board of Osteopathic Medical Examiners (NBOME) is an independent, nongovernmental, not-for-profit organization whose mission is to protect the public by providing the means to assess competencies for osteopathic medicine and related health care professions. The NBOME develops and administers a number of osteopathically distinct examinations, most notably the COMLEX-USA (Comprehensive Osteopathic Medical Licensing Examination of the United States), which is accepted for medical licensure in all 50 of the United States and other licensing jurisdictions. Visit NBOME.org for more information.

MEDIA INQUIRIES
Jeanne M. Sandella, DO
Associate Vice President for Research and Communications
jsandella@nbome.org

JUNE 5, 2020
American Association of Colleges of Osteopathic Medicine (AACOM) American Osteopathic Association (AOA) National Board of Osteopathic Medical Examiners (NBOME)

Joint Statement from AACOM, AOA, COCA and NBOME:
Support of COMLEX-USA Level 2-PE and COCA’s Temporary Modification of Graduation
Standards for the DO Class of 2021

The American Association of Colleges of Osteopathic Medicine (AACOM), American Osteopathic Association (AOA), Commission on Osteopathic College Accreditation (COCA) and the National Board of Osteopathic Medical Examiners (NBOME) have been working together on numerous challenges presented by the COVID-19 crisis. One such challenge is balancing the importance of appropriate testing and assessment for evaluation of students with the safety of testing and travel to testing centers, including the COMLEX-USA examination series that is administered by NBOME.

Today our organizations stand together in support of COCA’s decision to provide deans of accredited COMs the discretion to allow students who would otherwise be scheduled to be in the 2021 graduating class the option to graduate and receive the DO degree without having passed the COMLEX-USA Level 2-PE clinical skills examination, provided they have met all other graduation requirements and have been endorsed by the faculty.

COMLEX-USA Level 2-PE will still need to be completed for full licensure and is considered a necessary and ongoing requirement for the licensure of osteopathic physicians in all 50 states. This announcement does not affect COMLEX-USA Level 2-CE, although the availability of testing opportunities for this exam is being monitored very closely.

This decision helps to address some of the undue burdens placed upon our osteopathic medical students and ensures a pathway to graduation. It allows additional flexibility for students as to testing when it best meets their needs and personal circumstances given the pandemic.

AACOM, AOA, COCA, and NBOME remain committed to the valid, standardized measurement of clinical skills for licensure as part of our profession’s commitment to our patients’ safety and protection and the quality of healthcare overall, while acknowledging and preserving the interests and needs of our osteopathic medical students.


AACOM, AOA, COCA and NBOME are committed to serving our profession, collaboratively, but also individually through the distinct and specific services each of our organizations provides. To better understand how we work together, each organization’s unique contributions and roles are defined below.

About AACOM

The American Association of Colleges of Osteopathic Medicine (AACOM) was founded in 1898 to lend support and assistance to the nation's osteopathic medical schools, and to serve as a unifying voice for osteopathic medical education. The organization represents the administration, faculty and students of all osteopathic medical colleges in the United States and is actively involved in all areas of osteopathic medical education, including graduate medical education. Visit AACOM.org for more information, or ChooseDO.org for information about applying to osteopathic medical school.

About AOA

The American Osteopathic Association (AOA) represents nearly 151,000 osteopathic physicians (DOs) and osteopathic medical students; promotes public health; encourages scientific research; serves as the primary certifying body (specialty board certification) for DOs. To learn more about DOs and the osteopathic philosophy of medicine, visit DoctorsThatDO.org.

About COCA

The AOA Commission on Osteopathic College Accreditation (COCA) is recognized by the U.S. Department of Education as the accreditor of colleges of osteopathic medicine. COCA accreditation signifies that a college has met or exceeded the Commission's standards for educational quality. COCA is a division of the AOA, but operates independently to serve its role of accrediting colleges of osteopathic medicine.

About NBOME

The National Board of Osteopathic Medical Examiners (NBOME) is an independent, nongovernmental, not-for-profit organization whose mission is to protect the public by providing the means to assess competencies for osteopathic medicine and related health care professions. The NBOME develops and administers a number of osteopathically distinct examinations, most notably the COMLEX-USA (Comprehensive Osteopathic Medical Licensing Examination of the United States), which is accepted for medical licensure in all 50 of the United States and other licensing jurisdictions. Visit NBOME.org for more information.


Match Day is approaching, and with it looming ever closer comes the next important step of the journey – figuring out how to create the perfect Match rank order list. This is a critical part of the process, as you’re trying to determine where you’ll be spending the next 3+ years of your life, and it’s been made even more difficult in 2021 by not being able to visit those programs in person.

Match Day is approaching, and with it looming ever closer comes the next important step of the journey – figuring out how to create the perfect Match rank order list. This is a critical part of the process, as you’re trying to determine where you’ll be spending the next 3+ years of your life, and it’s been made even more difficult in 2021 by not being able to visit those programs in person.

To help out OMS IVs struggling with this step, Eleanora Yeiser, DO, PGY III, wanted to share some insights she learned when creating her own rank order list.

Dr. Yeiser is currently a PGY-3 family medicine resident at Main Line Health in Bryn Mawr, PA. She is a member of the Pennsylvania Osteopathic Medical Association Committee on Professional Guidance (East Region) and serves on her resident wellness and diversity committees. She currently serves as a NBOME Resident Ambassador, and works to advocate for DO students and their credentials. Her professional involvements include reviewing articles for the Osteopathic Family Physician Journal. After residency, she will be relocating to northern New Jersey to practice outpatient family medicine.


How did you know that the programs you ranked were right for you?

I ranked the programs that I knew I would be happy matching into—that’s the best you can do in a process that’s ultimately out of your control. My situation was unique since I rotated at my top ranked program as a third and fourth year student, and I knew it would be a good fit since I had a great experience there. Ultimately there is no one formula for how to rank programs. Personally, I used the same criteria for all my program, location and the people or the overall “fit” of the program. Residents change every year but program structure and faculty are less likely to turnover as frequently. If you don’t think you’ll be happy there based on your non-negotiables, intuition or general impression then don’t rank it. It’s also important to consider whether or not your interests will be supported. For instance, are there faculty or recent graduates who’ve done fellowships, additional training or research in their areas of interest? Is there support in pursuing new or away electives, scholarly activities, or responses to major life events (births, deaths, illness, etc.)? What are their wellness initiatives, and do the residents seem to have good work-life balance? Have residents felt supported during the pandemic (rotation changes and response, PPE)? These are all important factors to consider when finding the programs that are right for you.

What factors from your interview were the most meaningful in affecting how you created your rank list?

The main factor I considered was whether or not I could imagine myself at the program. I considered how the residents interacted with each other, and if it seemed genuine or forced. The availability of the attending who would become my next mentors and the culture of the program were important to me as well. I would also recommend considering the type of resources and support the program provides to ensure their residents succeed.

Did you receive feedback from any programs after the interview? If so, did this make a difference?

Yes, from some, and it’s helpful but I definitely wouldn’t rank a program lower because you don’t hear back. It’s also worth reaching out if you’re interested afterwards; every program is different and just because you didn’t hear back, doesn’t mean they don’t regard you highly. It’s also important to remember that programs are unable to contact applicants between the Rank Order List Deadline and the start of the Match Week, so don’t worry if you didn’t hear anything beforehand!

How did you go about creating your rank list? Did you rank according to your preference or did you try to anticipate which programs would rank you highly?

I was given the advice to rank where you would want to be and not based on the program you think will rank you highest. If I hadn’t taken that advice, I may have missed out. Ultimately, you can only match into one spot, and I wouldn’t want to risk losing a spot somewhere I’d love to be because of trying to predict where I’d actually end up. For example, it’s unlikely that the top six candidates for a program all want to be there equally when most people apply to numerous programs to increase their odds. But if you’re honest with yourself, you have a greater chance of matching at your ideal program. Rank in order of where you truly want to be, and it will all work out the way it’s supposed to in the end. If you are still feeling a little unsure about how to create your list, the NRMP has created a video detailing the Guidelines for Applicants for Creating a Rank Order List, as well as a helpful video that explains exactly how the matching algorithm works.


The rank order list submission is open until March 3, but we recommend trying not to stress and end up waiting until the last minute to submit your list on the National Resident Matching Program (NRMP) website. Remember, when you know, you know! If you’re still looking for additional help on creating your list, there is some helpful advice available from the American Osteopathic Association as well as published resources from the NRMP.


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As time approaches for the rank order deadline and the match, it is not unusual for students to experience anxiety and begin to doubt their plan. Counter this by setting a goal for yourself to submit and certify your list several days before it is due. This avoids any last minute mistakes, poorly thought-out changes, or delays due to unexpected internet issues.

As time approaches for the rank order deadline and the match, it is not unusual for students to experience anxiety and begin to doubt their plan. Counter this by setting a goal for yourself to submit and certify your list several days before it is due. This avoids any last minute mistakes, poorly thought-out changes, or delays due to unexpected internet issues.

Once your list is entered and you are awaiting the results, try to focus your thoughts on the known success that osteopathic applicants have had in the match, as reported by the NRMP.

In addition to the above statistics showing DO success in the match, the 2020 NRMP Program Director’s Report reminds us that the vast majority of programs (95%) cite interpersonal skills as a factor in ranking an applicant, and this factor carries the highest importance overall. As an osteopathic student, you have been well-trained to think holistically and communicate effectively. Trust in the process and in yourself; however, if you do find stress and anxiety to be overwhelming, be sure and reach out to your mentors, advisors, and/or a counselor for help. You can also refer to the Candidate Wellness portion of our Road to DO Licensure page for editorial that could be of benefit to you.


Tracy Middleton, DO, FACOFP, Chair & Clinical Professor, Department of Osteopathic Family & Community Medicine, Midwestern University, AZCOM
Sabri Zooper is certainly someone you want to know—an osteopathic medical student at Texas College of Osteopathic Medicine (TCOM) who is paving the way for fellow minorities on their Road to DO Licensure.

Sabri Zooper is certainly someone you want to know—an osteopathic medical student at Texas College of Osteopathic Medicine (TCOM) who is paving the way for fellow minorities on their Road to DO Licensure. Her passion and eloquence is a door-opener for other medical students of color following in her footsteps. She has her hands in many jars, acting as a Representative on the Advisory Council of the National Center for Pre-Faculty Development SNMA- BNGAP, National Osteopathic Affairs Chair of the Student National Medical Association, President of the Black Graduate Student Association - UNTHSC at Fort Worth, and as a Chapter Liaison for the Academic Medicine Career Development TCOM – BNGAP. We were honored to have the opportunity to hear her story with advice for other osteopathic medical students.


What inspired you to become a DO, specifically? Tell us your story.

My grandmother was unfortunately sick most of my life with type 1 diabetes and hypertension, and I found out from my mom when I was older that many of her doctors were osteopathic physicians. I’m from Michigan, and Michigan is a mecca for DOs.

I spent so much time in the hospital growing up. I have to give my respect to the nurses and doctors—one even sat down with me after my mother had donated a kidney to my grandmother to draw me a diagram and explain what was happening. At eight years old, it eased my soul when I was so scared in the middle of the hospital. I remember feeling alone, and I’m so grateful he took the time to go over it with me. It was a huge moment to be able to connect with someone beyond the world of medicine just as a person.

I’m a first generation medical school student—a trailblazer trying to figure it all out myself. So that moment when I was a little girl helped me do that. The decision to become a DO is rooted in my background, and is why I wanted to take this path. It’s not just something I found online that I thought was cool; it’s integrated into my history.

The DO approach I feel is what a physician should be. I always talk about this one time I had hurt my neck, and I went to see a doctor who happened to be an MD. He didn’t even touch me! He just looked at me, asked a question, and gave me some painkillers. And they were heavy painkillers—even during this opioid crisis we’re having. That wasn’t what I needed. He could have just touched it to try and see what was going on, but he didn’t even want to engage with me.

One of the best things about starting off at a DO school is how physical you are immediately. I was taught how to be comfortable with touching—how to palpate—how to engage in a permissible way. We’re taught to ask the patient, “Is this comfortable for you? If it’s okay, I’m going to palpate real quick and see some of the tense areas.” There’s even a double board certified doctor at my school in Neuromusculoskeletal medicine and also in OB/GYN, and she uses both to treat her patients! Who wouldn’t want to be a DO?

We often hear the phrase ‘osteopathic distinctiveness’ used across the profession. What does that phrase mean to you personally?

I can talk about that all day! I’ve rounded with some MD students and we are equally capable. However, I do think there are some benefits that DOs have that MDs may not. We know more about lymphatics and nervous systems; we know more about how things are connected—how the body’s systems work together as a unit. I feel as though DOs are distinctive in that we have a deeper background in the body: how it moves, how it works, how it doesn’t work, what we can do to help it flow better, how we can assist it in its own healing process, and how we can help it, period.

I feel MDs focus more on problem solving. They are the first ones to say: “Here’s the problem and here’s the solution.” I love that, but that’s not always the right approach to patient care. Sometimes, you need to be able to connect with the patient and understand why they have these issues—look at their stress levels, look at their support system, and look at what they’re eating. What other histories do they have that contribute to their issues? Being a DO has taught me how to look at the person as a whole picture instead of a problem. I feel that’s what osteopathic distinctiveness is. I don’t want to go into a patient room having read and judged their chart and that be my whole understanding of the patient. How do I gain their trust? How do I understand where they’re coming from? You can tell them all day what to do until you’re blue in the face, but if they don’t trust you, they’re not going to do it.

I just finished my OB/GYN rotation, and I was working with high risk pregnancies when a lady who was having twins came in. The MD had done a urinary drug screen on her and it came back positive for cocaine. I asked the doctor before we went in if we were going to talk about it, since she was already high-risk. The doctor said we weren’t. I was very disappointed that we did not address her screening; we needed to understand why she was positive and what was going on. Why is she doing cocaine? Is someone trying to put cocaine in her system? There are so many questions whose answers could potentially help her. This was the opportunity for us to partner with her. That’s another big thing about osteopathic distinctiveness—we partner with our patients. Just as much as I’m trying to help you in here, you have to help me out there.

I’m grateful for the training I’ve had about empathy. A lot of physicians don’t have it at all. It’s just a job sometimes, and it’s become almost robotic. I could never look at my patients like that. I could never see a positive cocaine drug screen and not talk about it. As a person, I can’t do that, and as an osteopathic physician, I definitely can’t do that.

In your speech to COCA, you mentioned how high your stress levels were when preparing for COMLEX-USA during both a pandemic and civil unrest. Tell us about the major challenges you’ve faced and how you overcame them.

In my second year, I really struggled with some aspects of medical school academically. I hit roadblocks with some classes, and I struggled to believe that I could make it. I didn’t open up about it. I was depressed. I didn’t know I was depressed. Thankfully, I got the help I needed to get through that, but then 2020 happened! And it just changed everything. My COMLEX-USA kept getting pushed back, and then my study schedule was off. Then, in the middle of that, civil unrest. We were struggling as a group of URMs (underrepresented minorities). Alongside studying for my exam, trying to figure out when I was going to take it, people were dying. There was protesting everywhere—the election; it was a mess. There were moments I didn’t even feel safe going outside of my house. I didn’t know if I was going to be a target. I know a lot of my friends truly struggled. We were afraid, and that fear was heavy.

A few students, including myself, were working with our school to increase our diversity, equity, and inclusion efforts. We reached out to our school to get support so we could feel safer. We wrote a petition of asks, similar to what the SNMA sent to COCA. We had over 400 signatures on it. I think that changed a lot of things not just at my college, but at our whole campus. How can we make TCOM better? It’s a great school, and we are working to make everybody feel like they have a space here.

All throughout that, my test kept getting pushed back, pushed back, pushed back. I finally was able to take my exam in October after I was originally supposed to take it in August. With everything going on, I still had to dig down and figure out what I needed to know to pass COMLEX-USA. What I ended up doing was hiring a board prep program. My tutor helped me so much, and I needed somebody to be with me through this because I knew I couldn’t do it alone.

Did you also take USMLE, and if not, why didn’t you?

All throughout my time in medical school, I was told over and over again that if I wanted to be an OB/GYN, I needed to take USMLE. But I’m not going to school for Step! I’m going to school for COMLEX-USA—for osteopathic medicine, and I’m very proud of that. I don’t feel the need to prove myself to another branch of physicians in order to be able to serve.

I don’t think it’s fair to ask students who work just as hard, if not harder than MDs (because we have an extra 300 hours of training) to take two separate exams in addition to medical school. I’m not taking another exam. I am a DO through and through, and that’s how I want to be received in a program. For me, there’s a reason I came to this school—there’s a reason I’m going to be a DO. I personally feel that I’m confident in my score, I’m confident in my application, and I’m going to be confident in my letters of recommendation.

What advice would you give to other COM students preparing for COMLEX-USA?

Reach out for help when you need it, and figure out what works for you. Even the best of the best students need a resource to help them. But because a lot of people come from backgrounds like me: single parent home, first person to do this, nobody around me knows what to do—they may not have the resources or the know-how to get those resources because they’re the first person trying to figure it out.

For me, I am a talkative person and I needed to interact with someone. I need someone to look at me through the screen and ask me: “What do you think about this?” and “Let’s do some practice questions together!” And then I’d teach the material back to them so I’d know I knew it.

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

The thing I’m looking forward to the most is having ‘Dr. Zooper’ on a piece of paper. The last thing my grandmother told me when I was a sophomore in college—she was dying and didn’t have a lot of strength left, but she wanted to make sure her only grandbaby finished. She told me to finish. I knew exactly what that meant. She didn’t have to say anymore—just, “Sabri, I want you to finish.” So, I’m finishing! I’m going to finish and I’m going to go through this.

Being a doctor is an opportunity for me to be able to be the inspiration that so many others were for me. I couldn’t have gotten through undergrad had I not seen other black women graduate in biology and go forward. I wouldn’t have been able to even think about medicine had it not been for my mom. They opened all these doors. I want to be that for others too and pass the torch—to keep that going. I don’t want to stop at being a doctor. I want to keep going and give back in medical education.

As an African American, one of the biggest reasons for our success and our progression has been our ability to educate ourselves—being able to read, go to school, have professions, and build lives for ourselves. It’s very important to continue that legacy—of going on to be an educator at the highest level. I want to be a dean. It’s important for all students to see different colors in leadership—different types of people and different perspectives. I want to be a part of the next generation of physician educators. That’s what I look forward to, and I’m excited!

I think the biggest power that I have is understanding that my life just isn’t about me. Yes, I’m the leading lady in my life, but, at the end of the day, it just isn’t about me. I think when you take the focus off yourself, there is so much more joy and wholesomeness in that. It’s about the impact you leave.

I heard a quote earlier this week: “When you’re born, you look like your parents, but when you die, you look like your choices.” What kind of choices am I going to make? I want to make the right ones! The most influential people are those who made you feel something—that made you believe something—that made you believe in yourself. I’ve been through so many things in my life where I didn’t feel good enough, strong enough, and I didn’t feel like I would ever be enough. I know what that feels like, and I know what it’s like to feel unseen, unheard, and unimportant. I want to make sure the people I come in contact with—no matter if they are doctors or not—that those people know I see them. You’re a human; I’m a human. Let’s be humans together! And let’s help each other because that’s what it’s about.


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Applying to Residency: Interview with Ronak Mistry, DO, on Fellowship. Despite the year that 2020 was, we are proud to say that this year’s Medicine Specialty Matching Program (MSMP) was the largest in history. Over 5,200 DO, MD, and IMG applicants matched to Medicine subspecialty fellowships.

Despite the year that 2020 was, we are proud to say that this year’s Medicine Specialty Matching Program (MSMP) was the largest in history. Over 5,200 DO, MD, and IMG applicants matched to Medicine subspecialty fellowships.

One subspecialty where DO matches really increased was Hematology-Oncology (64 DO matches!). We were lucky to be able to sit down and chat with our Resident Ambassador, Ronak Mistry, DO, who matched in Hematology and Oncology at Vanderbilt University.


What made you decide you wanted to do a fellowship?

I must say that I did wrestle with this question a bit during residency. I love Internal Medicine. I love the patient population, the variety in cases, the opportunity to build differential diagnoses, and testing these. However, I realized that any fellowship after an Internal Medicine residency would ensure that I could not only continue to do all of these things, but also be very skilled in one particular area. My genuine interest in hematology and oncology ultimately convinced me that a fellowship was the right way to go.

How did your osteopathic curriculum influence your interest in pursuing a fellowship and help you prepare for success?

My osteopathic curriculum at RowanSOM taught me to be an excellent clinician with great bedside manner and clinical reasoning skills. We were taught to always take the time to listen to our patients and ensure that they were part of the decision making for their treatment plan every step of the way. Being a DO helped me to be a great internist, which is the root of all sub-specialties within Internal Medicine.

As a DO, what advice would you give to those coming after you who are also thinking about applying for a fellowship?

The best advice I have is to keep an open mind when you start residency and to learn your field. Anchoring on a specialty too early will deter you from learning. The other thing to consider is that fellowship means more years of training, which means that there are financial implications and life implications. So it's important to ask yourself if this really is the best thing for you. There is nothing wrong with not wanting to pursue fellowship at all! But if you decide that you want to go ahead and focus on a sub-specialty, it is important to start to find a mentor or mentors in the field who can give you guidance, suggest research opportunities, and connect you with others.

Regarding research, please note that it is not a one-size-fits-all. Some fields value research more than others, and quantity is not always more important than quality. The types of projects and publications you need to be competitive in each field is different and that is where a strong mentor will be most helpful.

Lastly, when it comes time to apply, spend some time and consider what your priorities are. There are many factors that may be important to you, and can really affect the types of programs you will need to apply to help you be successful in your future career.

What made you choose hematology-oncology?

From a basic science perspective, I have been interested in hematology/oncology for quite some time. I majored in biochemistry and cell and molecular biology in college and so we frequently looked to cancers as a real-life illustration of what happens when the cell's intrinsic system of checks and balances goes awry. Through shadowing experiences and rotations throughout medical school and residency, respectively, I saw myself doing this every day. I witnessed the deep appreciation and trust patients have for their hematologists and oncologists. I wanted to the person to have the privilege of gaining that trust and ensuring that I was there for them on their best days and their worst days.

What aspects of being an osteopathic physician do you think will be a benefit to your Hematology-Oncology patients?

Central to Osteopathic Medicine is the tenet that each person is a unit of mind, body, and spirit. Dean Cavalieri at RowanSOM, where I went to osteopathic medical school, reminded us of this quite frequently. I have worked hard throughout my training as a student and a resident to be the best clinician, researcher, teacher, leader, and educator that I can be and I am very proud of that. I believe that these traits, my determination, and my holistic approach to medicine really came through when I interviewed—places that include some of the most elite and prestigious programs in the country. As a future hematologist/oncologist, I will continue to ensure that I find ways to connect with all of my patients on multiple levels using my osteopathic training to ensure that they feel heard, informed, and respected.

How excited are you about your match to Vanderbilt?

I am absolutely elated to have matched for my Hematology/Oncology fellowship at Vanderbilt University Medical Center in Nashville, Tennessee. Despite it being an atypical year for interview season—seeing that all of my interviews were virtual—I felt a sense of community amongst all of the faculty and the fellows just from observing their interactions and the way they spoke of each other. Furthermore, I was searching for a program with a strong commitment to teaching its fellows, a faculty who have varieties of research interests, and opportunities to grow as an educator. I saw all of this and more in the program and cannot wait to begin my fellowship.

That being said, I would be remiss if I did not acknowledge the support of my parents, my siblings, my fiancée, my incredible family, and friends who have supported me each and every day. Along the way, I have been incredibly fortunate to have had the most phenomenal teachers and mentors throughout my time in elementary school, high school, at Drew University, at Rowan University School of Osteopathic Medicine, at the Hospital of the University of Pennsylvania, and at Pennsylvania Hospital, who have always inspired me and motivated me to keep pushing the bar higher and making me the best clinician that I can be. I am also thankful to NBOME for giving me the chance to be a Resident (and future Fellow) Ambassador. I look forward to taking you all on my fellowship journey with me!


Navigating GME | Match Resources

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COMAT Clinical Subjects
In this section
When it comes to learning new information, we all have different learning styles. For most of us, it’s all about how the content is presented to us. There is also something to be said about the environment in which we learn in.

When it comes to learning new information, we all have different learning styles. For most of us, it’s all about how the content is presented to us. There is also something to be said about the environment in which we learn in. Some of us prefer to be indoors, seated at a computer and laser-focused with a cup of herbal tea, while others need sound or stimulation with fresh air and a can of Red Bull. Whatever your style, we’ve got you covered. Our newest product, WelCOM, creates an all-new way to test your osteopathic knowledge to see if you’re ready for COMLEX-USA Level 1 or 2-CE.

We’re pretty sure you’re familiar with COMSAE—you may have even used it. WelCOM is an entirely different self-assessment tool, designed for busy schedules much like yours. It’s a convenient formative assessment platform for durable and complex learning—essentially, we’ll help you learn and retain what is uniquely challenging to you through Q&A.

Now, you can not only fit more study-time into your busy schedule, but also receive immediate feedback and reference related materials right on the spot, (a big part of the learning and retention concept). Want to know more? Keep scrolling to explore all the reasons why you should check out WelCOM.

Convenient

Sometimes, you just want to pick up studying and go. Preparing for COMLEX-USA shouldn’t mean you have to press the pause button on your life and glue yourself to your computer. With WelCOM, you can access questions anywhere, anytime, using any smart device. When you’re on the go, or really just want to lay in bed and crank out a few questions, we’re here for you. WelCOM’s mobile smartphone app makes it almost too easy to access self-assessment questions.

Flexible

WelCOM not only lets you decide where you answer the questions, but also when. Don’t want to sit down for two hours and binge questions? You don’t have to. While the self-assessments we normally offer are taken at a single point in time, WelCOM allows you to customize the pacing of your questions to fit your own unique study schedule. You’ll even get reminders if you aren’t keeping up with your questions.

Responsive

That gut-wrenching ‘how did I do?’ anticipation has no place here. WelCOM provides instant feedback on each question as you complete it. No more waiting until the end of your self-assessment to find out how you did, wondering which questions you got correct, which you got incorrect, or why. WelCOM’s instant feedback is what helps guide your learning and increases your understanding as you go.

Enhanced Learning

What’s better than instant gratification? Rationales with associated references. A rationale tells you why the right answer is correct, and why the incorrect answers are not. This allows you to reinforce the material in the question so that you can learn from your performance on that question before you move on to a new concept. While answer rationales explain the ‘why,’ related references allow you to read further to reinforce your learning and help you to better understand the material, if needed for a particular concept

WelCOM also maps directly to COMLEX-USA blueprint, so you can see areas of the blueprint you need to focus on more in your future studies.

Modern Approach

We’ll help you tackle COMLEX-USA preparation from all angles. You don’t have to pick one or the other—WelCOM can be used in addition to COMSAE. It will work on your content and question format mastery, while COMSAE is perfect for getting game-day ready, since it mimics how COMLEX-USA will look when you go to take it. It is written by the same subject matter experts as COMLEX-USA, and to the COMLEX-USA blueprint, so you know you are getting the best preparation for COMLEX!

To learn more, visit the WelCOM page on our website or check out our latest video. Are you ready for launch?

 

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Match 2021 is off to a great start! This year’s NRMP Medicine Specialty Matching Program (MSMP) was the largest in history with over 5,200 DO, MD and IMG applicants matching to Medicine subspecialty fellowships – that’s a 6.1% increase! The MSMP includes nearly all 14 Internal Medicine subspecialties for fellowship positions that will begin in July 2021, and includes over 600 DOs who matched.

Match 2021 is off to a great start! This year’s NRMP Medicine Specialty Matching Program (MSMP) was the largest in history with over 5,200 DO, MD and IMG applicants matching to Medicine subspecialty fellowships – that’s a 6.1% increase! The MSMP includes nearly all 14 Internal Medicine subspecialties for fellowship positions that will begin in July 2021, and includes over 600 DOs who matched.

The number of DOs who choose to complete a fellowship in a subspecialty after completing their residency continues to rise. And this year’s MSMP was no exception—with DOs matching in 18 subspecialties and making up 12% of Internal Medicine subspecialty matches. This year, the number of DO graduates participating in the MSMP rose by 9.6% from appointment year 2020, and 101.6% from appointment year 2017, far more than any other applicant group.

Greater than 10% of the matches in the following subspecialties were made up of osteopathic applicants.

  • Cardiovascular Disease
  • Endocrinology, Diabetes, and Metabolism
  • Gastroenterology
  • Geriatric Medicine
  • Hematology and Oncology
  • Hospice and Palliative Medicine
  • Infectious Disease
  • Interventional Pulmonology
  • Nephrology
  • Oncology
  • Pulmonary
  • Pulmonary Disease and Critical Care
  • Rheumatology

If you’re considering a fellowship after finishing your residency, here are some resources from the American Osteopathic Association and the American Medical Association about what you should take into consideration before making your decision.

Congratulations to all the residents who matched to fellowships so far this year!


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The NBOME is pleased to recognize the 2020 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 exam programs. These volunteers wear a variety of hats for the NBOME – writing and reviewing test items, serving as physician examiners for COMLEX-USA Level 2-PE, and supporting our mission to protect the public through competency assessment.

PHILADELPHIA, PA. The NBOME is pleased to recognize the 2020 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 exam programs. These volunteers wear a variety of hats for the NBOME – writing and reviewing test items, serving as physician examiners for COMLEX-USA Level 2-PE, and supporting our mission to protect the public through competency assessment.

Each year, the NBOME selects the best-in-class item writers and case authors from a large group of contributors. Congratulations to these esteemed awardees for their exemplary commitment to producing valid and high quality exam content.

2020 COMLEX-USA Level 1 Item Writer of the Year: Hannah Coulson, DO

Dr. Coulson is an assistant professor of pathology at Edward Via College of Osteopathic Medicine – Carolinas Campus. She has been a significant contributor to all levels of COMLEX-USA since she joined the National Faculty in 2017.

2020 COMLEX-USA Level 2-CE Item Writer of the Year: Robert Gioia, DO, DDS

Dr. Gioia is an attending physician of family medicine at Spectrum Health in Michigan and has been a member of our national faculty since 2018.

2020 COMLEX-USA Level 2-PE Case Author of the Year: Kym Carpentieri, DO

Dr. Carpentieri is an assistant professor of family medicine at New York College of Osteopathic Medicine of New York Institute of Technology-Old Westbury. She has been a member of the Case Development Committee since 2013.

2020 COMLEX-USA Level 3 Item Writer of the Year: Suzanne Rogers, DO

Dr. Rogers is an assistant professor of pediatrics at Idaho College of Osteopathic Medicine. She has been a member of our National Faculty since 2018, and provided significant contributions to the COMLEX-USA Level 2-CE and Level 3 examinations as well as the COMAT Clinical Pediatrics examination.

2020 Clinical Decision-Making (CDM) Case Writer of the Year: Alesia Wagner, DO

Dr. Wagner is the Vice Chair for Primary Care and an Assistant Professor at Touro University College of Osteopathic Medicine – California, and has been a long-standing member of our National Faculty, as well as the CDM committee. She has provided significant contributions across all of the COMLEX-USA examinations.

2020 COMLEX-USA Osteopathic Principles and Practice (OPP) Item Writer of the Year: Edward Shadiack, III, DO

Dr. Shadiack is a Clinical Fellow at the Children’s Hospital of Philadelphia. He has been a member of our National Faculty since 2016, and has been heavily involved with all levels of the COMLEX-USA examinations and COMAT.

2020 COMLEX-USA Preventative Medicine/Health Promotion (PMHP) Item Writer of the Year: Theresa McCann, PhD, MPH, CHSE

Dr. McCann is a Professor and Discipline Chair for Epidemiology, Community & Public Health, and Preventive Medicine at Edward Via College of Osteopathic Medicine – Virginia Campus. She is a new member to our National Faculty in 2020, and has been heavily involved in all levels of COMLEX-USA examinations.

2020 COMAT Clinical Item Writer of the Year: Bernadette Riley, DO

Dr. Riley is an associate professor of Family Medicine at New York College of Osteopathic Medicine of New York Institute of Technology-Old Westbury and a long standing member of our National Faculty. She has been a significant contributor to both COMAT and COMLEX-USA examinations.

2020 COMAT Foundational Biomedical Sciences (FBS) Item Writer of the Year: Rebecca Pratt, PhD

Dr. Pratt is a professor of anatomy at Oakland University William Beaumont School of Medicine. She has been a member of our National Faculty since 2014, and contributes to both COMAT Foundational Biomedical Sciences and COMLEX-USA Level 1 examinations. Dr. Riley was also awarded Item Writer of the Year for COMAT Foundational Biomedical Sciences in 2018.

The NBOME is honored to have such talented and committed contributors in our National Faculty. Learn more about how to join our National Faculty here.


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On behalf of the Board of Directors, Board Chair Geraldine T. O’Shea, DO, and the staff of the National Board of Osteopathic Medical Examiners (NBOME), we extend special appreciation to the National Faculty Chairs whose terms ended on December 31, 2020 for their longstanding service. We appreciate their time and dedication, as well as those who encouraged, nominated or made it possible for these chairs to participate with the NBOME.

PHILADELPHIA, PA. On behalf of the Board of Directors, Board Chair Geraldine T. O’Shea, DO, and the staff of the National Board of Osteopathic Medical Examiners (NBOME), we extend special appreciation to the National Faculty Chairs whose terms ended on December 31, 2020 for their longstanding service. We appreciate their time and dedication, as well as those who encouraged, nominated or made it possible for these chairs to participate with the NBOME.

Clinical Sciences Department Chair, Osteopathic Principles & Practice / Neuromusculoskeletal Medicine

Mark Sandhouse, DO – Nova Southeastern University Kiran C. Patel College of Osteopathic Medicine

Dr. Sandhouse has served the NBOME in collective National Faculty leadership roles for over 15 years, as COMLEX-USA Composite Examination Committee Member: 2016-2020, COMLEX-USA Level 1 Advisory Committee Member: 2016-2020, CTAC Member: 2013, 2015 and National Faculty Department Chair of Osteopathic Principles and Practice / Neuromusculoskeletal Medicine: 2015-2020.

Clinical Sciences Department Chair, Obstetrics and Gynecology

Eric Carlson, DO, MPH – Philadelphia College of Osteopathic Medicine

COMAT Chair, Osteopathic Principles & Practice / Neuromusculoskeletal Medicine

Danielle L. Cooley, DO – Rowan University School of Osteopathic Medicine

Clinical Sciences Division Chair, Medical Ethics, Jurisprudence and Professionalism

Sarah Hall, DO – Oklahoma State University Center for Health Sciences College of Osteopathic Medicine

COMAT Chair, Family Medicine, served as Charter COMAT FM Chair

Tracy Middleton, DO – Arizona College of Osteopathic Medicine of Midwestern University

Dr. Middleton has been elected to NBOME Board of Directors starting January 2021

Additionally, we would like to congratulate and welcome the following National Faculty members who have been appointed to 2021 National Faculty Chair positions:

Clinical Sciences Department Chair – Internal Medicine, Geriatric Medicine and Dermatology

Wayne R. Carlsen, DO – Ohio University Heritage College of Osteopathic Medicine – Athens

Dr. Carlsen began his appointment in July 2020.

Clinical Sciences Department Chair – Obstetrics and Gynecology

Stephanie L. Zeszutek, DO, RPh – Touro College of Osteopathic Medicine – Middletown

Clinical Sciences Department Chair – Osteopathic Principles & Practice / Neuromusculoskeletal Medicine

Danielle L. Cooley, DO – Rowan University School of Osteopathic Medicine

Preventive Medicine & Health Promotion Division Chair – Medical Ethics, Jurisprudence & Professionalism

William R. Blazey, DO – New York College of Osteopathic Medicine of New York Institute of Technology – Old Westbury

COMAT Examination Chair – Family Medicine

Sarah M. Hall, DO – Oklahoma State University Center for Health Sciences College of Osteopathic Medicine

COMAT Examination Chair – Osteopathic Principles and Practice / Neuromusculoskeletal Medicine

Rebecca E. Giusti, DO – Western University of Health Sciences/College of Osteopathic Medicine of the Pacific

The NBOME is honored to have such talented and committed thought leaders that represent all aspects of clinical and foundational biomedical science disciplines in our National Faculty. Learn about our other National Faculty leaders and how to join our National Faculty here.


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Errichetti AM, Lorion A, Sandella JM. Defining Professionalism: Lessons learned from COMLEX-USA Level 2-PE. Presentation at: Educating Leaders 2022; April 2022; Denver, CO.

Boulet JR, Lorion A, Sandella JM. Assessing the Clinical Skills of Osteopathic Medical Students/Graduates without a National Licensing Examination. Presentation at: Educating Leaders 2022; April 2022; Denver, CO.

Mao X. A Validity Study of COMLEX-USA Level 3 With New Test Design. Presentation at: Educating Leaders 2022; April 2022; Virtual.

Mao X. Using a Data-driven Approach to Guide Item Development in Medical Examinations. Presentation at: 2022 Annual NCME Meeting; April 2022; San Diego, CA.

Peterson K, Lorion A. SP Assessments: A Thing of the Future as well as the Past. Presentation at: 2021 Association for Standardized Patient Educators Annual Virtual Conference; June 2021; Virtual.

Lorion A, Mirigliani L. In-Person High-Stakes Testing During a Pandemic. Presentation at: 2021 Association for Standardized Patient Educators Annual Virtual Conference; June 2021; Virtual.

Peterson K, Mirigliani L. Analyzing the SP Recruitment Process. Presentation at: 2021 Association for Standardized Patient Educators Annual Virtual Conference; June 2021; Virtual.

Maeda H, Barnum S. Comparison of Proctored and Self-Proctored COMAT Clinical Subject Examination Scores. Presented at: AACOM Educating Leaders 2021; April 2021; Virtual

Mao X, Zhang Q. An Exploration of an Integrated Approach for Enemy Item Identification. Paper presented at: American Educational Research Association annual conference; April 2021; Virtual.

Peterson K. Inclusion and Diversity in SP Recruitment. Presentation at: EMS Webinar; January 2021; Virtual.

Peterson K. Defining and Utilizing Health Literacy in SP Portrayal. Presentation at: 2020 Association for Standardized Patient Educators Annual Virtual Conference; June 2020; Virtual.

Mao X, Dickerman J, Tsai T-H, Wang Y. Exploring the psychometric properties of CDM items. Paper presented at: American Educational Research Association annual meeting; 2020.

Mao X. A comparison of methods for deriving composite scores for mixed-format test. Paper presented at: National Council on Measurement in Education annual meeting; 2020.

Maeda H, Wang X, Barnum S, Dawley M, Tsai T-H. Score Relationship of COMLEX-USA Level 1, COMSAE Phase 1, and COMAT FBS Comprehensive Examinations. Paper presented at: 2020 American Association of Colleges of Osteopathic Medicine Annual Conference; March 2020; Virtual.

Browne M, Wojnakowski M, Horber DT. Choosing Wisely: So Many Options for Assessment Administration. Which will Enhance Your Exam’s Validity and Fairness? Paper presented at: 2019 Innovations in Testing Conference; March 2019; Orlando, FL.

Castaneda R, Hudson KM, Wang X. Uncovering Hidden Response Time Patterns of COMLEX-USA Level 3 Examination. Poster presented at: 2019 American Association of Colleges of Osteopathic Medicine Annual Conference; April 2019; Washington, DC.

Errichetti AM. Standardizing Judgment: A Qualitative Study of How SPs Co-Construct Meaning. Presentation at: 2019 Association for Standardized Patient Educators Annual Conference; June 2019; Orlando, FL.

Errichetti AM. Debriefing Residents with Good Judgment. Presentation at: New York Colleges of Osteopathic Medicine Educational Consortium; April 2019; New York City, NY.

Horber DT, Waters S. CATALYST: Transforming Physicians’ Assessment into Learning. Presentation at: 2019 Meeting of the American Board of Medical Specialties; September 2019; Chicago, IL.

Hudson KM, Yin Y, Tsai T-H. Transitioning to Automated Test Assembly: A Comparison of Equating Methods. Paper presented at: 2019 National Council of Measurement in Education Conference; April 2019; Toronto, CAN.

Maeda H, Wang X. The effects of test familiarity on person-fit and aberrant behavior. Paper presented at: 2019 National Council of Measurement in Education Conference; April 2019; Toronto, CAN.

Mirigliani L, Lorion A. When Life Gets in the Way: Getting SPs out of Their Heads and into the Role. Presentation at: 2019 Association for Standardized Patient Educators Annual Conference; June 2019; Orlando, FL.

Parshall C, Julian E, Parikh S, Horber DT. Using Nudges for More Effective Exam Programs. Paper presented at: 2019 Innovations in Testing Conference; March 2019; Orlando, FL.

Ronkowksi E. “Collaborative Cognitive Item Mapping” as part of Innovations in Assessment, Learning, and Improvement: Lightning Round Part 1. Presentation at: 2019 Meeting of the American Board of Medical Specialties; September 2019; Chicago, IL.

Shaffer D, Waters S. Ensuring Ongoing Physician Competency with CATALYST. Presentation at: 2019 Meeting of the International Association of Medical Regulatory Authorities; September 2019; Chicago, IL.

Errichetti AM, Fancher S. Standardized Patient Communication Assessment in Medical and Advanced Practice Nursing Education: Two Perspectives. Podium presentation at: 18th International Meeting on Simulation in Healthcare; January 13-17, 2018; Los Angeles, CA.

Errichetti AM, Drda V, Kachur E. Using the ORID Framework to Conduct Difficult Conversations with SPs. Presentation at: International Meeting of Simulation in Healthcare; January 13-17, 2018; Los Angeles, CA

Gimpel JR, Shaffer DC. Use of COMLEX-USA Examination Program in ACGME Programs. Presented at the Accreditation Council for Graduate Medical Education’s Annual Educational Conference, Orlando, FL, March 3, 2018.

Roberts WL. An investigation of a rater-mediated licensing performance examination equating quality with the Rasch model. Paper presented at: American Educational Research Association Conference, April 2018, New York.

Horber DT, Flamini J. CATALYST: the continuous assessment platform for physician learning. Presented at the American Association of Osteopathic Medical Colleges (AACOM), Washington DC, April 18, 2018.

Shao C, Wang Y, Liu S, Tsai T-H. Investigation of Differential Item Functioning on COMLEX-USA Examination Series. Poster presented at: American Association of Osteopathic Medical Colleges; April 18, 2018; Washington, DC.

Gallagher LA. A Comparative Review of the Factors Which May Influence Residency Program Interviews & Ranking. Poster presented at: American Association of Osteopathic Medical Colleges; April 18, 2018; Washington, DC.

Lorion A, Mirigliani L. When Grief Isn’t Simulated: SPs Dealing with Real-life Death. Presentation at: Association of Standardized Patient Educators; June 18, 2018; Kansas City, MO.

Errichetti AM, Drda V, Kachur E. Lank A, Lorion A. Using the ORID Framework to Conduct Difficult Conversations with SPs. Presentation at: International Meeting of Simulation in Healthcare, Association of Standardized Patient Educators Annual Conference; June 20, 2018.

Murphy J, Errichetti AM. Training Standardized Patients in a Flipped Classroom. Presentation at: Association of Standardized Patient Educators Annual Conference; June 20, 2018.

Castaneda R, Zhang Q. Automated Item Generation Using Medical Diagnostic Information. Poster presented at: International Meeting of the Psychometric Society; New York, NY, July 2018.

Bruel L, Errichetti AM, Kachur E, Novak D, Jiraeviijinda. Linking Professionalism and Communication Skills in OCSE Stations. Presentation at: EACH International Association for Communication in Healthcare; September 2, 2018; University of Porto, Portugal.

Ferris M, Horber DT. Examinee References and Resources: Steps toward Open-Book Testing and Innovative Item Development. Presentation at: 2018 American Board of Medical Specialties Conference; September 2018; Las Vegas, NV.

Parshall C, Horber DT, Julian E. Improve Your Candidate Experience with Action Design. Presentation at: 2018 Institute for Credentialing Excellence (ICE) Exchange; November 2018; Austin, TX.

Examination Calendar

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 installation of its newest members of the NBOME Board of Directors. Brian A. Kessler, DO; Brookshield Laurent, DO; Tracy O. Middleton, DO; and Michael F. Oliverio, DO, were elected at the annual NBOME Board Meeting (virtual) held in December, 2020.

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 installation of its newest members of the NBOME Board of Directors. Brian A. Kessler, DO; Brookshield Laurent, DO; Tracy O. Middleton, DO; and Michael F. Oliverio, DO, were elected at the annual NBOME Board Meeting (virtual) held in December, 2020.

NBOME board members are carefully chosen based on expertise and experience in clinical disciplines, medical education and assessment, and medical or regulatory administrative experience reflective of the needs of the public.

“During the COVID-era, we are thrilled to be able to welcome four new members to our board to help lead the way to a better future in osteopathic medicine,” John R. Gimpel, DO, MEd, President & CEO shared, “As it is our mission to protect the public, we cannot do so without the guidance and perseverance of our dedicated board of directors.”

“It is with great honor that I welcome our newest board members—and such a warming sight to see more women standing with us,” said Geraldine T. O’Shea, DO, Board Chair, “It is important now more than ever to join hands in our fight against COVID-19 in protecting the public.”

Brian A. Kessler DO, FACOFP, Harrogate, Tennessee

Dr. Brian Kessler serves as the Vice President, Dean, and Chief Academic Officer of Lincoln Memorial University-DeBusk College of Osteopathic Medicine (LMU-DCOM) in Harrogate and Knoxville, Tennessee. LMU-DCOM has a mission to serve rural and underserved communities. LMU-DCOM is an integral part of LMU’s values-based learning community and is dedicated to preparing the next generation of osteopathic physicians to provide health care in the often-underserved region of Appalachia and beyond. Dr. Kessler was nominated to the NBOME Board of Directors by the AACOM.

Dr. Kessler is a graduate of Lake Erie College of Osteopathic Medicine in Erie, Pennsylvania. After completing a traditional rotating internship in Pennsylvania and an Osteopathic Family Medicine Residency at Cleveland Clinic South Pointe Hospital, he practiced with both the Cleveland Clinic and the University Hospitals of Cleveland. It was then that he joined Campbell University to pursue a career in academic medicine.

He served previously as the inaugural Associate Dean of Clinical Affairs at Campbell University Jerry M. Wallace School of Osteopathic Medicine in Buies Creek, North Carolina. He is the former Chief Academic Officer and Director of Medical Education at Cleveland Clinic South Pointe Hospital, Cleveland, Ohio.

Dr. Kessler is an AOA Health Policy Fellow, an Academic Leadership Fellow, and a Fellow of the American College of Osteopathic Family Physicians. He currently serves as a commissioner on the Commission on Osteopathic College Accreditation. He is a member of the American Osteopathic Association, the Tennessee Osteopathic Medical Association, and member and governor of the American College of Osteopathic Family Physicians. He serves as a state delegate to both the AOA House of Delegates and the ACOFP Congress of Delegates.

Brookshield Laurent DO, Jonesboro, Arkansas

Dr. Brookshield Laurent is the chairwoman and associate professor for the department of Clinical Medicine at NYIT-College of Osteopathic Medicine at Arkansas State University. She is also the Executive Director for the Delta Population Health Institute, the community engagement arm for NYITCOM at Arkansas State University.

Dr. Laurent earned her Doctorate in Osteopathic Medicine from Rowan-School of Osteopathic Medicine and completed specialty training in Family Medicine at Christiana Care in Newark, Delaware. Dr. Laurent is a fellow of the AACOM Osteopathic Health Policy Fellowship. Dr. Laurent is also a fellow of the Physician Leadership Institute through the American College of Osteopathic Family Physicians.

During Dr. Laurent’s tenure at NYITCOM, she has served as course director for foundational medical and clinical skills courses. Dr. Laurent was appointed as an associate faculty for the NYIT- Center for Global Health, teaching and providing students opportunities to engage in global health research, policy, and practice. Dr. Laurent’s work in global health led to her appointment as chair for the Peredo Hospital Health Advisory Board for a rural health care organization in Haiti.

Dr. Laurent was appointed as director for the NYITCOM Population Health Certificate Program, which was established to prepare rising physicians to become leaders in community health. She has further developed the program to equip student physicians to address social determinants of health and gain competencies in U.S. and global health policy, health advocacy, and rural health.

Tracy O. Middleton DO, FACOFP, Glendale, Arizona

Dr. Tracy Middleton is an educator, mentor and leader in osteopathic family medicine. She is board certified in Family Medicine and osteopathic manipulative medicine, with experience in private practice, as a residency attending physician, and as an academic physician. As Chair and Clinical Professor of Osteopathic Community and Family Medicine at Midwestern University, Arizona College of Osteopathic Medicine, she is devoted to the enhancement of osteopathic medical education, curricular reform and developing new learning experiences, and enjoys mentoring students and faculty.

Dr. Middleton is a 1988 graduate of Oklahoma State University-College of Osteopathic Medicine and completed her family medicine residency at Flint Osteopathic Hospital in Flint, Michigan. She is a fellow of the American College of Osteopathic Family Physicians (ACOFP), was recipient of the ACOFP Fellows Most Outstanding Scientific Paper Award, and is a regular chapter author for the 5-Minute Clinical Consult. As a NBOME National Faculty member, she has been an item writer since 1999, participated on several committees, served as the Chair of the NBOME COMAT Family Medicine Examination Committee and as Chair of the COMAT Advisory Committee. Dr. Middleton is on the board of directors for the Arizona chapters of both the American College of Osteopathic Family Physicians (ACOFP) and the American Academy of Family Physicians. She is a prior recipient of the Arizona Osteopathic Medical Association (AOMA) Outstanding Mentor Award, the AOMA Physician of the Year Award, the ACOFP Educator of the Year Award, the AzACOFP President’s Award, and has been named to the American Osteopathic Mentor Hall of Fame.

Michael F. Oliverio DO, North Bellmore, New York

Dr. Michael F. Oliverio is a solo practice Osteopathic Physician delivering Osteopathic Manipulation and primary care service to his patients on Long Island, New York since 2003.

Dr. Oliverio earned his D.O. degree from NYITCOM in 1997 after completing a 1 year undergraduate fellowship in OMM. He served his rotating internship and family practice residency at Long Beach Medical Center, earning both Intern of the Year and the Directors’ Award for Osteopathic Excellence.

A former Assistant Professor in OMM at NYITCOM, Dr. Oliverio has lectured on the state and national level on various topics relating to OMT in primary care. At the state level, he has worked as Executive Director for the New York State Chapter of the American College of Osteopathic Family Physicians (ACOFP) from 2015-2020. Nationally, he has served the American Osteopathic Board of Neuromusculoskeletal Medicine from 2014 to 2019 including 2 years as Vice Chair.

His service to NBOME began in 2001 as an exam reviewer / item writer and he has served as National Faculty Chair for COMLEX-USA Level 3 since 2013.


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NBOME Resident Ambassador, Carisa Champion, DO, JD, MPH, was selected to be a fellow in the Grey’s Anatomy Surgical Communications Fellowship that took place over the summer. We had the chance to sit down with her to briefly discuss her accomplishments and talk more about her own unique Road to DO licensure.

NBOME Resident Ambassador, Carisa Champion, DO, JD, MPH, was selected to be a fellow in the Grey’s Anatomy Surgical Communications Fellowship that took place over the summer. We had the chance to sit down with her to briefly discuss her accomplishments and talk more about her own unique Road to DO licensure.


What inspired you to become a physician? And what drew you to become a DO, specifically?

Growing up, I participated in medical mission trips with my family, and because of that, I was drawn to the field of healthcare—particularly nutrition and other adjunctive healthcare practices. While at Florida State, I learned about the field of public health, and realized that was ultimately what I wanted to be involved in. I also learned about osteopathic medicine and its focus on preventative healthcare during the same timeframe.

Since preventative healthcare was something I wanted to pursue, I specifically applied to DO schools around the country as well as to schools that were close to a law school or also had a public health program because I knew that I wanted to be in public health and use my physician background in that role.

The tenets of osteopathic medicine align well with public health because population health and good public health have a lot to do with preventative health. So, the idea that osteopathic medicine had always been focused on that and is a big part of COM culture and their curricula was attractive to me. I wanted to be able to explore nutrition, lifestyle, and all of those things that contribute to a person’s overall health—not just someone who’s sick, but the person’s whole self. I believe that everything from culture to community is part of osteopathic medicine.

There is so much about being a DO that is special and unique. We often hear the phrase ‘osteopathic distinctiveness’ used across the profession. What does that phrase mean to you, personally?

A lot of answers to our health problems lie in the tenets of osteopathic medicine. We’re dealing with so many health issues—from the opiate crisis to burnout and mental illness. Osteopathic medicine is more than a reaction to those needs of the day. It speaks to all of those areas and it always has because it looks at the whole person.

Thinking back to COMLEX-USA, would you have done anything differently, taken a different approach to studying, or focused less on certain things, more on others? What advice do you have for the COM students coming after you?

For me, I took my COMLEX-USA Level 1 exam during my first semester of law school, and that was one of the hardest times of my entire life—trying to balance my first semester of law school and studying for my first level of COMLEX-USA. I would have certainly changed the timing of that. I think it’s important to make time to study for these exams, and I would have started studying for them a lot earlier. I think there were people in my class that had Board study books in the first semester of medical school that they were referring to with every class they took. If we were studying different diseases or pathologies, they were already referring to their Board study books, where I was just focusing on the class materials. Osteopathic medical schools are meant to prepare you to be a good physician and not someone who is just good at taking tests, but I think that’s something that is a good idea to incorporate into your studying so that you’re aware of both.

What made you choose to specialize in general surgery?

I was drawn to surgery for the same reasons I was drawn to medicine as a career. I grew up doing medical missions and saw the disparities surrounding underserved populations. Surgeons are not only able to impact a community with medical care, but with surgical care as well. I’ve felt that this has prepared me to best serve broadly underserved populations.

We know there is a tremendous amount of stress and anxiety tied to this journey. How did you manage the stress? What worked best for you?

I think that mental health is something that is easy to lose sight of, especially when you’re going a million miles an hour. I learned that you have to take time to reconnect with who you are, and I’d actually schedule time to do so before I felt burnt out and it became an issue. I learned through different experiences that when you’re doing things that energize you and that you’re passionate about, you get more energy and that mental space to devote yourself to other things. I was involved in a lot of things that I was passionate about, and that gave me the motivation to do well in school because to be involved in clubs at my particular university, you had to have a certain GPA. Because of that, I wanted to keep all of my grades up so I could continue to be involved because I loved it.

I also think it is ideal for people to see a counselor and incorporate healthy practices for mental health proactively. Eventually I realized how large an issue this is, and saw compelling research that the COSGP did a couple years ago which showed staggering numbers of medical students that were actually planning to commit suicide—not just had thought about it, but were actually planning on doing it. With that in mind, I think it’s a really big deal to proactively take care of mental health.

What motivated you to apply for the Grey’s Anatomy fellowship?

Passion—this opportunity enabled me to connect my masters of public health and my interest in media together. I’ve enjoyed conducting research on many topics over the years, and the studies I’m involved in have the potential to be read by other doctors. Also, the general public also gets much of their health information from the media. Grey’s Anatomy prides itself on increasingly aiming to be medically accurate, and I’m excited to be a part of that!

What experiences led you to stand out and be offered the Grey’s Anatomy Fellowship?

Passion—this opportunity enabled me to connect my masters of public health and my interest in media together. I’ve enjoyed conducting research on many topics over the years, and the studies I’m involved in have the potential to be read by other doctors. Also, the general public also gets much of their health information from the media. Grey’s Anatomy prides itself on increasingly aiming to be medically accurate, and I’m excited to be a part of that!

How did your Grey’s Anatomy Fellowship go?

It went really well! I learned a lot, and I got to work with talented people who were very welcoming. I learned how much goes into this—things no one would typically know unless they’re there. And it was amazing to see the commitment they have on set in making sure that everything is medically accurate and tells stories that are important. All the medical issues depicted on the show have actually happened; it won’t be added to the show unless there is a case report. There are a lot of medical consultants for the show and I was able to talk to them about their experiences. Of course, the show has the weirdest, craziest, and the rarest things that are exciting and interesting to know about, but they’re still real.


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Twelve lucky winners will receive a FREE COMSAE! Please read the official rules for terms and conditions. Submission Period: December 1, 2020 – December 12, 2020 at 12:00am EST.

Twelve lucky winners will receive a FREE COMSAE!

How to Enter:

  1. Access our post here: INSTAGRAM | FACEBOOK
  2. Comment on the post and share some of your best tips and tricks to managing your wellness while preparing for COMLEX-USA.

Official Rules and Fine Print

  1. Submission Period: December 1, 2020 – December 12, 2020 at 12:00am EST.
  2. Submitted photos or text must be original. You hereby warrant and represent that (a) you own all rights to all Entry Materials submitted by you; and (b) all such Entry Materials are original works of authorship on your part and have not been copied, in whole or in part, from any other work and do not violate, misappropriate or infringe any copyright, trademark or other proprietary right of any other person or entity. You hereby verify that you will provide full written permission of any recognizable person, and their guardian if they are a minor, who are depicted in your Entry Materials.
  3. 12 winners will be randomly selected on December 14th and PM’d by NBOME for additional information through messenger. Please note you will need to accept the message request if you have not messaged with us before.
  4. Winners must respond within 24 hours to remain eligible, otherwise a replacement winner will be selected.
  5. Quotes from the comments may be utilized for future RTDOL social media posts by the NBOME. By responding to the giveaway, you also give us permission to use your suggestions in our campaign.
  6. The awarded COMSAE is non-transferable.
Forms

Name Change Form

Third Party Transcript Request Form

Rescheduling Fee Waiver

Instructions to Request Test Accommodations

Request Accommodation

Scoring & Reporting

After completing an exam, candidates will receive a Score Report and Performance Profile which provides a numerical standard score for the total test and a graphic presentation for performance on three groups of content areas.

Score Report

The COMSAE report consists of a three-digit numerical score for the total test and a graphic representation of performance by content area. COMSAE does not involve a numerical minimum passing score. Instead, based on standard scores, it provides the following three suggested performance levels:

Standard ScorePerformance Level
lower than 400Lower Performance
400 - 649Average Performance
higher than 649Higher Performance

When using the performance profile to assess strengths and weaknesses, examinees should be aware that information provided in content areas consisting of relatively few questions may be less reliable than information provided in content areas with a larger number of questions. Therefore, it is possible that some subtest score patterns are not precisely aligned with a candidate’s numerical score for the total test. COMSAE should not be used to predict performance on the COMLEX-USA cognitive examinations.

You might be familiar with Alin Gragossian, DO, from her blog, A Change of Heart, which provides insight into her experience as an ICU-fellow-on-call turned ICU-survivor.

Originally from Los Angeles, CA, Dr. Gragossian is a 2016 graduate of Lincoln Memorial University-DeBusk College of Osteopathic Medicine. From there, she accepted a residency in Emergency Medicine at Drexel Hahnemann in Philadelphia, which was interrupted when she was hospitalized and received an emergency heart transplant in the middle of her third year of residency.

NBOME sat down with Alin to talk about her extraordinary Road to DO Licensure and how she persevered to reach her goals.

 

Let’s start at the very beginning. What first inspired you to become a physician and why did you choose to become a DO specifically?

I can’t tell you of a specific event that inspired me, and I don’t have anyone in my family who is a doctor.  When I was five, a neighbor got hurt on our street and there were a bunch of ambulances. My parents said I was very interested in what was happening. Maybe, subconsciously, my drive to become a doctor came from that experience.

I started volunteering in the ER in high school and I found myself wanting to go there all the time.  I continued volunteering there throughout college, going on to become an EMT and shadowing the same physician. I was driven to do everything in that field.

As to why I chose to become a DO—osteopathic medicine stood out to me because of the way DOs approach the patient. They don’t just look at one part or one system, they look at the patient as a whole. I was intrigued by that as a basic principle.

 

Do you think the osteopathic approach helps a lot in the ER?

When it comes to the more chronic things like back pain, foot pain, or knee pain that have been going on for a while, or patients with chronic conditions, you definitely look at it from a more osteopathic approach. Having that background knowledge absolutely helps

 

There is so much about being a DO that is special and unique. We often hear the phrase ‘osteopathic distinctiveness’ used across the profession. What does that phrase mean to you, personally?

I’m not an MD—it’s not that MDs are no good—it’s just that I went to school to become a DO and that’s my distinction. I’m part of a minority of physicians that went through a special kind of training to learn more about the osteopathic approach to medicine. I’m very proud of being a DO and if the credentials on my badge are mistakenly printed with MD after my name, I will specifically call to get it changed because I really like showing that I’m a DO.

 

Thinking back to your COMLEX-USA Level 1 and 2 prep, what was your approach to studying? 

I took COMLEX-USA Level 1 after my first two years of medical school. We actually had a one month break to take the exam. I would wake up and literally study from 8am until 8pm—I even made a calendar for myself. I would do one topic in the morning, followed by questions in the afternoon.

For COMLEX-USA Level 2-CE and 2-PE, I took them after my third year during rotations and we didn’t have a break to study. Yet, at the same time, that test was more on clinical application, which we did a lot of during practice. It was a lot easier to remember that than the basic science. I would go to my rotation in the morning and in the afternoon, I would dedicate time to studying certain topics and then do questions at night. I definitely had a set way of studying and always allocated a time of day to do it.

 

What advice do you have for students preparing to take COMLEX-USA now?

Just answering questions—do as many question banks as you can possibly get your hands on. It’s not so much about getting the question right—it’s more about learning from what you got wrong by reading the answer and retaining what it was.

 

How would you advise DO students considering residency programs that might not be as familiar with COMLEX-USA?

Talk to somebody in the program, like the program coordinator, about the process.  And if you’re unsure whether or not they are familiar with COMLEX-USA—ask!  And if they don’t accept COMLEX-USA, find out why. Maybe it’s because they’ve never had a DO student before. Maybe it’s because they aren’t sure how it works. For the most part, most programs do accept DO students. There are probably some that historically haven’t, but in the future, everything should be more balanced.

For most of the emergency medicine programs I applied to, I already knew somebody in the program through an emergency medicine interest group at my COM. The program I ended up going to—which was Drexel—even had a resident who was an alumni from LMU-DCOM. Check out the various specialty interest groups at your school, see if there is anyone in a program you are interested in, and ask them for advice.

 

In your 3rd year of residency, you received a heart transplant, how did you pick up where you left off?

I was in the middle of my third year of residency and had just matched into my ICU fellowship. A few weeks later, I got very, very sick. It was so sudden when I went into cardiac arrest and needed a heart transplant. So, instead of starting an ICU fellowship, I became an ICU patient. I went back with 6 months left of residency only to find out that Drexel was shutting down the whole hospital. So not only did I have to work through my health condition, but I also had to find a new program.

During the five months I was recovering, I continued to do board review questions so I wouldn’t forget emergency medicine. Then I found a new program at UPMC Pinnacle in Harrisburg, PA.  Initially, I couldn’t see patients face-to-face because I was still immunosuppressed. I did mini shifts and then finally started seeing patients in October of 2019. The first couple of days were awkward, but muscle memory kicked in and I remembered everything pretty quickly.

I obviously didn’t know I was ever going to need a heart transplant—I’m 30 years old and completely healthy. But I was lucky to be in a residency program that was truly supportive. Faculty, attendings and co-residents were always there for me in case I didn’t feel comfortable or if I needed help.

 

As an ICU-survivor, but also as an ICU-fellow-on-call, you must have experienced some unexpected challenges. Tell me a little about what you’ve overcome to get to where you are on your Road to DO Licensure.

As acute care physicians, there’s always a lot of craziness around us—there could be a code, a trauma, and a stroke all at the same time and you have to know how to stay calm. You can’t just sit there and panic. I don’t know if I was always like this or if emergency medicine shaped me into who I am, but having the ability to stay calm is essential. That’s also what helped me get through my heart transplant. As scary as it was—as annoying, as angry, and as sad as I was—I had to just take it, deal with it, and show people that you can go back to living like you normally would.

 

We know there is already a tremendous amount of stress and anxiety tied to this journey—how did you manage all of it? What worked for you?

You have to have balance. Recently I found out I had been put on the schedule for multiple days in a row without realizing I had two 24s that week and no day off. Speaking up about that is important. I could have been fine that whole week without the day off, but I said something about it and told them, ‘this has been a crazy week for me.’ It ended up just being a mistake. Speaking up when you feel overwhelmed, making time for yourself, and having an outlet is very important.

I personally like to write. That’s just my way of dealing with things. Different people like to do different things—some of my colleagues write music, some of them like to draw, and one of my co-residents even makes videos and has channeled it into doing things related to COVID-19.  Find the thing that makes you happy, know when you feel overwhelmed, and be able to speak up.

 

You just moved to New York City to start the latest chapter of your life. Tell me a little about the Critical Care fellowship you’re currently doing.

I’m doing a critical care fellowship at Mount Sinai Hospital in New York City. It’s a medicine and surgical-focused two-year multidisciplinary fellowship. We rotate through all of the ICUs throughout the Mount Sinai Hospital system—neuro ICU, transplant ICU, surgical ICU, and medical ICU. At the end, we take the critical care boards. It’s similar to doing a home critical care fellowship, just without the pulmonary part. Most of my peers are all medicine trained—there are a few of us who are emergency medicine trained too so it’s interesting to have a good mix of people around me.

 

What’s next after this? What are you looking forward to the most?

After my fellowship, it would be awesome to stay on the east coast (because it stole my heart, quite literally). I would love to have a job where I do both ER and ICU because I’ll be boarded in both. I want to stay in academics and work with residents, teaching medical students what I know, learned, and experienced.

 

Based on your hands-on experiences, what advice do you have for those who are coming after you?

Don’t let anything stop you. There is going to be a lot that challenges your way of thinking and challenges you personally. There are going to be things that happen to you that you wouldn’t ever think would happen to you. There will be people who tell you that you’re not going to make it, and things that happen that will make you question whether or not you should be doing this. But, at the end of the day, if you really want to do it, don’t let anything stop you.

Feeling inspired by Dr. Gragossian’s story? Become an organ donor and advocate for others to become donors too. There are many myths around organ donation, and it’s important to realize how unfortunate circumstances can breathe new life into someone else who is in need.


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At this point, you’ve researched residency programs until you can’t see straight and are figuring out where to apply, which is never easy. To share some helpful advice we sat down with Carisa Champion, DO, MPH, JD, who opened up about the strategies and game plan she used while applying to residency. Read about what worked for Dr. Champion to see if it will work for you before hitting ‘Submit’ on your residency applications.

At this point, you’ve researched residency programs until you can’t see straight and are figuring out where to apply, which is never easy. To share some helpful advice we sat down with Carisa Champion, DO, MPH, JD, who opened up about the strategies and game plan she used while applying to residency. Read about what worked for Dr. Champion to see if it will work for you before hitting ‘Submit’ on your residency applications.

Dr. Champion is currently in the midst of completing her Grey’s Anatomy Surgical Communications Fellowship, and is completing her 4th year as a general surgery resident at the University Of Florida College Of Medicine at Jacksonville, Florida. Before beginning her residency in Florida, she did her first two years in General Surgery in Pennsylvania prior to the program’s closure. Dr. Champion is a graduate of the Nova Southeastern University Kiran C. Patel College of Osteopathic Medicine, earning her DO, MPH and JD degrees in 2016. As a former member of the American Osteopathic Association’s Bureau of Emerging Leaders (BEL), Dr. Champion currently serves as a BEL Committee Chair. She is also an active member of the Florida Osteopathic Medical Association (FOMA), working to attract residents to serve on FOMA committees.

The Road to DO Licensure has so many twists and turns and unexpected challenges. Talk to me a little about some of the more major challenges you’ve experienced and have been forced to tackle.

When my original residency program closed, I went from a program that was entirely osteopathic to a completely different world in a large academic Level 1 trauma center. My program has DOs, but there are still programs out there that won’t accept the COMLEX-USA exam, and that can prevent many DO students from applying to them. That’s something that I’ve been working against since I was a student. Any time I learned about a residency program that did not accept COMLEX-USA for DO applicants, I would contact the AOA or the NBOME and ask them to reach out to the program. Personally, I refused to take the USMLE examination. For me, it was important that I had chosen osteopathic medicine from the start, and I only wanted to go to programs that were going to accept my osteopathic credentials and not because of what exam I took. Ultimately, you need to decide what your priorities are and what is most important to you.

How would you advise DO students considering residency programs that might not be as familiar or accept COMLEX-USA scores?

I think that it depends on what you’re applying for because there are still some specialties that are difficult about accepting COMLEX-USA. When I come across those programs, I try and broker the relationship to show them that COMLEX-USA exists because we are a distinct profession and need to be evaluated as such. And I think that’s something that’s special that we bring to our programs—we DOs bring a special culture and background with us, and it benefits the programs to take DOs. I think that our heritage is something that is beneficial to patients and I think it’s something that DO students should be proud of and not something that they should try to hide.

What are some tips you would give DO students who are preparing to apply to residency?

I always tell students to figure out what their priorities are because it’s different for everyone. If your priorities are specialty, location, strong community, emphasis on research, or a community that values mental health, those are all things that you need to look at and apply to programs with those priorities in mind. Honor your priorities because it’s a big decision, and you’re going to spend a lot of your life in that place. It’s really beneficial when you choose the places you want to interview at so you can make sure they’re places that will have your priorities in mind. Make sure it’s a good fit for the program and a good fit for you. I think it’s so important that you rank places in the order of where you think you fit in well. I didn’t even rank places if I felt I’d be miserable there. Why would I want to spend five to six years of my life miserable when I could be somewhere I feel like I’m a good fit?

There is a perception that applying to residency has gotten so much more competitive—many students are applying to more and more programs every year. How many programs did you apply to and interview at? And how did you land where you are today?

My priority was to only apply to osteopathic residencies, and at the time, I think there were only about 20-30 surgical residencies that were osteopathic. It goes back to what I said about considering your priorities. A lot of it comes down to doing the best you can in your COMLEX-USA exams, getting good letters of recommendation, and volunteering for causes that you really care about.

Be authentic in the things that you’re passionate about—in the things you choose to pursue. I was really involved in medical school, and it wasn’t because I wanted titles or recognition. I was really passionate about a lot of things, and because I was passionate about them, I was able to be more effective. An unintended consequence was that I had a much better application because I went really far with the things I was passionate about. I had the energy to do that—it wasn’t just an obligation—I was excited about the opportunities it brought me. Do things that you’re passionate about, let your application reflect who you truly are. I think everything works out the way it needs to in that way, if you’re genuinely honoring who you are.

What skills did you bring to the table during your interview that made you stand out as an applicant?

In osteopathic medicine, we have a culture of attracting people to our profession who have grit, have had unique life experiences, and have an intentionality about them. There’s just a culture in our profession that is different—one that I recognized as healthy and part of why I chose osteopathic medicine. When I interviewed for residency, there was something about my interest in being involved, my interest in preventative benefits, and my genuine passion for healthcare that my program recognized and felt would be a good fit. I’ve been part of the profession now for 14 years, and our profession is still working to find the right words we can all agree on to define osteopathic distinctiveness. While it’s hard to define, it’s definitely there.


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The 2021 NRMP Main Match is open. But now what? There are thousands of programs with spots available in this upcoming match cycle, but that doesn’t mean you need to apply to all of them. We spoke with Breanne Jaqua, DO, MPH, Eleanora Yeiser, DO, and Ronak Mistry, DO, about what advice they have for students taking their next big step on their Road to DO Licensure – finding the residency program that feels right for them. Find out what worked for them, what didn’t, and what they wish they did differently.

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Breanne Jaqua, DO, MPH

Dr. Jaqua recently completed a residency in Emergency Medicine at the Mercy St. Vincent Medical Center in Toledo, OH and is now an Assistant Professor at the A.T. Still University School of Osteopathic Medicine in Arizona. She currently serves as the 2019-2021 Resident Representative to the ACGME’s Emergency Medicine Review Committee and the 2020-2021 Vice Chair to the ACGME’s Council of Review Committee Residents. She is also on the Board of the Emergency Medicine Residents Association (EMRA).

Eleanora Yeiser, DO

Dr. Yeiser is currently a PGY-3 family medicine resident at Main Line Health in Bryn Mawr, PA. She currently serves as a NBOME Resident Ambassador, and works to advocate for DO students and their credentials. Her professional involvements include reviewing articles for the Osteopathic Family Physician Journal. She is a member of the Pennsylvania Osteopathic Medical Association Committee on Professional Guidance (East Region) and serves on her resident wellness and diversity committees. After residency, she will be relocating to northern New Jersey to practice outpatient family medicine.

Ronak Mistry, DO

Dr. Mistry is currently Chief Resident at Pennsylvania Hospital of the University of Pennsylvania Health System/Penn Medicine in Philadelphia, PA. He started there as an internal medicine resident in 2017, and is currently applying for fellowships in hematology-oncology for the 2021 Match cycle.

Researching Programs

Making the decision about what residency programs to apply to is probably one of the biggest decisions you make in your career. How did you approach researching programs?

EY: I started with the non-negotiables, which, for me, was location. With residency comes a new set of stressors and demands. For the sake of my well-being, it was essential to be as close as possible to my spouse, my family and my friends. Consider settings that will allow you to gain experience with a patient population that will help you meet future goals; decide what’s best for you in the long-term, but also consider the short-term.

BJ: If I were researching programs today, I would definitely use EMRA Match to learn about emergency medicine programs. This tool is amazing and serves as an alternative to residency program listings or ranking websites and allows applicants to easily filter information. For EM applicants, EMRA Match is a treasure-trove of information. I got engaged during my residency application cycle and it would have been extremely difficult for my fiancé to relocate, so I put significant emphasis on the geographic location of the program. Participating in a “second look” visit at a few of my top choice programs after the formal interview day was also very helpful. This 3-4 hour shadow experience let me observe the flow of the emergency department and experience real-time interactions among residents, faculty, nurses, and staff outside of the formal interview setting.

RM: The first decision to make is what kind of setting you see yourself training in: a large academic institution, an academic-affiliated community institution or a community hospital. Each different setting provides different opportunities, so it’s important to determine where you see yourself. The second decision is going to be location. Although I didn’t think this was as important at first, as I went through my interviews I realized that location was more important than I had initially thought. Was I okay with being somewhere rural? Was I okay with being hours away from my family and friends? Was I okay with the options to enjoy life outside of the hospital, including outdoor activities, locations for shopping and restaurants? Once I answered these questions, I used websites like FREIDA, though the American Medical Association, to help narrow my choices.

What were the most important factors to you when you were considering different programs?

EY: Size, curriculum, and fit were important considerations for me. I wanted to train at a medium sized program. I also wanted to be in a program large enough that there was enough diversity and resources, but not so large that I became lost in the crowd. At the same time, I wanted to be in a program small enough that I could get enough individual attention, personalization and mentorship in my training. It’s important to consider the type of environment you will thrive in. I wanted to train at a place that felt like a good fit for me, which is not always something you can research — it’s more about intuition.

RM: The location and the type of program were very important to me up-front. Next, I looked at the types of rotations residents did and resident outcomes — not every program is the same. Some programs put an emphasis on getting residents into fellowships, while others are geared at molding future primary care doctors. It’s important to pick a program with a track record consistent with what you see yourself doing in the future, but also with enough flexibility and guidance in the institution to help you if you change your mind. When I was at the interviews, I was most interested in culture — what was the interaction like amongst the residents, attending physicians, and fellows? This is so important because you will spend countless hours at the hospital and it’s important that you work in an environment that is supportive and collegial, where you are not afraid to ask questions and have the opportunity to grow as a physician.

I will say, it is important to acknowledge that this year is somewhat unique since interviews are virtual. Being about halfway through my own interview season, do not let this dismay you. A lot of the information that we all want to know about is objective – schedules, vacations, educational opportunities. These are the same things that we would have read about on program websites, in emails, when talking to residents in the program and in program presentations. But culture is hard to gauge virtually. The best way to assess this is attend any and all opportunities you get to interact with current house staff and askthem about culture. I think a good metric to use is to see if you are getting consistent answers about what makes that place special to train in.

Applying and Interviewing

When you created your rank order list, how did you know that the programs would be right for you?

EY: I started by knowing which programs were not the right fit—you have to trust your instincts. No program is perfect, and you can’t truly learn everything or anticipate everything that may arise; the only way to get a true sense of it is once you are actually immersed. The same way you are putting your best foot forward, programs are doing the same. I would avoid putting too much emphasis on any one program feature. This year has shown us that things can change suddenly. Additionally, your interests, desires and needs can change as well. Programs change too — they grow and evolve just as you do throughout this process. Keeping that in mind, I recommend ranking programs based on where you think you would be genuinely the happiest.

RM: At the end of the day, I realized that many of my programs were similar and that I was lucky that I saw myself being happy being at any of the places I interviewed. The culture of the program and the feeling I got when I spoke to the residents was what ultimately helped me decide the order. I am happy to say that I was totally right about that “gut instinct”, having just completed residency at my top choice program this past June, and now being a Chief Resident and Hospitalist at this program!

We know residency programs come in all shapes and sizes and in towns big and small. As you looked for the program that was right for you, what major differences did you notice between rural and urban programs? And do you think this has an impact on training in certain specialties (fewer cases, etc.)?

RM: The biggest difference in rural vs. urban programs is the diversity of patients and access to different medical interventions. I found that in rural programs, oftentimes their patients tended to be more homogenous and the medical problems could, therefore, be limited. Furthermore, access to the latest innovations in healthcare may be limited. In an urban setting, particularly in a large city, I found more diversity in patient populations and medical conditions. That being said, many rural programs, especially very large academic hospitals, have huge catchment areas, so do not be fooled by what shows up.

What advice do you have for current applicants who are interviewing? What should they keep an eye out for?

EY: Be yourself. Every place where you interview will not be the best fit for you, but you can use each interview experience to help with the next. Don’t be afraid to ask questions — you can even ask a few of the same questions at different interviews to help compare programs and build your list. Talk to the residents and staff to get a sense of the program and its culture. Ask about the program’s response to the COVID-19 pandemic in different settings. How did they adapt to current and evolving circumstances? Did the residents feel safe and adequately supported?

How do you recommend applicants position their osteopathic education as a distinguishing characteristic to residency programs?

BJ: Approximately one quarter of medical students in the country are osteopathic medical students, and the interview is a great time to describe what your osteopathic medical education means to you. You can highlight school-specific initiatives you started or participated in, or emphasize unique aspects of the educational program at your school. One of many ways to emphasize your osteopathic credentials is to highlight in your personal statement or interview how your osteopathic education has shaped your journey in medicine. You may want to seek out programs that are accredited by the ACGME with Osteopathic Recognition, which signifies to prospective applicants that the program is dedicated to continuing osteopathic education in residency and/or fellowship training.


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The credentialing board enlisted the National Board of Osteopathic Medical Examiners to adapt its qualifying exam to the virtual space.

CHICAGO, IL Pandemic-driven necessity has led to new innovation in medical examinations, as proven by a recent collaboration between the American Board of Cosmetic Surgery (ABCS) and the National Board of Osteopathic Medical Examiners (NBOME). The ABCS, a credentialing board for surgeons specializing in cosmetic medicine and surgery, needed to find a physically-distanced way to hold its annual exam, which is usually conducted in-person. By collaborating with NBOME, they built an equally rigorous board certification exam that can be virtually delivered and assessed.

The testing experts at NBOME collaborate with numerous organizations, using a breadth of cutting-edge medical credential examination processes and technologies. The NBOME analyzed what processes would be needed to realize the ABCS’s goals for the examination, including confidentiality, private interview spaces, “movement” through the exam, and secure online scoring. They then created a virtual testing center and file sharing option that could accommodate these needs and worked behind the scenes to transition examiners and candidates throughout the examination, allowing participants to focus on the work of interviewing and being interviewed. The exam thus met the high standards of the ABCS while working seamlessly for all involved.

ABCS President Dr. Wilbur Hah praised the NBOME testing administrators’ work customizing their technology to support the ABCS’s rigorous exam process. He credited the success, in part, to the collaborative relationship between the two organizations.

“Having an established relationship with NBOME allowed us to dive into the process of adapting our exam as soon as it became clear that the pandemic would require us to take a different approach,” said Dr. Hah. “Board certification is core to our mission of promoting the safe and ethical practice of cosmetic surgery, and we are pleased to continue our work without interruption.”

“We love to innovate and find collaboration with our strategic partners a great opportunity to do so,” shared Gretta A. Gross, DO, MEd, Vice President for Clinical Skills Testing. “For the ABCS, we were able to start with their in-person examination processes and develop a virtual solution around it, all while keeping their mission and goal of providing a valid examination at the forefront of the process.”

With an ever-increasing demand for cosmetic procedures that has persisted through the pandemic, American Board of Cosmetic Surgery board certification remains a critical signal to patients, proving a surgeon’s knowledge and experience. Prior to undergoing the examination process, surgeons must have a primary board certification in a surgical specialty and then complete a cosmetic surgery fellowship, including performing 300 or more cosmetic procedures. ABCS certification goes beyond training and examination: it also requires diplomates to operate only in accredited facilities, prioritize patient safety at all times, and meet strict standards for conduct.

In a time when those working in telemedicine and education struggle to translate high standards to the virtual space, the organizations were celebratory. Dr. Hah surveyed the board members who served as examiners: “Would they give the exam virtually again?” While all said they missed the camaraderie afforded by the annual in-person gathering, the answer was a resounding “yes.”

NBOME Partners with ABCS on Successful Transition to a Virtual Exam

Fantastic news to share with US-educated doctors of osteopathic medicine who are interested in practicing in Australia — The Medical Board of Australia just established a new registration pathway for DOs, recognizing the National Board of Osteopathic Medical Examiners (NBOME) as a competent authority. This means that US DO graduates who have successfully completed the NBOME’s COMLEX-USA examination series since 2005, and have also completed two years of an ACGME- or AOA-accredited residency program will be qualified for provisional registration. “Registration” is the term used in numerous other countries for what we refer to as “medical licensure” in the United States.”

According to the Medical Board of Australia, until recently, doctors who had been awarded the DO degree in the United States were eligible only for limited registration in Australia. The new pathway streamlines the registration process and enables US DOs to be granted general registration after 12 months of supervised practice in Australia. In Australia, “DO USA” refers to physicians with a degree in osteopathic medicine to avoid confusion amongst patients with other types of health practitioners who hold qualifications in osteopathy.

The NBOME is the first international authority to receive competent authority for medical licensure in Australia in 15 years. The evaluation by the Medical Board of Australia included a robust and comprehensive review of the COMLEX-USA examination series, the licensure examination for DOs in the USA. COMLEX-USA Levels 1 and 2 (which includes a clinical skills evaluation) are also required by the American Osteopathic Association–Commission for Osteopathic College Accreditation (AOA-COCA) for graduation from a college of osteopathic medicine. The NBOME provided extensive documentation demonstrating adherence to quality assurance standards for validity, reliability, defensibility, and fairness to assess whether the COMLEX-USA examination program’s processes result in physicians who have the knowledge, clinical skills and professional attributes necessary to practice in the medical profession in Australia.

“Registration in Australia is all about safety to practice,” shared Dr. Anne Tonkin, Chair of the Medical Board of Australia, “We have streamlined our process and continue to welcome DO USA graduates so they can contribute to our profession and our community.”

The news was especially welcome to Nayla Boulad, DO, who submitted her application under the new pathway as soon as it was available and is eager to be able to practice osteopathic medicine in her new home in Australia. After completing her residency training in Pediatrics at the University of Connecticut Health Center in Farmington this summer, Dr. Boulad relocated to Perth, Australia to be nearer to her husband’s family, “I was literally working on my application when I got this fantastic news. I cannot believe the timing, this is so great!” she shared.

Prior to the Board’s recognition of the NBOME and COMLEX-USA, Dr. Boulad was preparing to complete the standard pathway application, a process that entailed extensive requirements, including completing another residency in Australia and taking other medical licensing examinations “In a time where travel and immigration is severely curtailed due to COVID-19, Australia faces a shortage of doctors and I am happy to have the opportunity to start working to fill those gaps. I am looking forward to continuing my learning and training here with hopes to be able to share what I learn with my peers back in the US.”

NBOME President and CEO, John R. Gimpel, DO, MEd, commented on the significant achievement and milestone for US DOs, NBOME’s COMLEX-USA examination program, and (former) AOA-accredited residency programs, now accredited by the ACGME. “Australia joins all United States medical licensing boards in entrusting NBOME’s COMLEX-USA program in the medical licensing process, on the merits of the evidence and the rigor of the exam program,” said Dr. Gimpel, “This is exciting news for DOs, the osteopathic medical profession, and the patients and communities of Australia. A special thanks to the AOA, the Australian Medical Council, the Medical Board of Australia, and all across the profession in the US and Australia who collaborated for more than a decade to make this a reality.”

PHILADELPHIA, PA.  The National Board of Osteopathic Medical Examiners (NBOME), an independent, not-for-profit organization who provides testing for osteopathic medical licensure, is pleased to share news that the Medical Board of Australia recently established a new pathway for osteopathic physicians to become registered to practice medicine in Australia.

Referred to as Category G UNITED STATES National Board of Osteopathic Medical Examiners (NBOME), this new pathway enables US educated DO applicants who have passed all levels of COMLEX-USA (including the Level 2-Performance Evaluation/clinical skills exam) and completed at least two years in a residency training program accredited by the Accreditation Council for Graduate Medical Education (ACGME) and/or by the American Osteopathic Association (AOA) to apply for provisional registration for medical practice in Australia. The evaluation by the Medical Board of Australia included a robust and comprehensive review of the COMLEX-USA examination series, including NBOME’s high standards for quality assurance in areas such as validity, reliability, defensibility and fairness. COMLEX-USA is the first international program to receive competency authority for medical licensure in 15 years.

“Australia joins all United States medical licensing boards in entrusting NBOME’s COMLEX-USA program in the medical licensing process, on the merits of the evidence and the rigor of the exam program,” said NBOME President & CEO, John R. Gimpel, DO, MEd. “This is exciting news for DOs, the osteopathic medical profession, and the patients and communities of Australia. Kudos and special thanks to everyone across the profession in the USA as well as in Australia who collaborated to make this a reality.”

 

###

About the NBOME
NBOME is an independent, non-governmental, non-profit assessment organization committed to protecting the public by providing the means to assess competencies for osteopathic medicine and related health care professions. NBOME’s COMLEX-USA examination series is a requirement for graduation from colleges of osteopathic medicine and provides the pathway to licensure for osteopathic physicians in the United States and numerous international jurisdictions.

Media Inquiries
Susan Peters, Director of Marketing and Communications
speters@nbome.org

Each year since 1991, the NBOME Board of Directors has convened its annual Liaison Committee Meeting, hosting representatives from organizations from across the continuum of osteopathic medical education and the house of medicine. The committee meets to share their experiences, ideas and concerns as they pertain to NBOME assessments as well as other challenges and opportunities facing the profession. This year’s Liaison Committee, while transitioned to a virtual and somewhat shortened format, was attended by 20 leaders from 12 different organizations, including members of the undergraduate and graduate medical education community from AACOM, AOGME, OPDA, ACGME; osteopathic medical students and residents from COSGP, SOMA, and the AOA-Bureau of Emerging Leaders; members of the licensure community from AAOE and FSMB; and professional organizations — AOA, AMA. NBOME also welcomed, for the first time ever, the National Resident Matching Program (NRMP), who shared results from the 2020 Program Director Survey, including a record high 86% of ACGME residency directors requiring COMLEX-USA for DO applicants.

This year’s Liaison Committee Meeting theme, chosen even before the pandemic, was Professional identity formation across the continuum — from medical education through practice. Dr. Geraldine O’Shea chaired the meeting with support from Board Vice-Chair Richard LaBaere, DO, and NBOME President and CEO, John R. Gimpel, DO, MEd. NBOME was further represented by members of the NBOME team, including Liaison Committee Lead, Sandra Waters, MEM, Melissa Turner, MS, and Marie Fleury, DO, MBA.

Following NBOME and COMLEX-USA updates, participants engaged in a facilitated discussion focused on COMLEX-USA scoring (numeric vs. pass/fail), osteopathic distinctiveness, and strategies to advance professional identity formation for DO students, residents, and practicing physicians. Participants showed support for NBOME’s agility and innovation throughout the pandemic, including the creation of a COM Liaison Team, development of COMAT self-proctored administration options, and enhanced collaboration with Prometric to test over 14,000 displaced COMLEX-USA candidates this summer.

Historically, this process has resulted in numerous opportunities to make improvements to NBOME initiatives, products and services. These improvements have shown to help meet the evolving needs of our candidates, colleges of osteopathic medicine, the licensing community, and others who rely on what we DO. The NBOME Liaison Committee meeting enables us to continue to promote a culture of collaboration, while endeavoring to continuously improve as we serve others and remain steadfast in our mission to protect the public via high-quality, valid and reliable assessment.

COMLEX-USA Computer-Based Examination Outline
Section Questions
1 44 Time: 4 Hours
Questions can be answered, reviewed, and changed one section at a time. Individual sections are not timed. Once you move to the next section the previous section is no longer accessible.
2 44
Authorized 10-minute break
3 44
4 44
Authorized 40-minute lunch break
5 44 Time: 4 Hours
Questions can be answered, reviewed, and changed one section at a time. Individual sections are not timed. Once you move to the next section the previous section is no longer accessible.
6 44
Authorized 10-minute break
7 44
8 44
Available Examination Features

Examination Review Screen
A review page is presented for each section. This provides candidates with information about the status of the items in the current section, which includes questions completed, questions marked for further review, and questions left incomplete (i.e., no answer is given).

Advancing through Examination Sections
Once a section is completed, the candidate cannot return to review or change any answers within that section.

Time Limitations
Although each session is 4 hours in length, the individual sections within a session are self-paced. A clock is provided to assist with time management. Warnings are given of the time remaining before the end of each 4-hour session.

Examination Visual References
Use of an “Exhibit” button may be required in order to see graphic materials related to a test question. These exhibits consist of images, videos, or audio avatars. In some cases, multiple exhibits may be used in order to answer a question.

Additional Tools
Functional features are available, including a standard calculator and laboratory values with reference ranges (where applicable) embedded directly into exam questions.

It was an historic Match Day for DO students and graduates. This year’s NRMP Main Residency Match was the largest on record, with over 40,000 applicants applying to positions in 5,048 programs across the US. Applicants in this year’s Match increased by 4.5% over last year to 37,256 available positions. On March 20th, 6,215 4th year osteopathic medical students and graduates who matched to PGY-1 positions learned where they’ll be spending the next three or more years in residency training programs in the specialty in which they’ll work.

NRMP President and CEO, Donna Lamb, DHSc, MBA, BSN, reported, “We are especially excited that the 2020 Match marks a milestone for the medical education community: The first Single Match for U.S. MD and DO senior students and graduates and the inclusion of DO senior students as sponsored applicants.”

                  

The results of this year’s Match, the first Single Match under the single accreditation system, continue to trend positively for osteopathic graduates entering residency training. Despite being socially distanced and self-quarantined due to the COVID 19 pandemic, students, schools, programs, specialty societies and others held remote “Virtual Match Day” celebrations in observance of the highest number of DO seniors who matched to PGY-1 positions—5,968—at a rate of 90.7%, compared to a match rate of 80.8% for all applicant types. Applicants who did not match to a residency position participated in the Match week Supplemental Offer and Acceptance Program (SOAP) to obtain one of 1,897 positions available. More DO applicants matched during SOAP, with data to be released in early May.

DO applicants in this year’s Match accounted for the largest increase in applicant groups — up by 19.2%, (1,153 applicants) and resulting in a 20.1% increase in DO seniors (up 1,103) compared to last year. Increased match rates for DO seniors ‒ up 2.6% from 2019 and up 13% from 2016 ‒ are especially impressive considering the increase number of applicants. The match rate for all osteopathic applicants (seniors plus prior graduates) also rose to 86.9%, up from 84.6% in 2019. Positive results by specialty include the 3 most popular specialty matches for DO senior applicants: Internal Medicine, Family Medicine, and Emergency Medicine. Orthopedic Surgery and General Surgery results for DO seniors also showed significant increases.

NBOME President and CEO, John R. Gimpel, DO, MEd shared his congratulations with students, COMs, AACOM, the AOA and many others who contributed to the success of this year’s single Match, “This year’s Match highlights the opportunity for the betterment of quality care and clinical learning involvement in our nation’s GME programs and the patients and communities we have the privilege to serve.” Dr. Gimpel remarked about the equivalent manner in which US DO and MD seniors and graduates are included in the NRMP Match reports, infographics and other communications. For more on the Match 2020 results, follow NBOME social media or read DO student Match stories here. Additional details about this year’s NRMP outcomes, can be accessed in the NRMP 2020 Advance Data Tables.

Jon Bardahl, DO, is currently training in pediatric medicine at OSF HealthCare. In the upcoming academic year starting in July 2020, Dr. Bardahl will be starting his fellowship in pediatric hematology-oncology at Duke University. Prior to medical school, Dr. Bardahl received his bachelor’s degree in biology from Governor’s State University and earned his osteopathic medical degree from Midwestern University in Chicago, Illinois. Throughout the years, Dr. Bardahl has been a consistent advocate for osteopathic medicine, and has been highly involved with the NBOME as a Resident Ambassador helping to spread information regarding COMLEX-USA to various student groups and stakeholder through social media.

 

You’ve almost finished your residency – we hear a fellowship is your next step, tell us about that — what made you choose hematology-oncology as a subspecialty?

I’m excited to be starting Pediatric Hematology-Oncology fellowship this July at Duke Children’s Hospital. I have been interested in cancer biology for some time, and have been lucky enough to be able to pursue it. Prior to medical school I conducted research on a protein expressed by Epstein-Barr virus and its influence when it comes to tumor development in certain cancers. While in medical school, I got involved in the St. Baldrick’s Foundation which helps raise money for childhood cancer research in exchange for participants shaving their heads. In residency I truly developed an appreciation for the field and loved the continuity with patients and their families, the pathology, the opportunity for research, and advocacy opportunities involved in the field.

 

Any advice for DO students and residents who might be thinking about completing a fellowship?

I think the biggest advice I would give any upcoming student or resident is to find a mentor and “pick” their brain. I have had so many mentors along the way that have influenced me both personally and professionally and I’m so grateful for the lessons I have learned and the advice they have given me.

 

You only took COMLEX-USA when you applied to residency – what was your thinking about that?

I’m a proud DO and fully support COMLEX-USA! I was only interested in residency programs that supported COMLEX-USA as well so the USMLE was never something I considered.

 

How would you advise DO students today in considering a specialty?

Students should try to keep an open mind when it comes to medicine. If they have a specialty they are interested in, they can identify mentors or research opportunities which may be helpful when applying to residency programs.

 

What about applying to residency?

Here are some things that I would recommend doing:

 

How would you advise DO students considering programs that might not be as familiar or accept COMLEX-USA scores?

Reach out to programs and ask them! If a program is unfamiliar you can always supply them with resources from the NBOME website or notify NBOME so they can advocate on your behalf.

 

Applying to residency has gotten so stressful – students are applying to more programs every year. How many programs did you apply to and interview at?

I applied to 20-30 programs for both residency and fellowship and I interviewed at 10-12 programs.

 

Did you do an audition rotation at your residency or fellowship program?

I did not. Audition rotations are a wonderful opportunity to learn and get a “feel” for a program, but it’s not mandatory. I have loved training at my current residency program and don’t think an audition rotation would have changed that.

What are some tips you would give DO students who are preparing to apply to residency?

These are some of the things that worked for me, and I hope they help others as well:

Were you always interested in pediatrics? When did you know that’s what you wanted to do and how did you decide that’s what you wanted to do?

Pediatrics was at the top of my list! I did consider family medicine at one point as well, but decided to pursue pediatric medicine after my 3rd year core rotation in pediatrics. I have always been interested in pathology and academic medicine, and wanted the opportunity to specialize in Hematology-Oncology to provide continuity of care by working with patients and their parents.


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With a single GME system comes expanded training opportunities for DO and MD applicants—and many are anxiously awaiting this year’s 2020 NRMP® Main Match, which is fast approaching. DO applicants have done well in the Match, and match rates for DO applicants have continued to increase throughout the transition to single GME. Still, there are many myths and misconceptions that surround Match 2020, single GME, and the use of COMLEX-USA scores for DO applicants. Here are a few of them—and the facts:

ACGME residency programs don’t accept COMLEX-USA.
The ACGME does not require one licensing exam over another—passing either COMLEX-USA or USMLE meets that requirement. Eligibility for appointment into residency programs accredited by the ACGME requires applicants to be graduates of AOA or LCME-accredited medical schools. Bottom line: programs can accept both USMLE and COMLEX-USA scores. Single GME does not exclude DO applicants with COMLEX-USA scores from applying.

A program I want to apply to doesn’t accept COMLEX-USA.
Most residency programs accept COMLEX-USA for application to their programs. In fact, in specialties preferred by DO applicants, 82% of program directors surveyed by the NRMP say they use COMLEX-USA Level 1 scores to consider applicants for interviews. In some specialties, it’s even higher. Historically, Match rates for DO students have been really high, and the overall match rate for DOs has been close to 99%, in fact. Results for DO applicants in the NRMP Main Match have continually increased over time.

Hear what Ken Simons, MD, Senior Associate Dean for GME and Accreditation, the Designated Institutional Official at the Medical College of Wisconsin has to say about this issue:

I heard about a program that accepts COMLEX-USA, but the scores are hard to understand so they don’t use them to select applicants to interview.
Residency programs are great at a lot of things, but some programs may not be as familiar with COMLEX-USA scores or are simply misinformed. COMLEX-USA score reports provide valuable information on performance and are easy to understand. Program directors are provided convenient access to a COMLEX-USA percentile score converter through the ERAS platform and the NBOME website. NBOME provides resources and research to program directors on the predictive validity of the exam and how it can be used as part of a holistic review of candidates.

I heard if you do an ACGME residency, you have to take USMLE to get a license.
Not true. COMLEX-USA is accepted in all U.S. states (and in some international jurisdictions) for licensure for DOs. The Federation of State Medical Boards, the FSMB, accepts COMLEX-USA as valid. According to the FSMB, there is no requirement for DOs to take USMLE in order to obtain a license, in any state.

DOs need to take USMLE in addition to COMLEX-USA because its a requirement for certification by ABMS boards.
DOs and MDs completing ACGME-accredited residency programs can choose to become board certified by the AOA and/or the ABMS. DOs who train in ACGME-accredited residency programs, and who hold a current and unrestricted medical license are eligible to sit for AOA and/or ABMS certifying boards. The American Osteopathic Association has great information board certification through AOA boards–find out more here.


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It’s Match week and everybody is invited.  Share your congratulatory messages, photos and videos here!

Real-time information about test center status.

Information about COVID-19 for travelers and travel related industries.

General information and situation updates from the Centers for Disease Control and Prevention.

Great resources for Match Week, SOAP applicants, and others.

If you don’t match, your chances of landing a residency position are still high.

 

We all strive to make #WorkLifeBalance part of our daily practice, but is it? With four years of undergrad, four years of med school, and a whole lot more years of residency, hours spent studying are what fill all the cracks between classes, clinical rotations, and the like. Studying becomes your personal mantra—your bread-and-butter—your life-force. You may feel duty-bound, mired by the responsibilities and expectations tied to your goal to become a DO. And as these responsibilities ramp up, there is the very real potential that the time and energy you once had for your passions and hobbies may be at an all-time low.
We all strive to make #WorkLifeBalance part of our daily practice, but is it? With four years of undergrad, four years of med school, and a whole lot more years of residency, hours spent studying are what fill all the cracks between classes, clinical rotations, and the like. Studying becomes your personal mantra—your bread-and-butter—your life-force. You may feel duty-bound, mired by the responsibilities and expectations tied to your goal to become a DO. And as these responsibilities ramp up, there is the very real potential that the time and energy you once had for your passions and hobbies may be at an all-time low.

#DOLOVE

We all strive to make #WorkLifeBalance part of our daily practice, but is it? With four years of undergrad, four years of med school, and a whole lot more years of residency, hours spent studying are what fill all the cracks between classes, clinical rotations, and the like. Studying becomes your personal mantra—your bread-and-butter—your life-force. You may feel duty-bound, mired by the responsibilities and expectations tied to your goal to become a DO.  And as these responsibilities ramp up, there is the very real potential that the time and energy you once had for your passions and hobbies may be at an all-time low.

The brain-sweat, tears, and hard work that are vital on your journey to DO licensure does not need to evoke feelings of guilt for not studying every hour of the day. So let’s tackle the study burnout and help you find ways to carve out time to keep doing what you love.  Here’s how:

Schedule it

Perhaps most of your life is meticulously mapped on a calendar, moment by moment—classes, clinical rotations, crazy amounts of studying, eating, sleeping, laundry, brushing your teeth, more studying. But your hobbies and passions are just as important to your well-being and your mental headspace, and they deserve dedicated time on your calendar too. Yes, yes, we know, there are only so many hours in a day, but who says your passions need to take hours? Take a 10-minute run (instead of your normal 10-mile jog), cook a 15-minute meal (instead of a multi-course masterpiece), read one chapter of a fiction book (instead of the whole thing), doodle for 10 minutes…you get the idea. Your hobbies and passions, just in smaller doses. Clear that brilliant brain of yours, nourish yourself with things that bring you joy, and then get back to the books!

Stop canceling

You’ve made the appointment, but are you going to show up?  This is the tough part because we all know how easy it is to cancel, especially when you are too tired, too busy, and too guilty (when you think you should be studying even more than you are). Showing up for yourself amidst COMLEX-USA exam prep might seem like a joke, but doing what you love is a big part of recharging and fueling what comes next. Be confident in the schedule you create and the choices you make, more importantly when they involve taking care of you.  If you don’t do it, no one else is going to do it for you.

Mix it up.

It’s easy to shelve the hobbies you’ve had for a long time. While they still bring you joy, they don’t give you the same butterflies-in-your-stomach feeling they did years ago.  Maybe it’s time to try something new: rock climbing, origami, ballroom dancing. Step out of your comfort zone and make use of an entirely different part of your brain or body. Getting out of your study-cave and into something new might also help ignite some of those old passions, clear your mind, and help energize you so you can get back to the studying. Plus, adding to your arsenal of interests may eventually help you connect and empathize better with your patients as well.

When studying starts to bleed into the things you love, take a step back and remind yourself that you’re a person before you are a physician—and even more important: you’re a person even after you become one. During this month of passion and #DOLove, encourage yourself, empower yourself, and break through your schedule to keep doing the things that bring you joy and keep you, you.


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COMLEX-USA Item Reduction

The NBOME Board of Directors approved plans to shorten COMLEX-USA Level 2-CE from 400 to 352 test items, beginning June 2020. This will only affect pre-test content, so exam validity/content coverage or reliability will not be impacted. This change should also reduce some of the stress associated with the time-pressured environment. Available test time will remain at 8 hours. Similar changes have been approved for COMLEX-USA Level 1 beginning May 2021.

Pretest questions are embedded into COMLEX-USA exams but do not count towards candidate’s scores. They provide useful information on the quality and relative difficulty of the questions to ensure fairness for candidates. They help obtain item statistics (for quality control as well as equating purposes), and to further test novel item formats.  The number of total items per block will decrease from 50 to 44 items.

 


 

Further Review of COMLEX-USA Exam Scoring and Score-Reporting

NBOME has continued to study the uses of COMLEX-USA scores and score-reporting as it relates to the primary and intended purposes of the examinations (i.e., licensure), as well as secondary uses (most cited one is in residency program applications.) Our Board of Directors has approved the continued use of pass-fail only for the COMLEX-USA Level 2-PE clinical skills exam, and recommended further study related to the use of pass-fail as well as numerical scoring for COMLEX-USA Level 1, Level 2-CE and Level 3. Further updates will be provided as early as July 2020.

 


 

Modification to COMLEX-USA Level 1 and Level 2-PE Test Cycles in 2020

In response to feedback from candidates and deans, NBOME has modified the 2020-2021 test cycle for COMLEX-USA Level 1.  It now commences 3 weeks earlier than prior years, running May 5, 2020 through April 2021.

We have also adjusted the COMLEX-USA Level 2-PE test cycle in response to increased demand during the spring months.  The 2020 test cycle will now end in early November 2020, with a new complete test cycle beginning November 30, 2020. This change should provide additional testing opportunities in times of higher demand, thus helping candidates and schools to better facilitate the residency program application process.

 


 

Prometric Test Center and COMLEX-USA Enhancements for New Test Cycles in 2020

To assure an optimal computer-based testing experience at Prometric Test Centers, modifications continue to be made for COMLEX-USA examinations. Effective with the new May 2020 test cycle for COMLEX-USA Level 1, and the new June 2020 test cycle for Level 2-CE, the Prometric test driver used for all COMLEX-USA examinations has been updated to that already being used in COMLEX-USA Level 3. We endeavor to provide an optimal testing experience for all COMLEX-USA candidates and feel confident that these changes will further enhance the COMLEX-USA program.

 



NBOME to Modify Attempt Limits for COMLEX-USA Effective July 1, 2022

The NBOME Board of Directors approved changes to eligibility for COMLEX-USA to limit the maximum number of attempts to 4 total per exam, effective July 1, 2022. This change is intended to minimize misclassification, enhance test security/integrity, and reinforce NBOME’s mission to protect the public. Exceptions petitioned by a state medical or osteopathic medical licensing board will be evaluated on a case-by-case basis. Further information will be outlined in the COMLEX-USA Bulletin of Information, planned for release in July 2020.

 



 

For more information, please contact NBOME Client Services at clientservices@nbome.org or 866.479.6828

 

 

The NBOME is pleased to recognize the 2019 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 exam programs. In addition to their professional roles, these volunteers wear a variety of hats – writing and reviewing test items, serving as physician examiners for COMLEX-USA Level 2-PE, and supporting the NBOME mission to protect the public through competency assessment.

Each year, the NBOME Board selects the best-in-class item writers and case authors from a large group of contributors. Congratulations to these esteemed awardees for their exemplary commitment to producing valid and high quality exam content.

 

2019 COMLEX-USA Level 1 Item Writer of the Year: Martin Schmidt, PhD

Jonathan D. Auten, DODr. Schmidt is a professor of biochemistry at DMU-COM in Des Moines, Iowa and a long-standing member of our National Faculty. His contributions have been to the COMLEX-USA Level 1 and COMAT Foundational Biomedical Examinations.

 

 

 

 

2019 COMLEX-USA Level 2-CE Item Writer of the Year: John Dougherty, DO

Brett S. Stecker, DODr. Dougherty is the Founding Dean and Chief Academic Officer at Noorda College of Osteopathic Medicine (proposed) in Provo, Utah. He has been a member of the National Faculty since 2016.

 

 

 

 

2019 COMLEX-USA Level 2-PE Case Author of the Year: Robyn Dreibelbis, DO

Maurice W. Oelklaus, DO

Dr. Dreibelbis is vice-chair and assistant professor of Family Medicine at WesternU/COMP – Northwest in Lebanon, Oregon. Dr. Dreibelbis has been selected for this award as a member of the Case Development Committee.

 

 

 

 

2019 COMLEX-USA Level 3 Item Writer of the Year: Binh Phung, DO, MHA

Megan Krease, DO

Dr. Phung is a clinical assistant professor of Pediatrics at OSU-COM in Tulsa, Oklahoma and a pediatric hospitalist at the Children’s Hospital at St. Francis. Dr. Phung has focused his talents on the COMLEX-USA Level 3 examination in both multiple-choice questions and clinical decision-making content.

 

 

 

2019 Clinical Decision-Making (CDM) Case Writer of the Year: Brett Stecker, DO

Teresa M. Kilgore, DODr. Stecker is the assistant professor at Alpert Medical School at Brown University and physician advisor at Steward Medical Group at Morton Hospital in South Easton, Massachusetts. Dr. Stecker is experienced in working with the COMLEX-USA Levels 1, 2-CE and 3 examinations, and was previously awarded Item Writer of the Year for COMLEX-USA Level 2-CE in both 2016 and 2018.

 

 

 

2019 COMLEX-USA Osteopathic Principles and Practice (OPP) Item Writer of the Year: Lauren Noto Bell, DO

Jason T. Eberl, PhD

Dr. Noto Bell is an associate professor at PCOM in Philadelphia, Pennsylvania and a long-standing member of the National Faculty. She has been involved with all levels of the COMLEX-USA examinations and the COMAT clinical exam. She was awarded item writer of the year for OPP in 2017.

 

 

 

2019 COMLEX-USA Preventative Medicine/Health Promotion (PMHP) Item Writer of the Year: Todd Coffey, PhD

Jason T. Eberl, PhD

Dr. Coffey is chair and associate professor in the department of research and biostatistics at ICOM in Meridian, Idaho. He joined the National Faculty in 2018 and contributes to all levels of the COMLEX-USA level examinations.

 

 

 

 

2019 COMAT Clinical Item Writer of the Year: Jessica Rogers, DO

Katherine A. Mitzel, DODr. Rogers is an Obstetrician and Gynecologist at Coyle Institute Female Pelvic Medicine & Reconstructive Surgery in Pensacola, Florida. She joined the National Faculty in 2014 and has been a significant contributor to both the COMLEX-USA and COMAT examinations.

 

 

 

 

2019 COMAT Foundational Biomedical Sciences (FBS) Item Writer of the Year: Lori Redmond, PhD

Rebecca L. Pratt, PhDDr. Redmond is a professor of Neuroscience at PCOM in Suwanee, Georgia and has been a member of our National Faculty since 2017. She was recruited for and has been a strong contributor to the COMAT Foundational Biomedical Sciences examinations.

NBOME recently sat down with Sandra Waters, MEM, Vice President for Collaborative Assessment & Initiatives, to learn more about the upcoming release of CATALYST, a new longitudinal assessment platform that will initially house COMSAE Phase 2 content when it launches this spring.

 

 

 

NBOME: Your team is debuting a new product this spring—COMSAE Phase 2 on CATALYST.  We’re already familiar with COMSAE, but what exactly is CATALYST?

Sandra Waters: CATALYST is a longitudinal assessment platform designed to enhance learning.  So, it isn’t actually content, it’s a new mechanism to deliver content to users.

NBOME: How is longitudinal assessment different from the more traditional learning approaches we’re used to? 

SW: The notion of assessing someone over time—that really is the key. In a traditional class, individuals learn about a subject for a period of time, and then they learn about another subject, and then another subject. Longitudinal assessment uses something called topics interleaving, which enables an individual to gain exposure to ALL of those different components at one time.  It creates these bursts of learning and knowledge acquisition.

If an individual is performing well in a certain area, they don’t need to be assessed nearly as frequently in that area.  In areas where an individual isn’t performing well, CATALYST can increase the volume and frequency of content related to that trouble spot. The intent is to fine-tune the learning component, make it more targeted, and use that to increase knowledge and skills.

CATALYST was developed to combine learning with assessment. The assessments NBOME normally conducts are taken at a single point in time. Whereas, the CATALYST platform enables an individual to assess their knowledge and skills over an extended period of time.  And it aids learning by providing users with immediate feedback while the material is still front-of-mind. Research has shown us that this is a much more effective way for an individual to learn—as opposed to sitting down, taking a test, and never truly understanding what you got wrong—or why.

NBOME: How did this all come about?  What’s CATALYST’s origin story?

SW: When we first had the idea for CATALYST, we focused our efforts on designing the technology for board re-certification.  The current approach involves a physician coming to a testing center every 6-10 years to take a closed book exam for 6-8 hours—not exactly the easiest feat when you’re running a full-time practice, seeing patients, and fulfilling all of the other responsibilities of a busy physician. CATALYST has the ability to change the whole playing field.

However, as we were developing and testing the platform, we continued to identify other ways to use it and other content we could put on there, including our own COMSAE content.

NBOME: Tell me more about why you decided to launch using COMSAE content.

SW: When we were developing CATALYST, we decided to pilot COMSAE Phase 2 on the platform.  It just presented itself as an easy entry point for developing the added features that make CATALYST so special.

Each question includes a rationale essentially explaining why the correct answer is correct and why the incorrect answer is not correct. CATALYST also provides references for further learning and understanding. It’s a self-contained way to test knowledge and skills while providing additional information.

Further, COMSAE on CATALYST is built for busy schedules and maximum flexibility. It’s designed to feed questions to users at self-selected intervals. For example, you could opt to receive 10 questions each week or 30 questions all on one day. As we discussed before, everyone learns a little differently, and we all have different needs and schedules. This platform helps speak to that.

NBOME: With such strong focus on mobility and digitally nimble technology these days, what is the roll-out plan for COMSAE on CATALYST?

SW: COMSAE and other products offered on the CATALYST platform will be available on all devices, and also include a mobile app.  Flexibility and convenience were extremely important to us as we developed the product.

NBOME: Who is eligible to purchase COMSAE Phase 2 on CATALYST and how does the system work?  Can you walk me through the user experience?

SW: It is available to anyone who has an account with NBOME. Candidates may purchase the product through NBOME’s secure portal, at which point, they’ll be sent a welcome email along with login credentials to access the CATALYST platform. From here, they can customize the frequency of questions to suit their unique needs and learning goals. Based on those settings, they will begin to receive notifications when questions are available.

NBOME: If I was a student considering COMSAE on CATALYST, why would I want this over the traditional COMSAE format? 

SW: I actually think you’d want both.  The traditional COMSAE allows you get game-day-ready in an environment that closely mimics COMLEX-USA. Questions are formatted to match in style, and it’s a timed administration—just like COMLEX-USA. You also receive a final report once you complete the assessment. COMSAE on CATALYST is much more of a learning tool. It focuses on mastery of the content. You receive question-by-question and performance-by-domain feedback, rather than just a final report.

Because they serve completely different purposes, I wouldn’t necessarily see one replacing the other.

NBOME: What future enhancements can we look forward to with the CATALYST platform and longitudinal learning?

SW: We’re working on plans to expand our content offerings on the platform. COMSAE Phase 1 is being considered as an option, as well as COMAT subjects. Stay tuned!


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Osteopathic International Alliance (OIA) Conference

From October 4-6, 2019, NBOME Board Vice-Chair Geraldine O’Shea, DO, and President and CEO, Dr. John R. Gimpel, attended the annual Osteopathic International Alliance Conference in Bad Nauheim, Germany.

The OIA is in official relations status with the World Health Organization, and “envisions a world in which every person has access to high-quality osteopathic medicine.” Next year’s AGM and conference will be held in Rio de Janeiro, Brazil from September 30-October 2, 2020.


National Resident Matching Program® (NRMP®) Conference

From October 3-5, 2019, NBOME Associate Vice President for Strategy and Quality Initiatives, Melissa Turner, MS, attended the National Resident Matching Program® (NRMP®) Conference in Chicago. The NBOME provided attendees with a COMLEX-USA update.

This year’s stakeholder conference, titled, “Transition to Residency: Conversations Across the Medical Education Continuum,” set a record for its 300 registrants. Focusing on a variety of topics related to residency, speakers included Ezekiel Emanuel, MD, PhD, Helen Fisher, PhD and Lawrence G. Smith, MD, MACP.


The COMLEX-USA Composite Examination Committee (CCEC) Meeting

The COMLEX-USA Composite Examination Committee (CCEC) met on October 14 and 15 in the Philadelphia Executive offices. This committee reviews all levels of the COMLEX-USA examination series, including statistics and candidate feedback, and provides a report to the NBOME Board of Directors. At this meeting, CCEC reviewed performance and innovations happening within the examination series — including the potential of reducing test items in Level 1 and 2-CE, as well as the Level 2-PE team researching possible modifications to the Humanistic and Biomedical/Biomechanical Domains. CCEC convenes the Blueprint Subcommittee, which regularly reviews the COMLEX-USA Master Blueprint to assure it keeps up with the evolving practice of osteopathic medicine.

The committee also discussed hot topics related to licensure examinations, such as the possibility of switching to a pass/fail scoring system, or keeping some form of numeric-based scoring. The CCEC is also reviewing the current maximum number of attempt limits per examination level. The Point-of-Care Knowledge, Education and Testing (POCKET) process was reviewed and decisions were recommended regarding next steps with this process.


Osteopathic Medical Education Conference (OMED)

From October 25-28, 2019, the NBOME participated in the Osteopathic Medical Education Conference (OMED) in Baltimore, Maryland. The American Osteopathic Association’s (AOA) annual conference brought together thousands of osteopathic physicians, medical students, and other health professionals from across the country for medical education, inspiration, networking and entertainment.

NBOME exhibited at the conference, featuring our new COMAT-Foundational Biomedical Sciences portfolio, as well as the COMLEX-USA examination series, the CATALYST platform and opportunities for doctors to explore the NBOME National Faculty Program. Attendees visiting the NBOME booth were greeted by staff who had meaningful conversations with many visitors and were on hand to answer student, faculty, practicing physician and others’ questions.

On day one of the conference, the American Osteopathic Foundation hosted its annual Honors Gala, presenting awards to a number of NBOME National Faculty members, including AOF Educator of the Year to Richard Jermyn, DO, from RowanSOM. In addition, and in honor of NBOME’s 85th anniversary year, the NBOME made a contribution to the William Anderson, DO Minority Scholarship Fund.

Early Sunday morning, a team of NBOME runners and walkers came out to join in the Advocates for the American Osteopathic Association (AAOA) Fit for Life Run 2019. The run benefitted osteopathic student scholarships and the NBOME was a featured sponsor as well.


Association of American Medical Colleges (AAMC) Annual Conference

From October 8-12, NBOME sent John R. Gimpel, DO, MEd to attend the AAMC Learn, Serve, Lead 2019 Conference in Phoenix, AZ. The meeting covered many of the successes and challenges of academic medicine nationwide, and was attended by medical educators from across the country. Retired President and CEO of AACOM, Steve Shannon, DO, received an achievement award.


Council of Medical Specialty Societies (CMSS) & Organization of Program Directors Associations (OPDA) Annual Meeting

From November 21-22, 2019, NBOME Vice President for Collaborative Assessment & Initiatives Sandra Waters, MEM and Associate Vice President for Strategic & Quality Initiatives, Melissa Turner, MS, attended the Council of Medical Specialty Societies (CMSS) Annual Meeting and Specialty Forum in Arlington, VA.

Together, they presented NBOME and COMLEX-USA updates at The Organization of Program Directors Associations (OPDA) meeting. “OPDA is dedicated to promoting the role of the residency program director and program director societies in achieving excellence in graduate medical education.”


The NBOME Test Accommodations Committee (TAC) Meeting

Between November 21-22, The NBOME Test Accommodations Committee, which is comprised of osteopathic physicians and other subject matter experts who review applications for special accommodations from COMLEX-USA candidates in cooperation with NBOME staff.

The Committee met to discuss trends and developments in the test accommodations realm, as they apply to high-stakes testing agencies like the NBOME.

 

Coming Up

In the next quarter, we’ll be making appearances at the following conferences and meetings:

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 Lori Kemper, D.O., M.S., FACOFP, as its newest Secretary-Treasurer. At their December Board of Directors Meetings, the NBOME elected Dr. Kemper to a two year term.

“I’m thrilled to have even been considered, let alone chosen, as the NBOME’s next Secretary-Treasurer,” said NBOME board member, Lori Kemper, D.O., M.S., FACOFP. “I look forward to working towards our mission in this new, exciting officer role.”

Dr. Lori Kemper’s more than 30-year career encompasses both independent practice and graduate medical education. Since 2007, she has been the dean of Midwestern University, Arizona College of Osteopathic Medicine, where she previously served as associate dean of graduate medical education and associate professor in the department of family medicine. She currently serves as a commissioner to the American Osteopathic Association (AOA) Commission on Osteopathic College Accreditation (COCA) and is the chair of the Board of Deans of the American Association of Colleges of Osteopathic Medicine (AACOM). Dr. Kemper currently serves the NBOME as a member of the Test Accommodations Committee and the Awards Committee.

“We’re ecstatic to announce Dr. Kemper’s election to Secretary-Treasurer of the NBOME,” said NBOME Board Chair Geraldine O’Shea, DO. “Her tenure on our Board of Directors has resulted in great strides for us as an organization, and we look forward to what she’ll help us accomplish moving forward.”

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, today introduced Juan F. Acosta, DO, MS, as its newest board member. He was recommended to the NBOME Nominating Committee via the Assembly of Graduate Medical Educators (AOGME, formerly known as the Association of Osteopathic Directors of Medical Education- AODME), filling the seat previously held by new NBOME Vice-Chair Richard J. LaBaere II, DO, MPH. He was elected at the annual NBOME Board Meeting in December.

“Joining the Board of Directors at the NBOME is an exciting opportunity for me,” said NBOME new board member, Juan F. Acosta, DO, MS. “I’d like to express my gratitude to Dr. Gimpel and his colleagues at the NBOME Board for electing me to this position.”

Dr. Acosta recently moved to New York where he serves as the Associate Medical Director for the Emergency Department at Saint Catherine of Siena Medical Center in Smithtown. He is also actively involved with the Disaster Medical Assistance Team (DMAT) and serves as a reviewer for the Journal of Emergency Medicine and a section editor for the West-JEM Journal. Dr. Acosta is an Oral Board examiner for American Osteopathic Board of Osteopathic Emergency Medicine (AOBEM). He is presently the secretary for the American College of Osteopathic Emergency Physicians (ACOEP) and Secretary for the Association of Osteopathic Directors and Medical Educators (AODME). Dr. Acosta also serves on the American Association’s Commission on Osteopathic College Accreditation (COCA) and the Committee on Continuing Medical Education (CCME).

“We are very fortunate to welcome Dr. Acosta to the Board,” said NBOME Board Chair Geri O’Shea, DO.  “His enthusiasm, decorated professional career and experience in graduate medical education, add to our Board at an exciting time for the NBOME and the osteopathic medical profession.”

COMAT Product Updates

The COMAT exam series will expand in January 2020 to include the new Foundational Biomedical Sciences (FBS) Targeted exams. Each of the 14 exams focus on a specific organ body system or basic science discipline introduced to osteopathic medical students in years one and two. Click here to see the full list of available FBS Targeted subject exams.

Since the introduction of the FBS Comprehensive exam in December 2018, a total of 20 Colleges of Osteopathic Medicine have used or plan to use the FBS exams for pre-clerkship assessments to complement their use of the COMAT Clinical discipline exams for their end-of-rotation needs in years three and four.

The October issue of the Journal of Graduate Medical Education included research on the concurrent and predictive validity of the COMAT discipline exams and COMLEX-USA Level 2-CE. The findings indicated statistically significant, positive associations between COMAT and COMLEX-USA Level 2-CE scores, which can support the use of COMAT for osteopathic medical schools.

 

COMSAE Product Updates

After the first several score releases for COMLEX-USA Level 1 beginning mid-July 2019 and Level 2-CE beginning mid-August 2019, the NBOME conducted a comprehensive evaluation of scores on COMSAE Phase 1 and Phase 2 and subsequent scores on COMLEX-USA Level 1 and Level 2-CE. Following this evaluation, both the COMSAE Phase 1 and Phase 2 new score reports and scoring will be implemented on February 3, 2020. Please note that the COMSAE Phase 2 cut-score remains the same as 2019.

In addition, the NBOME has conducted a concordance correlation study, which demonstrated a positive and significant correlation, around 0.70, with COMSAE Phase 1 and COMLEX-USA Level 1 and COMSAE Phase 2 and COMLEX-USA Level 2-CE. This concordance study finding is consistent with those of recent years for all forms purchased by COMs with timed administrations.

As always, caution should be exercised when using COMSAE scores to estimate subsequent COMLEX-USA scores or for uses other than those for which they were developed.

We will continue to communicate regularly with COMs regarding new information related to COMSAE scores and their relationship to COMLEX-USA scores, as well as other COMSAE program updates as they become available.

“When you show deep empathy toward others, their defensive energy goes down, and positive energy replaces it. That’s when you can get more creative in solving problems.” – Stephen Covey

Empathy has always been the root of human connection, and in that, stems the foundation of our capacity to help others—whether family, friend, or patient—it all comes down to the same core values. And yet, it is the humanistic domain that many question including as part of the DO licensure exam. How important is it?

Having worked in osteopathic medical education and licensing for over 25 years, I am frequently posed the question, what makes DOs different? My answer is always the same, it’s about patient empathy. This isn’t to say that MDs don’t possess this trait; they do. However, there’s a heightened sense of empathy and patient understanding that seems to steer certain candidates toward osteopathic medicine.

The DO approach is based on the unique connection between mind, body, and spirit as it relates to patient care. It’s this holistic, 360-degree assessment and desire for enhanced understanding that fuels empathy and a different shade of patient care. It also involves empathic inquiry, developing understanding beyond just the problem at hand, but also what other life factors are impacting the patient. As a doctor, understanding how these many dimensions interact and intersect on a deeper level is the basis of the DO approach.

To clarify, empathic doctors are not internalizing or ‘taking on’ a patient’s pain or discomfort in a therapeutic way. Rather, they’re attempting to understand the patient’s illness experience. A patient once told me, “I don’t need my doctor to love me, but I do need them to understand me.” That deeper level of understanding is what brings humanistic values back into the medical encounter, allowing for the establishment of a knowing relationship. Research has shown that empathy helps to build trust, is linked to better diagnoses, improves patient outcomes, and decreases malpractice lawsuits.

Now that we have better understanding of the importance of empathy, how do we measure it in a clinical setting? The COMLEX-USA Level 2-Performance Evaluation has been assessing interpersonal and communication skills and professionalism of candidates for the past 15 years. And empathy is one of six dimensions assessed. Based on evidence that patients place great value on their human connection to their doctor, there are several guiding principles that support the role empathy plays in patient care:

Empathy is connection.

Attend to the patient both verbally and non-verbally. Listen to them. Make eye contact. Actively respond to their condition or pain. Avoid giving patients the ‘clinical cold shoulder’ by focusing only on their symptoms.

Empathy is curiosity.

This is especially important for young doctors who don’t have a lot of patient experience. Learn from the patient. Explore their illness experience. Discuss their lifestyle, their belief system, their stress levels, what motivates them. Give patients the feeling of being understood.

Empathy is compassion.

This is the ability to imagine what a patient is experiencing without being overwhelmed by their pain or distress. Research has shown that people are selective when expressing empathy towards others. It’s hard to feel compassion, for example, when a patient is difficult, unlikeable, or struggling with unhealthy behaviors that put them at risk. But it’s these patients who are most deserving and in need of our compassion and understanding.

Empathy is not stress.

Stress is in opposition to empathy. It’s difficult to connect to a patient, or anyone for that matter, when we feel anxious and overwhelmed. Likewise, physicians who have difficulty managing their feelings towards patients are themselves at risk. Although the stress of working with patients is an unavoidable part of a physician’s work life, one goal of medical education should be to equip students with the skills to manage stress in healthy ways.

A generation ago, few were talking about the role of empathy in healthcare. But today, cognitive neuroscience has enabled us to look critically at what ignites and motivates our behaviors, including the empathic ones. This new knowledge and learning, coupled with a heightened focus on developing higher quality patient care, shines a bright light on the need and desire for greater empathic engagement. That said, empathy is not what makes good doctors; it’s what makes good doctors even better.

Demonstrating empathy is important to becoming a DO, and since 2004, passing this assessment has been required to obtain the DO degree, move into residency training, and obtain a license to practice osteopathic medicine.

 

Contributed by Tony Errichetti, PhD  |  Director of Doctor-Patient Assessment  |  NBOME


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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, announced the installment of three officers to its board of directors.

In addition to the new officers, the NBOME recognized Dana C. Shaffer, DO, FACOFP, for his service as Board Chair from over the past two years. NBOME President & CEO, John R. Gimpel, DO, MEd, expressed his gratitude for Immediate Past Chair Dr. Shaffer.

The following individuals were elected to serve as officers for the NBOME’s Board of Directors:

Board Chair: Geraldine T. O’Shea, DO 

As the Chair of the NBOME Board, Dr. O’Shea will lead the NBOME’s strategic plan for 2020-2022, ACEL and vision to become the global leader in assessment for the osteopathic medicine and related health care professions. Dr. O’Shea became a member of the NBOME Board in December 2009 and has served on the Awards Committee, COMLEX-USA Composite Examination Committee, Finance Committee, and the Marketing and Communications Task Force. She was installed as Vice-Chair in December 2017. Previously she served as Secretary-Treasurer from 2015-2017, chaired the Finance Committee and currently serves as a member of the Executive Committee, the Compensation Subcommittee, the SAS for GME Outreach Task Force, and as Liaison Committee Chair.

Dr. O’Shea has practiced internal medicine at the Foothills Women’s Medical Center in Jackson, California, since 1998. 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, Arizona. Dr. O’Shea served as president of the Osteopathic Medical Board of California from 2006 to 2012, and in 2013 as president of the American Association of Osteopathic Examiners. She also previously served on the Federation of State Medical Boards (FSMB) Nominating Committee and has served on the FSMB’s Awards, Audit, and Finance Committees.

Dr. O’Shea is a trustee of the American Osteopathic Association (AOA) and serves as chair of the Strategic Planning Committee, the Bureau of Membership and the Membership Value Task Force. Before being appointed to the AOA Board of Trustees, Dr. O’Shea served the AOA in many capacities, including vice-chair of the Bureau on Federal Health Programs and vice-chair of the Council of Women’s Health Issues. As past president of the Osteopathic Physicians and Surgeons of California (OPSC), Dr. O’Shea was chair of the California delegation to the AOA’s House of Delegates between 2006 and 2014 and received the OPSC’s Lifetime Achievement Award in February 2012.

Board Vice-Chair: Richard J. LaBaere, II, DO, MPH, FAODME

Geraldine T. O'Shea

Dr. LaBaere is the NBOME’s newly installed Vice Chair for 2020-2022. He joined the NBOME Board in 2010 and served on the organization’s Blue Ribbon Panel on Enhancing COMLEX-USA and the Marketing and Communications Task Force. Dr. LaBaere previously served as the Secretary-Treasurer on the Board of Directors, Chairs the Finance Committee and Chairs the COMLEX-USA Composite Examination Committee. He also serves on the Compensation Committee, and the Executive Committee, as well as the SAS for GME Outreach Task Force.

Dr. LaBaere is currently the associate dean for postgraduate training, the osteopathic postdoctoral training institution academic officer and an adjunct clinical professor of family medicine at A.T. Still University–Kirksville College of Osteopathic Medicine (ATSU-KCOM) in Missouri. He has served as regional assistant dean for the Michigan region at the Genesys Regional Medical Center in Grand Blanc, Michigan, where he began his career in 1993 in private practice and graduate medical education.

He has served in various roles as family medicine residency program director, director of medical education and designated institutional official for over 25 years. Dr. LaBaere has presented to local, state and national audiences and has received a number of awards, including the 2006 Osteopathic Family Physician of the Year by the Michigan Association of Osteopathic Family Physicians, and was inducted into the American Osteopathic Association’s Mentor Hall of Fame in 2007 and as a fellow in the collegium of the Association of Osteopathic Directors and Medical Educators (AODME) in 2008. He served as AODME president in 2013. Dr. LaBaere is certified by the American Board of Osteopathic Family Physicians. He earned his Bachelor of Science and master of public health degrees from the University of Michigan in Ann Arbor and his DO degree from the Michigan State University College of Osteopathic Medicine.

Board Secretary-Treasurer: Lori A. Kemper, DO, MS, FACOFP

Richard J. LaBaere II

Dr. Kemper will serve as the NBOME Secretary-Treasurer for 2020-2022. A member of the NBOME Board, Dr. Kemper is also a member of the Test Accommodations Committee and the Awards Committee.

Dr. Kemper’s more than 30-year career encompasses both independent practice and graduate medical education. Since 2007, she has been the dean of Midwestern University, Arizona College of Osteopathic Medicine, where she previously served as associate dean of graduate medical education and associate professor in the department of family medicine. She currently serves as a commissioner to the American Osteopathic Association (AOA) Commission on Osteopathic College Accreditation (COCA) and is the chair of the Board of Deans of the American Association of Colleges of Osteopathic Medicine (AACOM).

Dr. Kemper earned her DO degree from the Kirksville College of Osteopathic Medicine in 1981 and a master’s degree in biological sciences from Arizona State University. She is board certified in family practice and is a fellow of the American College of Osteopathic Family Physicians. Dr. Kemper has practiced as a family physician since 1982, starting her career with the National Health Service Corps, where she provided care for the underserved population in south Phoenix, Arizona. She served as director of medical education and as the family medicine residency program director for Tempe St. Luke’s Hospital in Tempe, Arizona, from 1993 to 2007, where she also served as chief of staff from 2005 to 2007.

Dr. Kemper has earned numerous awards, including the Arizona Osteopathic Medical Association (AOMA)’s Excellence in Osteopathic Medical Education award (2010), Phoenix Magazine’s “Top Doc” award (2007, 1997), and the AOMA’s Physician of the Year Award (2006). Dr. Kemper served as the program director for OMED 2011, the annual Osteopathic Medical Conference and Exhibition. She chairs the Professional Education Committee for the Arizona Osteopathic Medical Association, of which she is past president.

PHILADELPHIA, PA. The National Board of Osteopathic Medical Examiners’ (NBOME) Board of Directors appointed 12 new leaders to their National Faculty chair positions.

The NBOME’s National Faculty is made up of over 700 active, engaged members from across the nation. These thought leaders have diverse expertise in all osteopathic health professions and specialties, osteopathic medical education and evaluation, and osteopathic physician licensure and regulation. Together, they serve on operational committees that review exam criteria, write and review exam items, and serve other roles in our mission to protect the public through rigorous competency assessment of osteopathic medical practitioners.

On behalf of the NBOME Board of Directors and staff, we would like to congratulate and welcome the following National Faculty members who have been appointed to 2020 National Faculty Chair positions.

Foundational Biomedical Sciences Division Chair, Pharmacology

Adrienne Z. Ables, PharmD, MS, FNAOME – Virginia College of Osteopathic Medicine Carolinas Campus

 

COMAT Examination Chair, Emergency Medicine

Thomas E. Benzoni, DO, EM, AOBEM, FACEP – Des Moines University College of Osteopathic Medicine

 

Clinical Decision-Making and Key Features Chair

Peter F. Bidey, DO, MSEd – Philadelphia College of Osteopathic Medicine

 

COMLEX-USA Level 1 Examination Chair

Joyce A. Brown, DO, CHSE – Touro College of Osteopathic Medicine – Middletown

 

Clinical Sciences Department Chair, Radiology and Diagnostic Imaging  

Samuel M. Cosmello, DO, RPh – Private Practice, Fayetteville, NC

 

Clinical Sciences Department Chair, Surgery, Surgical Specialties and Anesthesia

Jay M. Crutchfield, MD, FACS – A.T. Still University School of Osteopathic Medicine in Arizona

 

Foundational Biomedical Sciences Division Chair, Biochemistry

Martha A. Faner, PhD – Michigan State University-College of Osteopathic Medicine

 

Clinical Science Department Chair, Preventive Medicine and Health Promotion

Joyce M. Johnson, DO, MA – Georgetown University

 

Foundational Biomedical Sciences Division Chair, Physiology

Kathleen P. O’Hagan, PhD – Midwestern University Chicago College of Osteopathic Medicine

 

COMAT Examination Chair, Surgery

Michelle M. Sowden, DO – University of Vermont College of Medicine

 

Foundational Biomedical Sciences Department Chair

Robert J. Theobald, PhD – A.T. Still University-Kirksville College of Osteopathic Medicine

 

Clinical Sciences Preventive Medicine and Health Promotion Division Chair, Biostatistics and Epidemiology

Eduardo Velasco, MD, MSc, PhD – Touro University College of Osteopathic Medicine – California

 

“Our National Faculty is crucial to our mission of protecting the public,” said Sandra Waters, MEM, NBOME’s Vice President for Collaborative Assessment & Initiatives. “The NBOME is honored to have such talented and committed thought leaders that represent all aspects of clinical and foundational biomedical science disciplines.”

About the NBOME

The National Board of Osteopathic Medical Examiners (NBOME) is an independent, not-for-profit organization that provides competency assessments for osteopathic medical licensure and related health care professions. NBOME’s COMLEX-USA examination series is a requirement for graduation from colleges of osteopathic medicine and provides the pathway to licensure for osteopathic physicians in the United States and numerous international jurisdictions.

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, salutes Dana C. Shaffer, DO, on the culmination of his two-year term as Chair of the NBOME Board of Directors. At their Board of Directors Annual Meeting and Gala Dinner in December, the NBOME recognized Dr. Shaffer for his exceptional leadership and service.

“My time with the NBOME and all the wonderful folks here have been instrumental in my career,” said current NBOME Board Chair, Dana Shaffer, DO. “It’s been a privilege to serve as the Board Chair, and I’m confident the future is bright for the NBOME and its leadership.”

Dana C. Shaffer, DO, the dean at the Kentucky College of Osteopathic Medicine (KYCOM) in Pikeville, Kentucky, was installed as Chair of the NBOME Board in December 2017. He serves as a member of the Executive Committee and Compensation Subcommittee. He previously served as Vice-Chair and Secretary-Treasurer of the NBOME Executive Committee, as a member of the Test Accommodations Committee and as chair of the Finance Committee and the Liaison Committee. Prior to serving as dean at KYCOM, Dr. Shaffer served as senior associate dean, and also the senior associate dean of clinical affairs at Des Moines University College of Osteopathic Medicine from 2006 to 2013. Prior to that, Dr. Shaffer practiced the complete spectrum of rural family medicine in rural Iowa for 22 years, including osteopathic manipulative medicine, obstetrics and emergency medicine, as well as both inpatient and outpatient care.

“Dr. Shaffer has excelled as a leader for us at the NBOME,” said NBOME President & CEO, John R. Gimpel, DO, MEd. “His wisdom, judgment, experience and commitment have been great assets for us, and we thank him for his countless contributions to the NBOME and our mission.”

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 today announced Kim E. LeBlanc, MD, PhD, as the recipient of their 2019 Clark Award for Patient Advocacy. The award was created to recognize those who have gone above and beyond the call of duty in their advocacy for patient safety, patient protection and quality of care. It recognizes those who have worked to assure patients that DOs have qualified for licensure by virtue of having passed the licensure examinations (COMLEX-USA) that are designed for and have evidence for validity for the practice of osteopathic medicine. Dr. LeBlanc was presented with the award as part of NBOME’s Annual Board Meeting and Gala Dinner.

“The NBOME has been so important to my professional life, and I couldn’t be more honored to have been chosen as their next Clark Award winner. I appreciate all of my colleagues at the NBOME and in the osteopathic medical profession. Nothing would be possible without all of your hard work,” said Kim E. LeBlanc, MD, PhD. “I have worked with colleagues at the NBOME and on the COMLEX-USA examinations since my tenure at the Louisiana State Board of Medicine and have been proud to endorse the use of COMLEX-USA for osteopathic medical licensure in Louisiana and across the nation.”

Dr. LeBlanc recently transitioned back to Louisiana from his position as Executive Director of the Clinical Skills Evaluation Collaboration (CSEC), which creates and administers the United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills examination. He was instrumental in advocating for equivalent licensure for DOs and acceptance of COMLEX-USA when he served as President of the Louisiana State Board of Medicine and on the Board of Directors of the Federation of State Medical Boards. Dr. LeBlanc was in the private practice of family medicine and sports medicine for nearly 20 years where he became involved in academic medicine. He also served as team physician for the University of Louisiana Lafayette, several US Olympic teams, and several professional baseball, soccer, ice hockey, and football teams.

“Dr. LeBlanc’s role in advocating for DOs and COMLEX-USA is a vital piece of NBOME’s exciting history, so it is fitting that he should be awarded the NBOME Clark Award for Patient Advocacy in this our 85th Anniversary year,” said NBOME President & CEO, John R. Gimpel, DO, MEd. “Dr. LeBlanc has made a major difference in health care and medical 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, today announced Gary L. Slick, DO, MA, as the recipient of their 2019 Santucci Award. Thomas F. Santucci, Jr., DO, was the NBOME’s President and Chair of the Board from 1985 to 1987, at a pivotal time of change for the organization. The Santucci Award is the NBOME’s highest honor, awarded only to an individual who has distinguished him or herself by their sustained outstanding contributions to the mission of the NBOME, protecting the public via competency assessment. Since 1978, Dr. Slick, has served in numerous roles at the NBOME, including as Chair of the Board of Directors from 2015-2017.

“I’m truly humbled to have been chosen by my peers to receive The Santucci Award,” said Gary L. Slick, DO, MA. “I want to thank all of my fellow board members at the NBOME for this distinction. Everything the NBOME has accomplished has been a team effort, and I look forward to what’s to come in the future.”

Dr. Slick currently serves as the designated institutional official of the graduate medical education residency and fellowship programs under sponsorship of the Oklahoma State University Center for Health Sciences (OSU-CHS), the chief academic officer of the Osteopathic Medical Education Consortium of Oklahoma, professor of medicine at the OSU-CHS, and member of the board of directors of the Accreditation Council for Graduate Medical Education.

A nephrologist, Dr. Slick has served the NBOME in numerous volunteer capacities over four decades, including as an item writer, test construction committee member, and final exam reviewer in physiology and internal medicine for COMLEX-USA examinations. He has served as committee chair of numerous NBOME Board and testing committees, including as the inaugural Chair of the COMAT internal medicine examination, tests now used in clerkship evaluation at almost every college of osteopathic medicine nationwide. Dr. Slick has been a member of the NBOME Board of Directors since 2005 and was installed as Board Chair in 2015.

“We are so pleased to recognize Dr. Slick with the NBOME’s highest honor,” said NBOME President & CEO, John R. Gimpel, DO, MEd. “Dr. Slick has made immeasurable contributions to the NBOME and the osteopathic medical profession since the 1970s, and how fitting that he should be a 2019 Santucci Award Winner in our 85th Anniversary year.”

As we continue to reflect on our 85th anniversary, we discussed the most memorable achievements in the history of NBOME with our Board of Directors.

 

What would you identify as NBOME’s greatest accomplishment since its founding?

Richard LaBaere II, DO, MPH: NBOME’s greatest accomplishment lies in the establishment of the COMLEX-USA series and its reputation as a nationally and internationally recognized assessment tool that is valid, reliable and relevant to what osteopathic physicians do. The NBOME has been tireless in implementing best practices in test development and testing, has made research a priority, and has employed a forward-looking approach to improvement and service.

Gary Slick, DO, MA: NBOME’s greatest accomplishment to date is being recognized nationally and at the federal and state level as one of two accepted licensing agencies in the U.S.

John Thornburg, DO, PhD: There has been significant evolution and growth from the original small ‘mom and pop’ organization, with only a few full-time employees, to what it is today. NBOME and COMLEX-USA have had much to overcome over the years and they have done so with tremendous grace.

 

What are you most proud to have been a part of since becoming involved with the NBOME?

Richard LaBaere II, DO, MPH: I am most proud of our thoughtful and deliberate growth in both capacity and relevance in the assessment and services NBOME provides. The implementation and further development of COMAT, the launch of a new testing blueprint, and the opening of a new clinical skills testing center are just a few great examples of strategic growth which has helped us in fulfilling our mission to protect the public. NBOME has been a reliable, steadfast partner to many affiliated organizations as well, willing and able to help others move forward during turbulent times of change.

William Anderson, DO: One of the most significant accomplishments that I am glad to have been a part of is the high standards that NBOME set for the profession.

John Thornburg, DO, PhD: One of NBOME’s biggest accomplishments has been the recent adaptation of COMLEX-USA to a competency-based blueprint with the highest standards of quality, enhancing our esteemed status as the one-and-only osteopathic medical assessment for licensure.

 

What is the biggest challenge you have seen the NBOME face and overcome?

William Anderson, DO: The USMLE examination has long been recognized as the licensure exam that allows medical students to practice independently. As a result, NBOME and COMLEX-USA have faced a great deal of competition and challenge while working to establish a unique path for osteopathic medical licensure. The fact that NBOME was able to meet these challenges and emerge successful as an equivalent evaluation, speaks to the high standards of COMLEX-USA, and its appropriateness as a tool to measure and assess osteopathic medical knowledge.

John Thornburg, DO, PhD: Over the years, NBOME has faced many significant challenges and has worked tirelessly to gain respect and acceptance across the medical community and the general public. The quality of our assessment products has been key to our success, as well as NBOME’s efforts to strengthen relationships with our many stakeholders, particularly residency program directors, FSMB, NBME, AOA, AOE, and COM deans.

 

What is the most dramatic change you have seen during your tenure at the NBOME?

Richard LaBaere II, DO, MPH: In the years since I have become a part of the NBOME, I’ve noticed the incredible growth in the understanding of COMLEX-USA in the past decade alone; more and more know about COMLEX-USA and how it reflects the performance of those training in the osteopathic profession.

Gary Slick, DO, MA: Originally, the NBOME only had one examination: COMLEX-USA. In recent years, however, there has been an explosion in the number of assessments developed—from COMSAE, to COMAT, to CORRE. These new assessments have allowed new knowledge to be assessed and a larger number of stakeholders to take advantage of our examinations, including students, COMs, physicians, etc.

John Thornburg, DO, PhD: When I first became involved with the NBOME, there were ten COMs, some with class sizes of less than 100. The subsequent increase in the number of COMs and their class size has resulted in a huge increase in revenue, as well as the need for more NBOME staff to meet this demand.  While the COMLEX-USA series remains NBOME’s primary product, the role new assessment products has played is far beyond what could have been foreseen 10 years ago.

 

What comes next for NBOME? What are you most excited about?

Richard LaBaere II, DO, MPH: I am really excited about the development of new technology platforms like CATALYST to sustain and drive easy access and expedite ways to continue life-long learning. I am also excited about how we can use assessment data in novel ways to assist both students and residency program directors in achieving the very best match possible in graduate medical education, especially in light of the single accreditation system for graduate medical education in 2020.

William Anderson, DO: I anticipate NBOME’s next steps will be closely tied to the single accreditation system for graduate medical education and the ACGME, respectively. As the GME landscape changes, the osteopathic medical community will need to adapt alongside it, working to earn a place in the new ACGME system and position itself as an asset to the practice of medicine.

 

Contributors

Richard J. LaBaere II, DO, MPH serves as the Secretary-Treasurer on the Board of Directors, chairs the Finance Committee and vice-chairs the COMLEX-USA Composite Examination Committee. Dr. LaBaere is currently the associate dean for postgraduate training, the osteopathic postdoctoral training institution academic officer and an adjunct clinical professor of family medicine at A.T. Still University–Kirksville College of Osteopathic Medicine (ATSU-KCOM) in Missouri. 

 

Gary L. Slick, DO, MA is Immediate Past Board Chair on the Board of Directors and member of the NBOME’s Compensation Subcommittee and Nominating Committee. Dr. Slick also currently serves as the designated institutional official of the graduate medical education residency and fellowship programs under sponsorship of the Oklahoma State University Center for Health Sciences (OSU-CHS).

 

John E. Thornburg, DO, PhD serves as a National Faculty Chair in Foundational Biomedical Sciences at NBOME. Dr. Thornburg also currently serves as Professor Emeritus in the  Pharmacy and Toxicology department at Michigan State University. In 2012, he was awarded the AOA’s Distinguished Service Certificate during AOA OMED.

 

William G. Anderson, DO, was an active member of the NBOME Board of Directors from 2003 through 2014 and was member of its Executive Committee from 2007 to 2010. Dr. Anderson is a professor of surgery and senior adviser to the dean at the Michigan State University College of Osteopathic Medicine (MSU-COM). 

 

 


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Horber DT, Waters S.  CATALYST: Transforming Physicians’ Assessment into Learning.  Presentation delivered the 2019 Meeting of the American Board of Medical Specialties, Chicago, IL, September 2019.

 

Session Summary

For years, physicians have criticized maintenance of certification as an ineffective requirement that is irrelevant to practice and cost-prohibitive. In response, several specialty Boards have implemented longitudinal assessment formats to ensure continuing physician competency. The National Board of Osteopathic Medical Examiners (NBOME) has developed CATALYST, an assessment platform supported by findings from cognitive learning that emphasize the value of retrieving previously learned content, providing immediate feedback, spacing questions over time, and interleaving topics in order to produce more complex and durable learning.

During 2017 and 2018, in conjunction with the American Osteopathic Association (AOA), the NBOME conducted 16-week pilot studies with three osteopathic specialty boards. Results provided overwhelming support for the CATALYST assessment platform: of the 196 diplomates surveyed, 95% agreed or strongly agreed that CATALYST would help them stay current in their specialties and over 98% preferred the CATALYST format to traditional Board examinations. A significant pilot finding was that different specialty Boards have different requirements and expectations, as did the physicians within the specialty. In order to provide greater customization within CATALYST, the NBOME is implementing a new CATALYST platform, with a follow-up study.

The presentation will describe CATALYST as an assessment format, summarize NBOME’s development path including the new platform and pilot outcomes, and describe alternative uses for CATALYST. Lessons learned from this journey and planned next steps will provide insights to organizations seeking alternative modes of ongoing physician assessment. Audience participation and questions will be encouraged

 

Learning Objectives

By attending this presentation, attendees will be able to:
• Describe CATALYST’s basis in cognitive learning theory
• Summarize the outcomes reported in the CATALYST pilot studies
• Describe next steps for CATALYST

Shaffer D, Waters S.  Ensuring Ongoing Physician Competency with CATALYST.  Presentation delivered at the 2019 Meeting of the International Association of Medical Regulatory Authorities, Chicago, IL, September 2019.

 

Abstract

The purpose of maintenance of certification in the United States is to ensure ongoing physician competency in order to safeguard patient safety. In recent years, maintenance of certification, with its generally unpopular traditional, high-stakes, multiple-choice examination, has been criticized as a cost-prohibitive process that is not relevant to physicians’ clinical practice. In response, some specialty Boards, among them the American Board of Anesthesiology, the American Board of Pediatrics, and the American Board of Internal Medicine, have implemented alternative assessment formats that focus on facilitating physician’s continued learning.

In keeping with its mission, the National Board of Osteopathic Medical Examiners (NBOME) has developed CATALYST, a longitudinal assessment designed to provide specialty Boards with a potential means of assessing ongoing physician competency. CATALYST is based on findings from cognitive learning which emphasize the retrieval of previously learned content, providing immediate feedback, spacing questions over time, and interleaving topics. The NBOME, in conjunction with the American Osteopathic Association (AOA) conducted 16-week pilot studies to gather data concerning how diplomates from three osteopathic specialty boards viewed the CATALYST assessment platform and the assessment process. Participants were recruited from the American Osteopathic Board of Internal Medicine (AOBIM), the American Osteopathic Board of Pediatrics (AOBP), and the American Osteopathic Board of Obstetrics and Gynecology (AOBOG).

Results indicated overwhelming support for the CATALYST platform: of the 196 diplomates surveyed, 95% agreed or strongly agreed that CATALYST would help them stay current in their specialty and 91% thought it would help them take better care of their patients. Over 98% stated that they would rather answer a fixed number of CATALYST questions periodically than take the traditional recertification examination.

This presentation will describe the use of CATALYST as an assessment format and summarize the outcomes of the pilot studies and their outcomes. As well, next steps for CATALYST, including the development of a new technology platform, will be discussed. Lessons learned will assist participants in considering exploration or potential enhancement of similar programs in their jurisdictions.

 

Behavioral Learning Objectives

By attending this presentation, attendees will be able to:
• Explain the elements of cognitive learning theory that support CATALYST as a longitudinal assessment.
• Describe the outcomes of the pilot studies with diplomates of three osteopathic specialty boards.
• Describe next steps for CATALYST.

 

References

The American Board of Anesthesiology – Part 3: MOCA Minute®. http://www.theaba.org/MOCA/MOCA-Minute. Accessed February 4, 2019.

The American Board of Pediatrics – MOCA-Peds. https://www.abp.org/mocapeds Accessed February 4, 2019.

Madewell,JE, Hattery, RR, Thomas SR, Kun LE, Becker GJ, Merritt C, Davis, LW, American Board of Radiology: Maintenance of Certification. Radiology. 2005 234(1): 17-25. Published Online:Jan 1 2005https://doi.org/10.1148/rg.251045979.

Brown PC, Roediger HL, & McDaniel MA. Make it Stick: The Science of Successful Learning. Cambridge MA: Harvard University Press, 2014.

Moulton CA. Dubrowski A, MacRae H, Graham B, Grober E, & Reznick R. Teaching Surgical Skills: What kind of Practice Makes Perfect? A Randomized, Controlled Trial. Ann Surg. 2006 Sep;244(3):400-9.

Mirigliani L, Lorion, A. When Life Gets in the Way: Getting SPs out of Their Heads and into the Role. Presentation delivered at the 2019 Association for Standardized Patient Educators Annual Conference, Orlando, FL, June 2019.

 

Overview

We ask Standardized Patients (SPs) to put the outside world aside during encounters and focus only on what is happening in the room, but this is not always easy, even for the best SPs. SPs being distracted by real-life concerns may lead to struggle with portrayal, recall, late arrivals or callouts, or unpredictable responses to co-workers or feedback. Without attention, an SP may continue to struggle—in work and out. Yet, the integrity of the simulation must be protected, and sometimes the SP’s employment will be in jeopardy. This session will help participants be prepared to recognize potential signs of SPs who are struggling emotionally; be receptive to having conversations with those SPs; identify tools and resources that can assist the SPs; be able to set limits; and be able to hold to those limits, even if it means the SPs going through corrective action, up to and including termination.

 

Rationale

An SP’s emotional state can have serious repercussions, impacting other SPs and staff as well as the SP, making portrayal of some cases more difficult and potentially risking an examination’s standardization. Being aware that shifts in emotional state are a possibility, being able to address the situation with the SP, and having tools and resources readily available for the SP will help trainers and administrators intervene, address the root cause of unusual behavior, and potentially assist a valued SP. Setting and holding to limits will help the trainer or administrator protect him or herself and the simulation.

 

Objectives

Participants will be able to:
1. Help SPs recognize what may be “triggers” for them, including having to simulate something they are experiencing in real life.
2. Encourage SPs to do emotional “self-checks” prior to simulations.
3. Start a potentially uncomfortable conversation with the SP.
4. Have tools and resources at hand.
5. Set limits to preserve the integrity of the simulation.

 

Intended Discussion Questions

1. Have you been in this situation before, on either side of the conversation? If so, what did/did not go well and what did you learn?
2. What tools have you used/could you use to help SPs dealing with emotional issues to focus on the simulation and their responsibilities to the center, their co-workers, and the students?
3. What resources are available at your institution that could assist SPs struggling with emotional difficulties?
4. Given your role, how will you prepare your colleagues and share information?

 

References

Spencer, John and Jill Dales, “Meeting the Needs of Simulated Patients and Caring for the Person Behind Them?” Medical Education 40.1 (2006): 3-5.

Bokken, Lonneke, Van Dalen, Jan, and Jan-Joost Rethans, “Performance-related stress symptoms in simulated patients,” Medical Education 38.10 (2004): 1089-1094.
Varlander, Sara, “The Role of Students’ Emotions in Formal Feedback Situations,” Teaching in Higher Education 13.2 (2008): 145-156.

Lewis, Karen L.,Carrie A. Bohnert,Wendy L. Gammon, Henrike Hölzer, Lorraine Lyman, Cathy Smith, Tonya M. Thompson, Amelia Wallace, and Gayle Gliva-McConvey “The Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP)” Advances in Simulation 2:10 (2017).

“Building Workplace Resilience.” Guidance Resources Online. 2018. ComPsych Corporation. Retrieved from https://www.guidanceresources.com/groWeb/s/article.xhtml?nodeId=809859&conversationContext=1

Ronkowski, E. Collaborative Cognitive Item Mapping Paper presented at the 2019 Conference of the American Board of Medical Specialties, Chicago, IL, September 2019.

 

Learning Objectives

Attendees will leave this presentation with ideas on how to innovate traditional item-writing workshops through Collaborative Cognitive Item Mapping (CCIM). They will also have an understanding of how to implement the Plan-Do-Check-Act (PDCA) model to innovate test development in a data-driven manner.

Session Summary

Collaborative Cognitive Item Mapping (CCIM) is a dynamic, new form of item development that builds on the literature in automatic item generation (AIG). In CCIM, a small group of subject matter experts (SMEs) develops items that assess essential testing objectives related to a clinical presentation, such as neck masses. The SMEs select high-frequency, high-impact diagnoses related to the topic, then map out patient findings and clinical decision-making processes. An item editor transforms the map into a set of items.

CCIM is beneficial because it is collaborative, systematic, and intentional. Independent item writing (IIW) can be challenging for physicians who are used to constant interactions and movement; CCIM allows SMEs to develop items without the intimidation of the blank page. The systematic approach of CCIM ensures that items include necessary details, such as duration of symptoms, and results in better distractors as SMEs think through plausible options for multiple diagnoses at the same time. With IIW, it is difficult to control for SMEs writing similar items on the same topics. With CCIM, a small group, rather than an individual, decides the testing objectives and diagnoses; this results in items that reflect the breadth and scope of the topic.

To develop CCIM, we implemented the Plan-Do-Check-Act (PDCA) model. At a pilot workshop, participants wrote items through IIW and CCIM. Through a collaboration of psychometricians, editors, and test developers, we fast-tracked a group of nearly 100 items for pretesting, and the results showed no significant statistical difference in item performance between the CCIM and IIW items. Our preliminary findings also suggest that CCIM can boost item production as much as 30% compared to traditional workshops.

Beyond the NBOME board, executive leadership, and even our 700+ member National Faculty, there are dozens of staff members and collaborators helping us protect the public in their roles behind the scenes. To commemorate our anniversary, we turned to some NBOME insiders for their insights at the work and  culture of the NBOME. Last week we heard from, Shirley Bodett, and Dennis J. Dowling, DO.  This week a few more long-time NBOME staff and collaborators shared their perspectives of our work over the years.

 


 

Sydney Steele, JD has been NBOME’s General Counsel for over 25 years. With a deep knowledge of the Americans with Disabilities Act (ADA), Sydney has been instrumental in establishing our modern Test Accommodations practices. In 2019 he won NBOME’s Santucci Award for a career of sustained contributions to the mission of the NBOME.

 

What was going on at the organization when you started?

When I started As I recall there were only about 12 or so employees in the Conshohocken office. There was no full-time President. There was no office in Chicago. There was no PE exam. And there were very little if any ADA claims by test-takers.

What were some of the biggest shifts in the NBOME during your time here?

The NBOME has become substantially more sophisticated in their testing practices, including Level 2-PE, and expanded testing into related health care professions.  Technology has driven a lot of that, as did my role in developing our ADA accommodations for students with disabilities.

What is your fondest memory of your time with the NBOME?

Working with the talented and dedicated people at the NBOME, and watching the organization grow from about 12 or so employees without a full-time president, to what it is today.

 


 

NBOME’s principal Research Associate, Yi Wang, MS has been with the organization for 18 years. She was awarded the President’s Award for Outstanding Service.

 

 

How has technology changed how the organization works?

When I started working with NBOME, all of our assessments used paper and pencil.  In 2005, we moved COMLEX-USA to a computer-based format and began developing COMLEX-USA Level 2-PE. Following that we built and entire portfolio of computer-based, and even web-based assessments.

What’s your favorite thing about working at the NBOME?

Everybody probably says the same thing, but it’s really true that the people that make up the NBOME are really the best thing about it. I’ve been here nearly 20 years, and I’ve seen us grow from 20 employees in 2001 to nearly 130 today, but I still know I can count on every member of my team.

 


 

The first face you see when you enter our Philadelphia corporate offices is Rachel Maxwell. She keeps us running like a well-oiled machine as our Coordinator for Operations. She has been with the organization for 15 years.

 

 

What’s changed since you’ve worked here?

When I first started in 2004 we were just opening the testing center for the COMLEX-USA Level 2 PE exam.  Nothing was done electronically the first few years.  Each students filled out a paper application and mailed a check in to pay for their exam.  We manually registered students for each testing date were on paper and then uploaded into the system to run the exam.  We sent all score reports via snail mail as well. We’ve come a long way since then. Computers have simplified a lot of processes, but they still keep us busy.

What is your fondest memory of your time with the NBOME?

Do I have to pick one?  I’ve been here so long that I have so many fond memories of NBOME.  There were times when we were smaller when we’d hold company events at the company president’s house,  a company outing for an afternoon of snacks and swimming, the entire staff even attended dinner with the board.

What’s your favorite thing about working at the NBOME?

I have met some very interesting people while working with our National Faculty, but more importantly I have made some wonderful friends with my coworkers as well.  I think that no matter what, the NBOME is growing, but I still feel like we maintain a small company type feel where everyone knows each other, cares about each other and like any family, we go through our ups and downs, good and bad.

 


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We are pleased to congratulate Karen J. Nichols, DO, former president of the AOA and vice chair of the Accreditation Council for Graduate Medical Education (ACGME) board, for being named chair-elect of the ACGME.

“I have had the honor of serving on the ACGME board for five years and have clearly seen the laser-focus of the entire organization on our mission – ‘…to improve health care and population health by assessing and advancing the quality of resident physicians’ education through accreditation,'” said Dr. Nichols.

Dr. Nichols has a long, decorated history in osteopathic medicine. She served as the first woman president of the AOA, president of the Arizona Osteopathic Medical Association and president of the American College of Osteopathic Internists.

From 2002-2018, Dr. Nichols was dean of Midwestern University Chicago College of Osteopathic Medicine. Prior to that, she was assistant dean, post-doctoral education and division director, internal medicine, at the Midwestern University Arizona College of Osteopathic Medicine. A frequent national speaker on leadership, end-of-life care and osteopathic medicine, Dr. Nichols has also received seven honorary degrees and top awards from the AOA and the American Association of Colleges of Osteopathic Medicine.

She currently holds several positions at the ACGME.  In addition to her newly appointed post, she is a member of the executive committee, chair of the governance committee, and a member of the standing committees for education, policy and monitoring.

“The ACGME has worked to transition to an accreditation model that encourages excellence and innovation. My vision is to work with our fine ACGME board, staff and volunteers to see that the ACGME continues to move forward while being thoughtful and current.”

All of us at the NBOME recognize Dr. Nichols’ accomplishments, and we sincerely wish her the best of luck in her new role with the ACGME.

Read more about Dr. Nichols’ role as chair-elect of the ACGME.

In honor of the NBOME’s 85th anniversary since our founding, we sat down with some inspirational members of the osteopathic medical community to discuss their thoughts and perceptions of the NBOME over the years and now.

 

As NBOME celebrates 85 years of osteopathic medical assessment, how do you feel the organization has impacted the osteopathic medical profession over recent decades?

John Potts, MD: The NBOME’s examinations, developed by their many highly capable and dedicated volunteers, have continued apace of the rapid advance of medical knowledge. As such, the NBOME has pushed both osteopathic medical students and the colleges of osteopathic medicine to ever-higher achievement.

Thomas Cavalieri, DO: The NBOME has impacted the osteopathic medical profession through its commitment to excellence and its steadfast adherence to protecting the public. Fulfilling this mission derives from NBOME’s ability to create an exam that truly integrates osteopathic principles and practice while providing evidence for the need for a distinct profession to have a distinct licensure exam.

Bill Burke, DO: The NBOME, through the actions of its Board and staff, has made an invaluable contribution to the growth and development of the osteopathic medical profession. The ability of DOs to obtain licensure in all 50 states, is in large part due to the development and continuous modernization of the COMLEX-USA series. It is exciting to see the innovation coming from this organization, which will assist practicing physicians in maintaining their board certification through platforms like CATALYST.

William Mayo, DO: Throughout the entirety of its history, the NBOME has defended the distinction of DOs and our approach to our patients—sometimes even against strong opposition. Psychometrically valid, defensible exams, such as COMLEX-USA, provide a strong case to be made on behalf of the profession, and have been endorsed by a number of organizations.

 

What advice would you give the NBOME as it completes its first 100 years between now and 2034?

Karen Nichols, DO, MA: I would encourage the NBOME to continue holding the bar high in order to ensure that qualified osteopathic physicians are prepared to serve the public.

John Potts, MD: These times are challenging in many ways and I can only predict more challenging times ahead for medical education, both osteopathic and allopathic. I expect the NBOME will continue to fulfill its mission as it has in the past, and continue to uphold the standards that further enable protecting the public.

Humayun Chaudhry, DO: NBOME faces the same challenges confronting all testing entities: the need to demonstrate the continued value of independent assessment as a critical adjunct to medical education and training. This is particularly important at a time when the broader environment seems less amenable to regulation overall.

William Mayo, DO: I would recommend that the NBOME continues to collaborate with the AOA, AACOM and the FSMB to promote distinctiveness across the continuum.

Thomas Cavalieri, DO: It is my hope that the NBOME remains steadfast in its commitment to protecting the public and assuring continued high-quality examinations that truly reflects the essence of osteopathic medicine.

 

Contributors

John R. Potts III, MD, is the Senior Vice President, Surgical Accreditation at the Accreditation Council for Graduate Medical Education (ACGME). Dr. Potts also serves as an adjunct professor of Surgery at the University of Texas Houston Medical School (UTHMS). He has also served on the ACGME’s Committee on Innovation in the Learning Environment and on the Standing Panel for Accreditation Appeals in the specialty of surgery.

 

Thomas A. Cavalieri, DO, is the dean at Rowan University School of Osteopathic Medicine and also serves as a professor of medicine and Osteopathic Heritage Endowed Chair for Primary Care Research. Dr. Cavalieri is a past chair on the NBOME’s Board of Directors, and a longtime National Faculty leader. He was first recruited to the National Faculty in the late 1980s as an exam writer, and oversaw the launch of the COMLEX-USA Level 2-PE in 2004.

 

Bill Burke, DO, is the Dean of the Ohio University Heritage College of Osteopathic Medicine-Dublin Campus and Chair of Osteopathic International Alliance. He served as a trustee of the American Osteopathic Association (AOA) and as the chair of its departments of Educational Affairs, Governmental Affairs, and Research and Development, as well as its Bureau of Communications and Committee on AOA Governance and Organizational Structure. He is a founding director of the International Primary Care Educational Alliance.

 

William S. Mayo, DO, was president of the American Osteopathic Association (AOA) for 2018–2019. Throughout his tenure, Dr. Mayo has served the AOA in many capacities. Additionally, Dr. Mayo is a past president of the Mississippi Osteopathic Medical Association and the Mississippi EENT Society. He has served on the Mississippi State Board of Medical Licensure since 2006 and was president from 2010-2012.

 

Karen J. Nichols, DO, MA, MACOI, CS, is the chair elect of the Accreditation Council for Graduate Medical Education board of directors, and has served as president of the American Osteopathic Association, president of the Arizona Osteopathic Medical Association (AOMA), and president of the American College of Osteopathic Internists, being the first woman to hold all of those
positions.

 

Humayun Chaudry, DO, is the President and Chief Executive Officer of the Federation of State Medical Boards (FSMB) of the United States and was chair of the International Association of Medical Regulatory Authorities (IAMRA) from 2016 to 2018.

 

 


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Beyond the NBOME board, executive leadership, and National Faculty, there are dozens of staff members and collaborators helping us protect the public in their roles behind the scenes. To commemorate our anniversary, we turned to some NBOME insiders for their insights at the work and the culture that’s brought us to where we are today.

 


 

Senior Operations Specialist, Shirley Bodett has been with us longer than any other staff member. In her 34 years with us, she’s witnessed many of the changes that have shaped the modern day NBOME.

 

 

NBOME: What was happening with the organization when you started?

When I was hired in 1984, there were only two other employees – an Executive Director, Carl W. Cohoon and his assistant Carol Thoma. I was hired to answer phones and do clerical work.

To create exams (one for each discipline), the discipline chair would look through coded cards and select test items based on categories. The staff would then use a word processor and floppy discs to put these questions into a two-column document. This was then sent to a printer, who published the exam books.

Exam scoring was contracted out to the University of Iowa, where score reports were printed and sent to us in triplicate for distribution. We entered candidate names into huge black books by hand, in alphabetical order, by school and graduating class. Later, we entered each candidate’s scores into that same book. When transcripts were ordered, we again opened these books to find the information needed to complete the transcript.

What were some of the biggest changes you’ve seen in the organization?

Computerization has completely changed how we do nearly everything. We’ve brought a lot of our processes in-house, and our vastly expanded staff is much more involved in item creation, editing, and review.

What is your fondest memory of your time with the NBOME?

Working with some of the same people for many years, and getting to know physicians Board members, other Subject Matter Experts, and staff as individuals rather than as defined by their profession.


 

A lifelong advocate for Osteopathic Manipulative Medicine (OMM), Dr. Dennis J. Dowling, DO, FAAO, our Coordinator for OMM Assessment began working with the NBOME 26 years ago. His work has been instrumental in launching our COMLEX-USA Level 2 PE.

 

 

When did you begin working with the NBOME?

I started in the early 90s after becoming a faculty member at NYCOM. One of my professors, Robert E Mancini, PhD, DO was a pharmacologist who became an osteopathic physician as well as a former NBOME president. Dr. Mancini got me involved with a task force he had put together to integrate Osteopathic Manipulative Medicine (OMM) with other questions.

 

What were some of the biggest changes in your time here?

In 1997 I expressed an interest in the examination of osteopathic manipulative skills and utilizing scoring rubrics to better reflect the process. We came to a major crossroads in the early 2000s that could have easily led to DO students taking a generic test for all medical students, with a tacked on OMT station or two, and no other osteopathic distinctions. But thanks to our work at the time, we now have a fully integrated osteopathic examination that is a much more effective way of testing osteopathic students preparing to enter postgraduate training.

How has technology changed in terms of how we operate?

Technology expands the ability to create much more material and develop alternate processes of testing. It also opens up to greater security risks than ever before. We have to keep up with advancing technology and capabilities, while meeting the needs of the population that we are examining.

What’s your favorite thing about working at the NBOME?

There’s a camaraderie and a sense of purpose that permeates everything we do. We are truly trying to develop the best product for protecting the public and enhancing osteopathic medicine. Without the strength of the NBOME, osteopathic medicine would be a very different and much less effectual profession than exists today.

 


 

Next week we’ll catch up with former NBOME General Counsel, Sydney Steele, 2019 NBOME President’s Award winner Yi Wang, and Coordinator of Operations, Rachel Maxwell for their perspectives on 85 years of NBOME.

 


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Sheryl Bushman, DO, served as our Chair from 2005-2007, overseeing a great investment in development for the board, the organization, and its products to guarantee their validity at a time of increased scrutiny. From 2011 to 2013, Janice Knebl, DO came on as chair, and oversaw the creation of the Blue Ribbon Panel to modernize COMLEX-USA to a competency based model (which we’ve just finished implementing this year). Both these women have had their own distinct impact in shaping of our organization, they also happen to be the first and second chairwomen of the NBOME.

We sat down with these two important figures to hear their perspective of the NBOME’s 85 year history, and their own part in it.

 

When AT Still opened the first COM in the 19th century, it was pretty radical that women were able to study there. Famously the first person to take the NBOME’s first exam was a woman (Margaret Barnes). How do you feel about the state of women in the NBOME, and in osteopathic medicine on the whole? Are we living up to the legacy?

Dr. Sheryl Bushman: The NBOME has always treated women with the utmost respect.  It is part of our DNA.  I recall before becoming Chair they asked “What should we call you?  Chair-man Bushman doesn’t sound appropriate.” We’ve simply called the position “Chair” ever since. Even to this day, I see committee Chairs purposefully review the demographics of their members and try to generate membership to reflect the profession considering race, sex, age, location, etc.  This encourages the NBOME’s culture of collaboration, intellectual stimulation, respect and sensitivity. AT Still would be proud to see how far we have come.

Dr. Janice Knebl: I am so very proud that while I was NBOME Chair, the Board of Directors was composed of 40% women. As I participated in the Coalition for Physician Accountability, which included all of the other major physician groups, we had the largest percentage of women physicians and board members than any of the other organizations. It is critical for the NBOME Board to reflect the “face” of osteopathic medicine which is on average about 50% women in every College of Osteopathic Medicine Class.

 

What do you think women bring to the table, particularly when it comes to leadership roles?

SB: Whether we are men or women, we all come to our leadership roles with a different style. I am certain that my role as Chair helped me develop my leadership skills in being able to provide difficult news clearly, directly, but gently.

JK: I believe that women bring empathy, strong work ethic and collaboration to osteopathic medicine. Of course, these are generalities that don’t apply to all women. When working with women leaders in osteopathic medicine I have seen them be solution focused and being inclusive of diversity of opinions. Most of the women leaders I have worked with have given over 100% to their positions.

 

What does the NBOME do well when it comes to promoting gender diversity in leadership, and what do you think we could do better?

SB: As I’ve said, the NBOME has been committed to reflecting the demographics of the osteopathic profession, even as I first became involved in 1989.  They do a good job. If there is a gap, I imagine it’s due more to a lack of awareness among the candidate pool than a lack of inclusivity on the NBOME’s part. Perhaps identifying a way to advertise or communicate opportunities could improve participation.

JK: NBOME intentionally recruited women for the Board of Directors during my tenure as Chair. In order to have the gender diversity, there needs to be an intentional approach by inviting and encouraging participation in all aspects of the organization by women. There needs to be an understanding and respect that women may have other roles and responsibilities during their careers that will change to enable them to participate at different times in the organization. NBOME could consider supporting a leadership track for women and men who are identified for future leadership roles within the organization.

 

How do you look back on your experience with the NBOME?

SB: Among all the leadership positions I’ve held in my career, I treasure this position the most for several reasons. The NBOME is made up primarily of volunteers with great affection for the osteopathic profession and the desire to give back.  Unlike many professional organizations, egos are left at the door.  Patient wellbeing and student fairness are always at the forefront in our decisions, from test development to the cost of exams, etc.  Working with colleagues across the entire spectrum of medical care for this organization is a true blessing.

JK: It was a true privilege for me to serve as an officer and Chair for the NBOME. Being involved with the NBOME and having the opportunity to be a leader in assessment for osteopathic medicine has been a true highlight of my career as an academic osteopathic physician. The mission of the NBOME to protect the public is noble and necessary for the public good and for all of us as patients.

 

Contributors


Sheryl Bushman, DO currently works as Chief Medical Informatics Officer at Optimum Healthcare IT, and contributes to on our COMLEX-USA Level 2-PE Advisory committee. She served the NBOME’s Board Chair from 2005-2007

 

Janice Knebl, DO currently practices and teaches Geriatric Medicine in Fort Worth TX, in addition to chairing our COMLEX-USA Composite Examination Committee. She served as NBOME Board Chair from 2011 to 2013

 

 


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COMLEX-USA  |  New Level 1 and Level 2-CE Exams Have Launched

We are pleased to announce the completed launch of all elements of the enhanced COMLEX-USA exam series under the new COMLEX-USA Enhanced Master Blueprint.  Level 1 successfully released this spring, followed by Level 2-CE’s in late summer. These exams have joined Level 3 and Level 2PE, which launched in 2018 and earlier this year, respectively.  New passing standards for COMLEX-USA Level 1 and 2 have also been implemented for the 2019-2020 test cycles.

This multi-stage release is the culmination of nearly 10 years of work in evidence-based design by experts and leaders from across the organization and the country who contributed in all areas to the creation and deployment of this state-of-the-art assessment.

The exams launched to heavy candidate volume with over 1,500 candidates completing each exam during the first weeks. To date, over 5,000 Level 1 examinations have been administered, with similar numbers for Level 2-CE.

These examinations also mark a move to Prometric’s new test driver, SURPASS, where NBOME already administers its Core Osteopathic Recognition Readiness Examination (CORRE), as well as the latest version of COMLEX-USA Level 3.  Since the move to SURPASS, some students have encountered performance problems during their administrations, including latency and examination restarts.  Prometric continues to investigate the cause and has made system upgrades in early June to address issues.  NBOME is currently offering online tutorials for Levels 1, 2-CE and 3 for candidates who would like to learn more about the new test interface being offered at Prometric Testing Centers.

Please visit the COMLEX-USA pages of our website to learn more.

 

 

COMAT  |  Foundational Biomedical Sciences (FBS) Exams Available this Academic Year

Since the inception of the COMAT Clinical Exams in 2011, osteopathic medical students have taken over 250,000 COMAT Clinical exams. As a result, we have seen dramatic improvement in COMLEX-USA Level 2-CE scores by osteopathic medical students. This is particularly important in the era of Single Accreditation for GME.

Celebrating 85 years of protecting the public through valid and reliable licensing exams, NBOME has spent the last 5 years developing an expanded COMAT portfolio to assist in DO student success.

COMAT Clinical exams initially focused on assessment of clinical education and knowledge typically found in year 3 and 4 COM curriculum. The success of this initial series of exams led the NBOME, in collaboration with its National Faculty, to expand its offerings and develop assessments for the Foundational Biomedical Science (FBS) curriculum which take place during year 1 and 2. After careful development and testing, the COMAT FBS Comprehensive (FBS-C) exam became available in December 2018. Since its inception, the 5-hour, 250-question COMAT FBS-C has successfully been utilized by many COMs across the country. This assessment has enabled both COM students and faculty to better understand the effectiveness of the school’s classroom curriculum and identify areas for student development.

Scheduled for release in January 2020, the suite of 14 FBS Targeted (FBS-T) exams further supports osteopathic medical student professional success. These exams are divided between 6 core science disciplines, including Anatomy and Pharmacology, as well as 8 body systems, including musculoskeletal and cardiovascular. Each 90 minute, 62 question COMAT FBS-T exam is designed to evaluate a student’s knowledge in a focused subject area. Timely score reports detail areas of strength and challenge, and will provide COM faculty and students insight to guide COMLEX-USA Level 1 preparation.

Should you have any questions about COMAT or the new FBS examinations, please visit the COMAT pages of our website.

Contributed by:  Michael Finley, DO  |  Senior VP for Assessment  |  NBOME 

 

 

CATALYST  |  Continuous Learning Platform

Wouldn’t it be nice if you could make learning new material easier?  And what if you could avoid taking another traditional multiple-choice exam to demonstrate what you’ve learned?

Inspired by research from leading cognitive psychologists, as well as by the success of the American Board of Anesthesiology’s MOCA-Minute, the NBOME began its research journey into developing its own continuous learning platform – CATALYST.

CATALYST is a formative assessment platform designed as an alternative to traditional physician competence and practice-relevant assessment. Based on the outcomes of several successful pilots conducted in 2017 and 2018, the NBOME has expanded its partnership with ITS to develop a more sophisticated platform that can be customized to meet various client assessment needs.

With the primary goal of eliciting user feedback on the newly designed platform, the CATALYST 2.0 Platinum Pilot was released on June 5.  Participants included osteopathic medical students, residents, NBOME National Faculty and NBOME staff. Learners were asked to answer 70 multiple-choice questions during a five-week period and were offered a choice of receiving 2 items a day, 14 items a week, or all 70 items at once. Following the completion of each item, participants were asked to gauge their confidence in answering the question and the question’s relevance to their specialty / field of study. Whether or not the question was answered correctly, the participant was provided with immediate feedback including the correct answer, a rationale for the answer, as well as references and links to additional learning resources.

Feedback has been very positive — 94% said the platform met their expectations and 91% found the system easy to navigate. What did participants like most about CATALYST?  One responded that it was “very easy to navigate, good questions.” Another “liked that the platform showed the learning objectives of each question, helped identify why the question was being asked, and identified what the learning goals were for each question.” And a National Faculty member liked that “it could be done on my own time across multiple platforms and devices.”

The cross-functional CATALYST team, led by Sandra Waters, MEM, VP for Collaborative Assessment & Initiatives, is preparing for the next CATALYST release in September which will include an enhanced dashboard with normative statistics, highlighting of item components, and streamlined registration. Preparation has also begun for the delivery of COMSAE Phase 2 on CATALYST, providing COMLEX-USA Level 2-CE candidates the opportunity for alternative learning through formative assessment.

Contributed by:  Dot Horber, PhD  |  Director for Continuous Professional Development  |  NBOME

In this section

Browne, M, Wojnakowski M, Horber DT.  Choosing Wisely: So Many Options for Assessment Administration. Which will Enhance Your Exam’s Validity and Fairness? Paper presented at the 2019 Innovations in Testing Conference, Orlando FL, March 2019.

 

Short Description

With advances in assessment, credentialing organizations are presented with myriad options to “enhance” test format and administration. Two organizations have been conducting research and pilot testing to explore some options alone and in combination – use of resources while testing, and, high stakes testing in remote proctored conditions.

Reference availability may increase an assessment’s fidelity to real life clinical situations, but it raises many implementation questions: Which references will be useful and what is the best way to make them available? What is the effect on test time needs, outcomes, and validity?

Remote proctoring is attractive to candidates as a convenience and can offer some cost savings. In reality though, just how easy is it to test from home? What are the security implications? Copyright treats remote proctored tests differently; how can this be addressed?

The presenters will discuss obstacles encountered, comparison of outcomes, and best practices found.

 

Full Description

With advances in assessment, credentialing organizations are presented with myriad options to “enhance” test format and administration. Two organizations have been conducting research and beta testing to explore some options alone and in combination – use of resources while testing, and, high stakes testing in remote proctored conditions.

 

As certification organizations move toward nontraditional assessments, provision of reference resources during assessment is one of many areas of uncertainty. Although reference material availability likely increases an assessment’s fidelity to real life applicable clinical situations, it raises many implementation questions as well as concerns about test outcomes and validity.

 

Remote proctoring, long a hot topic, has rarely been contrasted with in-person proctoring in a high stakes examination. The differences that materialized in candidate acceptance, test administration and outcomes can inform much constructive discussion.

 

One organization is researching options for continued professional certification for its 50,000-plus certificants. A 1,500-participant research study incorporating open-book features and different proctoring conditions was completed in October 2018. The research divided the participants into six different experimental conditions – in-person proctored vs remote proctored, no resources, e-resources, and hard copy resources.  Presenters will discuss development of the research design as well as the research outcomes.

 

Presenters from the second organization will discuss aspects of the development of an innovative item format that focuses on competency domains other than clinician knowledge recall. This incorporates the use of online resources to locate clinical diagnostic and treatment information to answer questions. The item format contains a clinical case scenario with associated multiple-choice items that would require most examinees to access online resources in order to answer the questions. In current day-to-day practice. Presenters will discuss the item development process and relate quantitative and qualitative data obtained from the Proof-of-Concept study. Lessons learned from this study and planned next steps will provide insights to organizations seeking more authentic modes of assessment of clinical behavior and decision-making.

 

NCME Paper 2019

The Effects of Test Familiarity on Person-Fit and Aberrant Behavior

Hotaka Maeda, Ph.D. & Xiaolin Wang, Ph.D.

 

Abstract (50 words)

The person-fit to the Rasch model was evaluated for examinees taking multiple subject tests with a similar structure. The evaluation considered which test in the sequence (i.e., first, second) was taken. Compared to an examinee’s first test, person-fit improved for later tests. Test score reliability may improve with test familiarity.

 

Introduction

Aberrant behaviors are unusual test-taking behaviors that introduce noise to test data. They introduce nuisance constructs that are not intended to be measured and thus threaten measurement validity. One source of aberrant behavior is unfamiliarity with tests (Meijer & Sijtsma, 2001; Rupp, 2013). Examinees who take a new and unfamiliar test are likely to struggle to understand the test structure, gauge how much time they have for each item, navigate through a computer-based test, and handle their nerves. In contrast, examinees who are familiar with the test structure are likely to be less stressed, know how to prepare, and be able to complete the test efficiently. Compared to first-time takers’ results, scores for examinees who are familiar with the test structure may be less affected by the nuisance construct of test unfamiliarity and be more representative of their underlying ability. To the authors’ knowledge, this speculation has not been investigated and reported in the literature. Therefore, the purpose of this study is to examine the effects of test familiarity on person-fit and aberrant behavior using observed data.

 

Method

The instrument used in this study is a comprehensive medical achievement examination composed of eight clinical subject tests. Medical students typically take the test at the end of their clinical rotation in a given clinical subject. All clinical subject tests are structured identically:

  • They are administered through the same platform.
  • Item stems are worded similarly as they all target commonly encountered patient scenarios.
  • All items in all tests are multiple-choice items with only one best answer.

 

Many examinees take all eight clinical subjects, but they do not take them in the same order. They can also choose to retake any clinical subject test. Therefore, the context of the instrument used in this study can be considered a quasi-experimental setting for assessing the effects of test familiarity on person-fit and aberrant behavior, where test familiarity can be defined by the number of clinical subject tests (including retakes) a candidate has taken.

Response data in all clinical subjects from July 2017 to June 2018 were used. Exploratory factor analysis with no rotation was conducted for each subject separately in order to identify high-quality items. Items were removed from the data if the factor loadings on the first dimension were less than 0.1. Then, the data were modeled using the Rasch model. For each subject, test forms were equated through concurrent calibration. Ability was estimated with maximum likelihood, which was standardized as N(0,1) and bound between [-5, 5] so that the values could be compared across subjects.

Aberrant behavior was assessed using the lz* person-fit statistic (Snijders, 2001). The lz* is asymptotically distributed as N(0,1), where positive values represent good person-fit, and negative values represent poor fit. If examinees respond to the items in a reasonable manner (e.g., not aberrant because of the familiarity of tests), lz* should be a high value, which shows that their responses fit well to the model. The lz* is uncorrelated with ability when aberrant behavior is not present. One of the typical cutoffs for determining poor person-fit is -1.645, which is equivalent to the one-tailed .05 alpha level.

The degree of person-fit (i.e., lz*) was regressed on the sequence of tests using two separate two-level random intercept models. As examinees took multiple tests, the tests were modeled as nested within examinees. Model 1 included three exam-level predictors: 1) examinee age in years at the time of the exam, 2) standardized test score, and 3) whether the subject being taken is a retake. The only predictor at the examinee-level was the number of times the person had ever retaken any clinical subject test (0, 1, 2, and >2). The model could be written as:

 

Model 1: lz* ~ age + test.score + subject.retake + total.retake

 

Model 2 included all the predictors in Model 1 in addition to the test sequence as a categorical variable from 1 to 11 (i.e., the order in which the examinees took the test, such as first test, second test, etc.).

 

Model 2: lz* ~ age + test.score + subject.retake + total.retake + test.sequence

 

The test sequence for some students did not start with “first” if they had taken the tests prior to July 2017. The test sequence can extend longer for students who retake some clinical subject tests.

Residual plots were used to confirm that the residuals were approximately normally distributed with the same mean and standard deviation at every fitted value. Because Model 1 was nested within Model 2, they were compared using a likelihood-ratio test.

 

Result

For the purpose of this specific study, 1,422 out of 5,594 items were removed from analysis, many of which were pretest items. All subjects achieved unidimensionality after the removal of such items. In addition, response data from 55 tests were removed because of an abnormally high test sequence due to retakes (12 or more). The final sample size across all test subjects was 4,172 items on 42,903 test administrations given to 10,135 examinees (see Table 1). Each test contained an average of 96.7 items (SD = 9.3). A majority of examinees had no history of retaking any clinical subject test (68.4%). Only 6.7% of the tests were retakes.

 

Table 1. Number of Exams by Sequence and Clinical Subject

Test Sequence Clinical Subject
A B C D E F G H Total
1 71 672 568 394 2656 585 468 507 5,921
2 138 1,261 881 809 476 730 646 678 5,619
3 172 705 744 824 577 769 767 884 5,442
4 192 700 760 825 473 744 753 738 5,185
5 198 697 660 721 642 803 681 774 5,176
6 231 598 737 705 924 698 676 667 5,236
7 527 590 683 617 574 615 629 689 4,924
8 1181 352 334 288 575 262 287 353 3,632
9 207 124 175 90 109 99 90 125 1,019
10 228 51 64 26 75 37 41 35 557
11 75 4 7 8 80 8 6 4 192
Total 3,220 5,754 5,613 5,307 7,161 5,350 5,044 5,454 42,903

Note. Many examinees take all eight clinical subjects, but they do not take them in the same order. Although there are only eight clinical subjects, the test sequence can extend beyond eight because of retakes.

 

Mean lz* was 0.04 (SD = 1.09), while mean standardized test scores was 0.02 (SD = 1.14). Mean SE of the standardized test scores was 0.51 (SD = 0.07). Mean standardized test scores for those who had a history of retaking any clinical subjects test was lower (M = -0.36, SD = 1.13) than those who did not (M = 0.25, SD = 1.08). The percent of the test records exhibiting poor person-fit (i.e., lz* < 1.645) was 6.7%. Standardized test scores were positively correlated with lz* (r = .23).

A likelihood-ratio test showed that the addition of the test sequence predictor significantly improved the model fit, χ2(10)=75.05, p<.001. Controlling for examinee age, total historical test retake count, whether the subject being taken is a retake, and standardized test score, the student person-fit was the poorest for the first test compared to all later tests (p < .05). The coefficients from Model 2 are shown in Table 2. Compared to the first test, person-fit improved for the second exam by 0.07, and on the 11th test by 0.27.

 

Table 2. Model 2 Coefficients

Coef SE df t p
(Intercept) 0.41 0.05 32,754 8.65 <.001
Examinee-level predictors
Retake total = 0 (Reference)
Retake total = 1 -0.04 0.02 10,131 -2.62 .009
Retake total = 2 -0.11 0.02 10,131 -4.61 <.001
Retake total > 2 -0.19 0.03 10,131 -6.73 <.001
Test-level predictors
Standardized score 0.19 0.01 32,754 38.17 <.001
Examinee age in years -0.02 0.00 32,754 -9.30 <.001
Retaking the clinical subject 0.10 0.02 32,754 4.44 <.001
Test sequence = 1 (Reference)
Test sequence = 2 0.07 0.02 32,754 3.63 <.001
Test sequence = 3 0.08 0.02 32,754 4.27 <.001
Test sequence = 4 0.10 0.02 32,754 5.03 <.001
Test sequence = 5 0.13 0.02 32,754 6.62 <.001
Test sequence = 6 0.13 0.02 32,754 6.57 <.001
Test sequence = 7 0.10 0.02 32,754 4.66 <.001
Test sequence = 8 0.13 0.02 32,754 5.86 <.001
Test sequence = 9 0.10 0.04 32,754 2.79 .005
Test sequence = 10 0.20 0.05 32,754 4.12 <.001
Test sequence = 11 0.27 0.08 32,754 3.27 .001

Note. Person-fit was modeled using a two-level random-intercept model.

 

Model 2 also showed that those who had a history of retaking any clinical subject test tended to have lower person-fit than those who did not (p <.05). However, retaking the same clinical subject test was associated with an increase in person-fit by 0.10 (p <.001).

 

Discussion

This study shows that person-fit to the Rasch model improves as examinees gain experience in taking a series of tests with a similar structure. Improvements in person-fit were observed beyond the first and second tests. Test familiarity increased lz* by 0.1 or more. For reference, an increase in lz* from 0 to 0.1 is equivalent to an increase in person-fit by 3.98 percentiles. The findings indicate that the reliability of the test scores may improve with test-taking experience, and they show the importance of examinee familiarity with the test structure. The improvement in person-fit by increased test familiarity supports the provision of practice materials in order to minimize the negative impacts from test unfamiliarity and to promote measurement validity.

When interpreting the data, retakes of the same clinical subject exams needed to be considered. The option to retake any test allowed the test sequence to go beyond the number of available clinical subjects (i.e., eight). Clearly, a person who has taken the same test multiple times (despite taking a different form every time) should be more familiar with the test than the first-time takers. The examinees who have retaken any of the clinical subject exams tend to be lower achievers and have lower person-fit compared with non-retakers. However, their person-fit improved upon retaking the same clinical subject test. Also, results suggest poor person-fit occurred due to spuriously low aberrant behavior (i.e., poor performance) such as running out of time, more often than spuriously high-scoring behavior such as item pre-knowledge. This led many of the poor performers to retake the test. However, regardless of the test-retaking behavior, familiarity of the test structure led to increases in person-fit.

The study is limited in that we did not directly investigate whether improvement in person-fit is in fact associated with an increase in the accuracy of the standardized test scores. This is rather difficult to show empirically, but it should be pursued in the future. Further, a quasi-experimental design was used, where some factors were uncontrolled, including allowing examinees to retake any test at their own will. These test-retaking patterns were not random as they were correlated with important variables such as the standardized test scores. The study should also be replicated using other psychometric models and test data.

 

References

Meijer, R., & Sijtsma, K. (2001). Methodology review: Evaluating person fit. Applied Psychological Measurement, 25, 107-135.

Rupp, A. A. (2013). A systematic review of the methodology for person fit research in Item Response Theory: Lessons about generalizability of inferences from the design of simulation studies. Psychological Test and Assessment Modeling, 55, 3-38.

Snijders, T. (2001). Asymptotic null distribution of person-fit statistics with estimated person parameter. Psycho

New York Colleges of Osteopathic Medicine Educational Consortium (NYCOMEC)

This presentation to osteopathic medicine residency directors focused on preparing for their Clinical Learning Environment Review (CLER), an ACGME program instituted as part of the next accreditation system. The goal of CLER is to ensure residency programs train residents to ensure patient safety. The presentation focused on what is required to ensure patient safety, i.e. “learner safety.” It presented how to debrief residents using “good judgment” (a focus on performance gaps) and “empathic inquiry” (debriefing that develops self-reflection and self-correction). The talk provided examples of effective and ineffective feedback and debriefing approaches.

Parshall C, Julian E, Parikh S, Horber DT.  Using Nudges for More Effective Exam Programs. Paper presented at the 2019 Innovations in Testing Conference, Orlando FL, March 2019.

Short description:

Nudges are small, deliberate tactics we can use to help our test-takers (and our SMEs) do the things they want to do. While our testing programs have many points that can derail candidates, through small and subtle changes we can help them persist through the life cycle of application, testing (and retesting), and ongoing certification. For example, framing tactics in messaging can effectively decrease the number of test-takers who fail to show. Nudges can also be used with SMEs to increase JTA survey response rates and committee volunteer numbers. Join us for a panel discussion with researchers and practitioners using nudges in testing.

 

Full description:

Behavioral nudges have been used forever to help people remember to do things, or follow through on things they started. New research has identified the strategies that are most effective, as well as the research tools for increasing their success in a specific environment. As a result, the use of nudges is moving from ad hoc to intentional and systematic. Educators, corporate offices, and governmental institutions are formally incorporating nudges into their interactions with the public and their staff, and testing programs can use them to support examinees, subject-matter experts, staff, and employers in doing what they already want to do.

The underlying goal is to influence, or “nudge,” people in positive ways that are in their own best interest, as defined by themselves. This presentation will discuss ways that a variety of testing programs are already using nudges and will share the evidence of their effectiveness.

This session will have a panel that includes researchers and practitioners effectively using nudge tactics in the field of testing. They will share real-world successful (and unsuccessful) examples of nudges in testing.

Presentations will include:

  • an overview of nudges: what they are, the evidence for their effectiveness, and a simple research plan for implementing nudges effectively.
  • a discussion of common areas in testing programs where people have agreed to do things, but often need help carrying them out: e.g., examinees would benefit from nudges to meet registration deadlines, study, stay honest, show up for the test on time with appropriate accouterments; SME’s would benefit from nudges to volunteer, write items, review items.
  • a presentation on before-and-after data on how timely phone calls decreased candidates “no-show” for a medical licensure performance exam; additional nudge interventions from the program’s in-development continuous assessment will be included.
  • a case study of nudging applied in a high school equivalency program, with specific behavioral techniques and overall results.

 

References:

Ariely, D. (2008). Predictably Irrational: The Hidden Forces That Shape Our Decisions. New York: HarperCollins.

Kahneman, D. (2011). Thinking, Fast and Slow. New York: Farrar, Straus, and Giroux.

Thaler, R.H., & Sunstein, C.R. (2008). Nudge: Improving Decisions About Health, Wealth, and Happiness. New Haven, CT: Yale University Press.

 

 

Authorship

Kimberly M. Hudson, PhD, National Board of Osteopathic Medical Examiners

Yue Yin, PhD, University of Illinois at Chicago

Tsung-Hsun Tsai, PhD, National Board of Osteopathic Medical Examiners

Grant Number/ Funding Information

Not applicable

Corresponding Author

Kimberly Hudson, 8765 West Higgins Road, Suite 200, Chicago, Illinois 60631; 773-714-0622; Kimberly.shay86@gmail.com

Key Words

Equating, Automated Test Assembly, Optimal Test Assembly, IRT, Rasch Model, CINEG

Abstract

As early as the 1960s, testing organizations began implementing Automated Test Assembly (ATA) to simplify the laborious process of manually assembling test forms and to enhance the psychometric properties of the examinations (Wightman, 1998; van der Linden, 2005). But it is unclear what impact transitioning to ATA has on equating outcomes. The purpose of this research study was to evaluate outcomes from different IRT scale linking and equating methods when a testing organization transitioned from manual test assembly to ATA.

After crossing each scale linking procedure with each equating method, I calculated error and bias indices (e.g., RMSD, MAD, MSD) and evaluated the decision consistency of the equating outcomes.

The results showed that the mean/mean scale linking procedure paired with the IRT preequating method produced the lowest bias and error, and highest level of decision consistency.

The results of this study support the importance of aligning psychometric and test development procedures. The findings of this study suggest that the equating outcomes were related to the similarity in statistical test specifications. ATA resulted in more parallel test forms with better psychometric properties than forms assembled manually. Therefore the modifications to assembly practices warrant the reconsideration of a new base form for scaling and standard setting.

 

 

Introduction

In high-stakes medical licensure testing programs, test developers and psychometricians work together to develop multiple test forms that can be administered simultaneously to examinees to enhance examination security. Although the volume of forms may differ between testing programs, it is crucial that all test forms are built according to the same test specifications (von Davier, 2010). Furthermore, scores on the test forms must be interchangeable and candidates should perceive no difference between the test forms administered (Kolen & Brennan, 2014). The test development processes and psychometric procedures are inherently connected and both must be considered when developing multiple test forms.

Traditionally, test developers have manually assembled multiple test forms according to a set of content requirements. Test developers typically evaluate statistical criteria such as mean proportion of correct responses (p-value) or mean point-biserial correlation upon completion and make adjustments to confirm that statistical specifications are met. Manual test assembly (MTA) is a time-intensive process, typically requiring the attention and work of multiple test developers. However with the widespread use of computers, testing organizations can improve the laborious manual process by developing and employing computer programs to automatically assemble tests. If staff members possess technical computer programming skills, they might create computer programs that can assemble multiple test forms simultaneously by balancing the content and statistical constraints.

When assembling tests manually, test developers use a variety of informational inputs, or constraints, to create multiple forms of an assessment that are balanced in terms of content, difficulty of items, item formats, contextual information of items (e.g., the patient’s life stage), item duration, word count, and exposure rate. Test developers first compile an item pool, which contains a selection of items that meet some basic requirements for inclusion on a test. Scorable items function as operational or anchor items and often have known item parameters based on a prior administration. Test developers iteratively select a group of items that meet the minimum proportions of each domain as specified by the test blueprint and evaluate the range of item statistics or average item statistics, such as p-values and point-biserial correlations. The number of parallel test forms and the number of constraints undoubtedly impacts the complexity of manually assembling forms. Moreover, many testing organizations implement this resource-intensive process across numerous testing programs on an annual or semi-annual basis.

Automated Test Assembly (ATA) is an efficient alternative to this laborious process with unique challenges (Wightman, 1998). Unlike MTA, ATA programs utilize the test information, the summation of item information across the ability continuum, in the creation of multiple parallel test forms. Thus, ATA improves the manual procedure by not only saving time and resources, but also enhancing the psychometric quality of balanced forms according to a predetermined set of constraints and maximization of the specified objective function. ATA may improve reliability across examination forms due to the standardization of the test development process. Therefore the impact of ATA is not just a question of “Can the computer do it,” but rather “Can the computer do it better?”

In medical licensure examinations there is a critical need for score comparability across test forms to not only ensure that scores are an accurate, reliable representation of examinee ability, but also to make pass/fail distinctions based on the scores. Earning a passing score on a medical licensure examination allows examinees to enter into supervised medical practice. Therefore psychometricians work to maintain decision consistency, regardless of the test assembly method and the form administered to examinees. Decision consistency refers to the agreement of an examinee’s pass/fail decisions on two (or more) independent administrations of unique forms and decision accuracy refers to the agreement between an examinee’s pass/fail decision and whether the same decisions made based on an examinees’ true ability (Livingston & Lewis, 1995). These two indices are necessary to evaluate in high-stakes medical licensure testing. In this research, I compare the decision consistency of equated results after implementing ATA.

The results of this research provide a psychometric framework to evaluate results from different equating methods upon the implementation of ATA. When testing organizations implement new test development processes, it is critical to examine the impact on examinee scores (AERA, APA, & NCME, 2014). Testing organizations monitor and evaluate scores and decision consistency of scores on examinations that ultimately license examinees to practice medicine in supervised or unsupervised settings. Neglecting to examine this may inadvertently lead to passing unqualified physicians, or failing qualified physicians.

In ATA, psychometricians and test developers often define linear and/or non-linear constraints in order to maximize a specific objective function, typically the test information function (TIF), at a given score point on the true-ability continuum (van der Linden, 2005). In a high-stakes licensure examination, the minimum passing standard (or cut-score) is commonly used for optimization because it maximizes test information near the cut-score and minimizes the standard error of measurement (SEM) at the cut-score. This leads to increased reliability of scores closest to the cut-score and better accuracy of pass/fail distinctions. Therefore, ATA is designed to enhance the psychometric qualities based on prior item information (i.e., higher reliability coefficients, and lower standard error of measurement near the cut-score), and the efficiency of assembling test forms. However, research has not yet addressed the impact of transitioning from MTA to ATA on results from equating methods. In this study, I investigate the differences in equated results between MTA and ATA forms.

Most ATA processes use a framework of Item Response Theory (IRT) to construct forms with computer programs integrating item-level information according to a set of predetermined constraints. The use of IRT typically goes hand-in-hand with the psychometric framework utilized by the testing program. In IRT, items have a set of unique characteristics; some items are more informative than others at different ability levels. Psychometricians investigate the individual contribution of an item to a test by reviewing the item information function (IIF). The TIF is the summation of IIFs across the ability continuum. The TIF in the ATA represents the characteristics and composition of all items on each test form. Moreover, in the context of medical licensure examinations, using the minimum passing standard as the value for optimization ensures that scores are precise ability estimates for minimally qualified examinees. Thus, when the TIF is optimized at the cut-score, it ultimately reduces the probability of Type I error (unqualified examinees passing the examination). Furthermore, Hambleton, Swaminathan, and Rogers (1991) suggest that the test characteristic curve (TCC) creates the foundation for establishing the equality of multiple test forms, which is certainly the case when optimizing the TIF. The TIF provides aggregate information from each item on the examination, whereas the TCC shows the probability of an expected raw score with a given ability level, . If we wish to create parallel test forms, then the TCC provides evidence that a given ability level relates to similar expected scores for two parallel forms of the same test. Furthermore, the use of content and statistical constraints in ATA computer programs provides evidence that all test forms are balanced in terms of statistical specifications.

Once parallel forms are assembled, reviewed, published and administered, the results must be analyzed and equated. Equating refers to the use of statistical methods to ensure that scores attained from different test forms can be used interchangeably. Equating can be conducted through a variety of designs, approaches and methods (Kolen & Brennan, 2014). Although there are key differences between IRT and the Rasch model, this research will focus on the applicability of IRT equating methods to a testing program that utilizes the Rasch model as a psychometric framework. Within IRT equating methods, both preequating and postequating methods are widely implemented in K-12 educational settings to ensure scores can be used interchangeably (Tong, Wu, & Xu, 2008). Psychometricians may use IRT to preequate results prior to the start of examination administration, which assuages the tight turnaround time between examination administration and score release. Alternatively, postequating methods use response data from complete current examination administrations (Kolen & Brennan, 2014).

In IRT preequating methods, item parameters are linked from prior calibration(s) to the base form of an examination. For the purpose of this research, item difficulties will be the only item parameter used, which is in alignment with the testing program’s psychometric framework (the Rasch model). The base form (denoted as Form Y) is the form in which the cut-score was established. In order to implement preequating methods, item difficulties for scorable items must be estimated prior to examination administration. Prior to ATA, scorable item difficulties must be known to calculate and maximize the TIF. The alignment of previously calibrated item statistics that are used both for assembling forms using ATA and for preequating may support the applicability of this equating method.

Measurement Models and ATA

IRT allows test developers to “design tests to different sets of specifications and delegate their actual assembly to computer algorithms,” (van der Linden, 2005, p.11). By setting constraints for computerized test assembly, including blueprint domain representation or reasonable ranges for item statistics, test developers can create multiple forms of examination that are parallel in difficulty. ATA can incorporate item details regardless of the psychometric paradigm used to calibrate or score examinees and can be applied to polytomously or dichotomously scored examination. As discussed previously, this study uses data previously calibrated using the Rasch model.

While CTT, IRT, and Rasch approaches to ATA can utilize population dependent item statistics (i.e., p-values and discrimination indices) as constraints, in CTT there is no equivalent metric to the TIF. In order to construct parallel test forms in ATA, Armstrong, Jones and Wang (1994) maximized score reliability through a network-flow model. The authors stated that it was advantageous to use the CTT approach because it was computationally less expensive and produced comparable results in relation to the IRT approach to ATA. When this research was published, computational power was indeed a challenge; however, advances in computer memory and technology are much greater now, so the cited advantage does not hold the test of time. As such, IRT or Rasch approaches to ATA are more supported in the literature and are the focus of this study.

Prior to beginning ATA, test assemblers must calibrate response data to estimate item parameters from the sample population. Psychometricians often examine the goodness-of-fit of the data to determine the best IRT model (i.e., 1-PL, 2-PL) or confirm that the data fit the Rasch model. Once the examination is administered, psychometricians anchor item parameters based on prior calibrations to estimate examinee ability (van der Linden, 2005). In this study, I calibrate data using the Rasch model and will provide some evidence supporting the appropriateness of the model.

In ATA, test assemblers often optimize the TIF and evaluate the similarity of the forms by comparing the TIFs. However, even well-matched TIFs do not necessarily yield equitable score distributions (van der Linden, 2005). Thus, psychometricians must also continuously evaluate and monitor the score distributions once the examination forms are administered. The main question of this study is which IRT equating method (IRT observed score, IRT true score, or IRT preequating) yields the most comparable scores and decision consistencies when transitioning from MTA to ATA. In the following section, I provide a foundation of linking, equating, and scale linking as it pertains to this study.

Equating

Equating is the special case of linking in which psychometricians transform sets of scores from different assessment forms onto the same scale. By definition, equating methods are only applied to assessment forms that have the same psychometric and statistical properties and test specifications. The primary goal of equating is to allow scores to be used interchangeably, regardless of the form that an examinee was administered (Holland & Dorans, 2006; Kolen & Brennan, 2014).

Assessment programs can employ a variety of equating designs and methods, each design with unique characteristics and assumptions. Assessment programs often administer examinations within and across years. For the purpose of this section, I notate an original form of an examination as Y and a new form of an examination as X, with the understanding that assessment programs may administer multiple new forms ( ) or multiple original forms ( ). CINEG design are commonly used and require previously administered items from original forms of an examination to be included on new forms by a set of common or anchor items. The CINEG design is considered a more secure design than the random groups design because only a set of common items are exposed from an original form, rather than exposing an entire original form.

The CINEG design not only accounts for the difference in form difficulty, but also accounts for the difference in the population of test-takers. The statistical role of the common items is to control for differences in the populations, therefore removing bias from the equating function. In order to implement the common items design, the common items must meet several requirements (Dorans et al., 2010). First, the common items must follow the same content and statistical specifications as the entire full-length test. Second, there should be a strong positive correlation between scores on the full-length test form and scores on the common items because the common items follow the same specifications as the full-length test. Thirdly, measurement and administration conditions for the common items must be similar across new and original forms. Lastly, prior research recommends the use of common item sets include at least 20% of the full-length test, or consist of at least 30 items (Angoff, 1971; Kolen & Brennan, 2014). Satisfying these requirements ultimately ensures that the reported scores and the decisions based on the reported scores are accurate and reliable. The testing program used for this study meets the conditions described above.

IRT equating methods can be applied to data calibrated using the Rasch model and are the focus of this study. In this section, IRT equating methods are discussed in detail; however, first psychometricians must use scale linking procedures to examine the relationship between newly estimated item parameters and original estimations of item parameters from two independent calibrations. Due to the assumption of item invariance, if item parameters are known, no equating or scale linking is necessary and IRT preequating methods can be implemented prior to test administration (Hambleton et al., 1991). However, in practice it is important to implement scale linking procedures because there are often differences in item parameter estimates (Stocking, 1991).

Scale linking is the process by which independently calibrated item difficulties are linked onto a common scale. Several methods can be used to calculate scaling constants in order to place the item difficulties from form X on the same scale as Y (Hambleton et al., 1991). The mean/mean, mean/sigma, and TCC methods are discussed in their application to this study. Prior research supports the performance of TCC methods over other methods (i.e., mean/mean or mean/sigma) for scale linking due to the stability of the results and the precision, even when item parameters had modest standard errors (Kolen & Brennan, 2014; Li et al., 2012). Other research investigated the adequacy of different scale linking procedures within the Rasch model.

The mean/sigma method calculates scaling constants A and B based on the mean and standard deviation of the difficulty parameters of the common items on form X. There are two main TCC scale linking procedures, which are iterative processes that utilize item parameter estimates; the focus of the current student is on the Stocking and Lord (1983) procedure. The scale indeterminacy property of IRT is used in this method, such that an examinee with a given ability will have the same probability of answering an item correctly regardless of the scale used to report scores. The Stocking and Lord TCC procedure calculates the probability of correctly answering an item on the original scale ( ) and the new scale ( ) for each common item ( ) by taking the difference in examinee ability into consideration. Equation 10 represents the difference in TCCs ( ) between common items administered on form Y and form X, respectively. Then an iterative process solves for A and B by minimizing  across all examinees.

(10)

(11)

Once item parameters are on the same scale, IRT equating methods are employed. IRT true score equating is the most commonly used IRT equating method. In IRT true score equating, true scores ( ) are represented as the number-correct score for examinee ( ) with given ability ( ; Kolen & Brennan, 2014). Additionally, true score equating assumes that there are no omitted responses (von Davier & Wilson, 2007). In a simplistic example, psychometricians first identify a true score on form X, then estimate the corresponding ability level is determined (see equation 12). Then, the true score on form Y ( ) is determined by using the corresponding ability level (see equation 13). Therefore, the equivalent score is the inverse of the ability distribution. This process is iterative, which typically involves the Newton-Raphson Method (Kolen & Brennan, 2014; Han et al., 1997).

and                                                          (12)

(13)

Unlike IRT true score equating methods, the IRT observed score equating method depends on the distribution of examinee abilities. The IRT observed score equating method is similar to equipercentile equating methods without the application of additional smoothing techniques, as previously discussed. It requires specifying the distributional characteristics of examinees prior to equating, using prior distributions (Kolen & Brennan, 2014).

All of the IRT equating methods previously discussed require data from the current test administration cycle. However, the IRT preequating method can be used when items are pretested prior to operational use. Once items are on the same scale, psychometricians generate raw-to-scale conversion tables prior to form administration, which ultimately decreases the workload for score release (Kolen & Brennan, 2014). Many testing organizations utilize IRT preequating in order to shorten the window for score release after examination administration.  Testing organizations may also prefer IRT preequating methods due to their flexibility when equating scores for computer-based examinations that are administered intermittingly over a long testing cycle.

Researchers have compared the results among equating designs, methodologies and procedures; yet no researchers have compared scale linking or equating outcomes among ATA and MTA forms. In the current study, RMSD, MSD and MAD were calculated to examine the error and bias associated with scores. Researchers have commonly used these indices to evaluate the comparability of equating methods (Antal, Proctor, & Melican, 2014; Gao, He, & Ruan, 2012; Kolen & Harris, 1990).

Decision Consistency

In the context of testing programs that aim to categorize examinees into one or more groups based on their scores, such as medical licensure examinations, classification accuracy is a measurement of whether examinees were accurately classified based on their true ability (Lee, 2010).

Research Questions

The goal of this study is to compare the equating results when a testing organization moved from MTA to ATA. The research questions address the comparability of outcomes from three different methodological approaches to equating, after combining three IRT equating methods with three scale linking procedures.

  1. Which method of IRT equating (e.g., IRT observed score, IRT true score, or IRT preequating methods) minimizes error and bias associated between MTA and ATA developed forms?
  2. Which method of IRT equating (e.g., IRT observed score, IRT true score, or IRT preequating methods) yields the highest expected decision consistency of pass/fail distinctions between MTA and ATA developed forms?

METHOD

Data

In this study I used two years of response data from a large-scale medical licensure examination. From the 36 Y forms, I selected four forms (denoted ). There was item overlap among the 36 Y forms, which made it possible to concurrently calibrate data from the 36 Y forms simultaneously using the Rasch model.

First, I aggregated key information for each form, where pretest items were not embedded within each Y form. The pretest design used a total of 12 unique pretest blocks, each consisting of 50 items with overlap. The test administration vendor randomly assigned pretest blocks to examinees. Therefore, pretest items needed to be reviewed and selected for the form by form calibration for CINEG design. Figure 5 shows the design of an intact Y form (denoted form A) of operational items and plausible assignment of six pretest blocks. In Figure 5, Form A consists only of operational items, the test vendor randomly assigned a pretest blocks from group A (PTA) and a pretest blocks from group B (PTB). The diagram is a simplified depiction of the true design, which can ultimately yield more than 5,100 different combinations. Therefore, I employed a threshold of 30 responses to determine which pretest items had sufficient exposure for inclusion in the form by form calibration. Despite anchoring the item difficulties, at least 30 exposures ensured there was sufficient data to investigate data-model fit.

The concurrent calibration of the operational and pretest items on Y forms resulted in item difficulties on the same scale of measurement. Additionally, I selected four X forms (denoted ). I used three criteria to select the eight forms for this study: (a) X forms with the highest volume of administrations after the first several weeks following the examination launch, (b) X forms and Y forms with at least 20 percent overlap or at least 30 common items for scale linking purposes, and (c) the common item set was representative of the test blueprint (Angoff, 1971; Kolen & Brennan, 2014). The data design is shown in Figure 6. The common set of items on  and is denoted as , the common set of items on  and  is denoted as , the common set of items on  and  is denoted as , and the common set of items on  and is denoted as .

Approximately 7,600 examinees took one of the Y forms in year 1 and 4,300 first-time examinees took one of the X forms in the first testing window of year 2. After selecting the four forms, as previously described, I used data from the approximately 1,300 examinees who were administered  or  and the approximately 1,200 examinees who were administered  or . Table IV displays a summary of the data selected for this research study.

Response data from year 1 on all 36 Y forms were concurrently calibrated using WINSTEPS® (Linacre, 2017). The estimated item difficulties were then used as anchors for each separate form calibration of . Y is considered the base form of the examination and therefore no equating on original forms was conducted.

Data Analyses

All data management and analyses were conducted in RStudio (2016), unless otherwise specified. The criterion of  was used to examine the statistical significance of tests, unless otherwise specified.

1.                  Research Question 2: Equating Methods and Error

                        Which method of IRT equating (e.g., IRT observed score, IRT true score, or IRT preequating methods) minimizes error and bias associated between MTA and ATA developed forms?

            I employed three scale linking approaches (mean/mean, mean/sigma, and Stocking-Lord TCC) and three equating methods (IRT observed score, the IRT true score, and the IRT preequating). I utilized the PIE computer programming to implement IRT observed score and IRT true score equating methods (Hanson et al., 2004b). To assess the equating results, I compared the root mean squared difference (RMSD), mean absolute difference (MAD), and mean signed difference (MSD) on X’ to Y. I then evaluated which method minimizes bias by identifying RMSD values close to 0 and evaluated which method minimizes error by identifying MSD and MAD close to 0. Higher indices indicate an accumulation of error and are not preferred. Findings from prior research show that IRT preequating methods often have higher levels of error associated with the examinee scores. However, due to the alignment of using precalibrated item difficulties for both ATA and preequating methods, I expect that the design of ATA may have an impact on the equated results.

2.      Research Question 3: Equating Methods and Passing Rates

                        Which method of IRT equating (e.g., IRT observed score, IRT true score, or IRT preequating methods) yields the highest expected decision consistency of pass/fail distinctions between MTA and ATA developed forms?

Using the outcomes from research question 1, I estimated decision consistency indices using Huynh’s methodology (1990), which uses the probability density function, item curve functions (ICFs) and relative frequencies of a single population to estimate to common decision consistency indices: a raw agreement index,  and kappa,  (see equations 18 and 19). The raw agreement index,  is calculated using the cumulative distribution function of test scores, and relative frequencies of test scores. Kappa is calculated as the difference between the raw agreement index, and , the expected proportion of consistent decisions if there is no relationship between test scores. Kappa indicates the decision consistency beyond what is expected by chance (Subkoviak, 1985).

(18)

Where

,                                                                                                       (19)

,                                                                                                     (20)

And

(21)

Where represents the ability level at a given raw score, ;

represents the difference in cumulative distribution functions of the raw cut-score,  at ability level, ;

represents the relative frequency distribution at  and

represents the number of classifications.

RESULTS

Research Question 2

To evaluate the adequacy of the results, I calculated the RMSD, MSD, and MAD. RMSD is a measure of bias, and MSD and MAD are measures of random error. Values closer to 0 indicate no raw score point differences between MTA and ATA forms. Overall, there were large differences in the amount of bias and error associated across forms and equating methods, therefore RMSD, MSD and MAD are presented separately for each form (see Table XV). Across all forms the equating and scale linking method with the least amount of error and bias was the mean/mean preequating method.

Table XV

BIAS AND ERROR INDICES BY EACH SCALE LINKING AND EQUATING METHOD

Observed Score True Score Preequating
Form Index MM MS SL MM MS SL MM MS SL
RMSD 19.35 20.46 21.85 19.51 20.55 22.10 8.02 8.41 8.278
MSD -18.83 -20.27 -21.38 -18.97 -20.35 -21.62 -7.71 -8.05 -7.96
MAD 18.83 20.27 21.38 18.97 20.35 21.62 7.71 8.05 7.96
RMSD 10.37 5.47 9.40 10.35 5.70 9.40 4.74 5.24 4.91
MSD -10.31 -4.18 -9.35 -10.29 -4.29 -9.34 -4.31 -4.75 -4.46
MAD 10.31 4.34 9.35 10.29 4.49 9.34 4.32 4.75 4.47
RMSD 2.53 4.57 1.53 2.51 4.53 1.53 2.51 2.96 2.68
MSD -2.32 -4.45 -0.62 -2.27 -4.39 -0.58 -1.69 -2.08 -1.89
MAD 2.38 4.48 1.29 2.35 4.41 1.28 1.99 2.34 2.15
RMSD 12.42 12.46 15.91 12.92 13.03 16.84 2.55 3.01 2.82
MSD -11.92 -11.83 -15.29 -12.30 -12.26 -16.02 -1.90 -2.27 -2.20
MAD 11.92 11.83 15.29 12.30 12.26 16.02 2.07 2.43 2.31

Note. MM represents mean/mean scale linking, MS represents the mean/sigma scale linking, and SL represents the Stocking and Lord TCC scale linking procedure. Due to the disparate index values across forms, results are shown for each form separately.

Boldface signifies values more favorable results with indices close to 0 per index per form (by row).

 

Preequating Method

Across the three equating methods paired with the three scale linking procedures, the results indicated that the mean/mean scale linking procedure with the preequating method performed the most favorably for three of the four forms ( ). For , the mean/mean preequating method resulted in lower bias and error in comparison to all other methods (RMSD = 8.02, MSD = -7.71, and MAD = 7.71), whereas the highest amount of bias was related to the Stocking and Lord TCC procedure paired with the IRT true score equating method (RMSD = 22.10, MSD = -21.62, MAD = 21.62). For , the mean/mean preequating method produced the most favorable results in comparison to all other methods (RMSD = 4.74, MSD = -4.31, and MAD = 4.32). However, the Stocking and Lord TCC scale linking procedure paired with the preequating method produced only slightly higher results than the mean/mean preequating method (within 0.5 raw score points). The small difference of 0.5 raw score points in RMSD, MSD and MAD between the scale linking procedures within the preequating method was present across all forms. For form 3, the mean/mean preequating method produced slightly higher RMSD in comparison to the Stocking and Lord true score equating method (RMSD = 2.51, RMSD = 1.53, respectively). These differences relate to a difference of about 1 raw score point. Therefore, the results from the mean/mean preequating method showed a slight improvement over the other scale linking procedures within the preequating method, although there was very little practical difference in the results across each scale linking procedure.

True Score and Observed Score Equating Methods

The results from the true score and observed score equating methods with each scale linking procedure were comparable across all forms. For , the true and observed score methods yielded very consistent results. Specifically, the mean/mean observed score method and the mean/mean true score method resulted in similar levels of error (MSD = -18.83, MSD =        -8.97, respectively) and the maximum deviation between raw scores in terms of MSD of the mean/sigma true score and observed score methods was approximately 0.35 raw score points. Furthermore for , the Stocking and Lord TCC scale linking procedure paired with the observed score and true score methods produced similar high amounts of error (RMSD = 9.400, 9.399, respectively). Unique to form 3, the Stocking and Lord true score and observed score methods produced the lowest bias (RMSD =1.53) and error (MAD =1.279 and MAD = 1.292, respectively) across all other conditions. The results from combining each scale linking procedure with the true score and observed score methods were varied across forms; in some cases, the Stocking and Lord TCC procedure performed least favorably ( ), while in other cases, the mean/sigma scale linking procedure performed the least favorably ( ). Therefore the findings are inconclusive in terms of the preferred scale linking procedure for the IRT observed score and true score methods, although the evidence suggests that the Stocking and Lord TCC procedure produced higher levels of errors for two forms.

Research Question 3

Overall, the mean/mean preequating method and the Stocking and Lord TCC preequating method performed the most favorably ( ). The true score and observed score methods produced similar levels of decision consistency, indicating not much practical difference.

 

Figure 10. Mean decision consistency indices,  (blue) and (red) across all forms. MM represents mean/mean scale linking, MS represents the mean/sigma scale linking, and SL represents the Stocking and Lord TCC scale linking procedure.

 

The average decision consistency indices across all ATA forms improved in comparison to baseline estimates using MTA forms. For example, the raw agreement index was 1% to 3% greater for ATA forms than MTA forms. For 3 of the 4 forms, the raw agreement index was the highest for preequating methods. Similar to the findings from research question 2, the results from the decision consistency evaluation indicated that the Stocking and Lord TCC scale linking procedure paired with the IRT true and observed score methods performed the most favorably for form 3 (see Figure 11). Results for each form and equating method are displayed in Appendix B.

 

 

 

 

 

Discussion

In order to examine the differences in equating outcomes that transitioning from MTA to ATA introduces, I employed three scale linking procedures and three equating methodologies. I calculated the RMSD, MSD, and MAD in order to determine which combination of scale linking procedure and equating method resulted in the least amount of bias and error. The preequating method with the mean/mean scale linking procedure produced the most favorable results for three of the four forms, even when the number of common items did not meet recommended criteria. Lastly, results from the decision consistency analyses indicated that the preequating method outperformed the true score and observed score equating methods in terms of , however the true score and observed score methods produced the most favorable decision consistency in terms of . The variation in error terms of equated scores across forms suggests that MTA and ATA forms cannot be directly compared. If testing organizations begin to implement ATA for form assembly, they should give thoughtful consideration to the use of MTA forms as the base forms for equating purposes.

Research Question 2: Equating Methods and Error

Due to the nature of implementing IRT equating methods following scale linking, the results of the equating methods are based on the quality of the results on the scale linking procedures. The common item sets were sufficiently sized for only form pair 1 and form pair 3; therefore the generalizability of the equating results of forms 2 and 4 are limited. Yet all previous known item statistics were used for preequating, not just those included in the common item set.

It is important to note that for the purpose of this research raw scores were used to evaluate the error and bias associated with scores that were equated for each method. Overall, the optimal method for three of the four forms was the mean/mean scale linking procedure paired with the preequating method. The mean/mean preequating method produced the lowest amount of bias as measured by RMSD. While other methods produced slightly lower MSD or MAD, there was not an appreciable or practical difference in these values from others (typically less than 0.2 raw score points). For the two forms with sufficient common item sets, the mean/mean preequating method and the Stocking and Lord TCC true score methods produced the most favorable results. Similar favorable findings from the mean/mean preequating method were found across the remaining forms; meaning, despite having an insufficient amount of items for scale linking purposes, the results still supported preequating methods. This may be due in part to the similarity between the Rasch equating model and the mean/mean preequating method.

There were large differences in the magnitude of results of RMSD between true score, observed score and preequating methods across the forms. Specifically, form 1 had the highest values of RMSD across all equating methods, whereas form 3 had the lowest values of RMSD across all equating methods. The differences in RMSD across the forms provide additional evidence that the new and original forms were not built to the same statistical specifications.

Results from prior research indicated that preequating methods have performed poorly in comparison to postequating methods. Kolen and Harris (1990) reported that the IRT preequating method resulted in the highest values of RMSD and MSD in comparison to IRT postequating methods. Tong and Kolen (2005) compared the adequacy of equated scores from the traditional equipercentile, IRT true score, and IRT observed score equating methods using three criteria and found that the IRT true score method performed least favorably in comparison to the IRT observed score. In this respect, the results from the current study disagreed with previous literature. Yet, the goal of the current study was to evaluate differences in equating outcomes between MTA and ATA forms. At this point in time, no research studies have compared outcomes from different equating methods when testing organizations transitioned from MTA to ATA, therefore the lack of consistent findings with prior literature may be in relation to the change in test development procedures, the differences in psychometric framework (i.e., IRT 2-PL versus Rasch model) or differences in the nature and purpose of the testing program (i.e., K-12 versus medical licensure). For example, much of the body of literature on equating utilizes K-12 assessment programs to investigate differences in equating methodologies. K-12 assessment programs are built to different test specifications as the purpose of these examinations may be to evaluate and monitor student growth rather than passing or failing examinees. Often these types of assessment programs have different characteristics than medical licensure examinations, including shorter administration windows and mode of delivery. The difference in results can also be explained by the utility of a purposeful equating design. Although the testing program used for the current study did not operationally implement a CINEG design, I employed this design by selecting data that conformed to the design (i.e., requirements were met). Two of the four forms had sufficiently sized common item sets. Yet the favorable findings for the preequating method were in agreement for three of the four forms used. This may be due to the fact that the preequating methodologies relied on a quality bank of linked items rather on a small common item set.

The RMSD, MAD, and MSD are commonly used measures to gain an overall understanding of the differences between equated scores and those on the base form. Yet the standard error of equating is another commonly used approach to evaluate the adequacy of equating results and can be used to gain a better understanding of the error associated across the distribution of equated scores. The standard error of equating replicates hypothetical samples to approximate the standard deviation of each equated score (Kolen & Brennan, 2014). Future research can expand on this study by calculating the standard error of equating for the IRT true and observed score equating methods.

The results of this research question suggest that prior to implementing ATA, the equating design should be thoroughly considered in light of the purpose of the assessment. In agreement with the best principles of test assembly, any time new test development procedures are implemented, results processing should be carefully considered (AERA, APA, & NCME, 2014). The implementation and variation in test assembly procedures necessitates the need for reviewing and evaluating current psychometric procedures (e.g., standard setting, equating designs, etc.). A key recommendation for practitioners is to discontinue the use of MTA forms as the base form when an organization is newly implementing ATA procedures as the findings from this research suggest that there is more variation in the statistical specifications of MTA forms to support continual use as the base form.

Research Question 3: Equating Methods and Decision Consistency

Although there are many ways to evaluate decision consistency, decision consistency was measured using two estimates, the proportion of raw agreement ( ), and the kappa index ( ) which corrects the raw agreement index by what is expected by chance. Both the mean/mean preequating methods and Stocking and Lord TCC preequating methods produced the highest raw agreement indices across forms ( ). This finding supports the findings from research question 2, in which the lowest error and bias were found in the same methods. The raw agreement indices for other equating methods differed slightly within each form, typically within 1%. In comparison, the  estimates were inconsistent across forms (see Appendix B). Moreover, the decision consistency index of ATA forms was 1% to 3% greater than that of the MTA forms. This finding provides additional evidence that ATA enhances the psychometric properties of examinations that make pass/fail distinctions.

Although decision consistency is an important aspect for psychometricians to explore, it does not fully explain outcomes of examinations with pass/fail decisions. Specifically without simulation studies, where true ability is known, one cannot know for certain that decisions are accurate. Although there are ways to explore and provide evidence of decision accuracy, it was beyond the scope of the current study. Future research is warranted on different approaches like Lee (2010) to evaluate both decision consistency and decision accuracy when testing programs newly implement ATA.

Limitations

The testing program did not implement a CINEG design operationally; however, the data easily lent itself to the implementation of a CINEG design based on the use of anchor blocks in ATA. Although I confirmed key equating requirements and controlled for others by carefully selecting the forms used in study, the common item sets were not a perfect representation of the content or statistical specifications to that of the entire test. Moreover, the pretest item design had also changed between MTA and ATA forms, which may have influenced the findings. Specifically, pretest item blocks were assigned randomly to examinees in Y forms, whereas pretest items blocks were embedded within each X form. Although understandable when using operational data, there are limitations in the findings. Lastly, the 0.3 logit criteria used to establish the common item set is operationally employed although there are alternative methods one can use to identify outlying items in the common item set. Therefore, future research is warranted to address the replicability of this study when considering the purpose of the examination and equating designs in conjunction with test design decisions (i.e. ATA).

In addition, the assessment used in this study has unique and complex characteristics (e.g., test specifications, blueprint, and constraints) that may limit the generalizability of the results. For example, the forms assembled using ATA programs involved approximately 70 content and statistical constraints (i.e., domain representation, life stage of patient, clinical setting, mean item p-value, etc.), and maximized the TIF to create parallel forms. Although MTA and ATA forms were built according to the same domain representation, in MTA other variables were not as controlled as they were in ATA. Furthermore, ATA employs over 70 standardized constraints, whereas test developers loosened the constraints one by one, form by form during MTA. It is expected that the similarity of constraints between ATA and MTA procedures influenced the findings of this study. The results of this study shed light on the enhancement in quality of ATA forms; however this improvement necessitates the reevaluation or reconsideration of continuing to use MTA forms as the base examination. Future research may address the similarities or differences in MTA and ATA procedures by simulating ATA conditions and assessing the outcomes from different equating methods. Future research would provide insight as to how the similarity (or differences) between assembly procedures may influence different outcomes from equating methodologies.

Prior researchers have developed a variety of models that can be used in order to implement optimal test design. A brief overview of the different models is discussed in van der Linden (1998). It is well-documented that forms developed via ATA produce more favorable psychometric properties than MTA due to the overall test design and the defining attributes of ATA (Luecht, 1998; van der Linden, 2005). This research study provides some evidence that ATA creates more parallel test forms, not only in terms of content and statistical specifications, but also with respect to test information, data-model fit, and decision consistency. Yet, very few studies have provided empirical evidence of the quality improvement of ATA over MTA. Due to the growing popularity of ATA, more research is warranted on the replicability of this study (e.g., simulation studies), on other psychometric advantages that result from implementing ATA, and on the application to assessment programs that have different purposes and test designs.

Summary

The widespread implementation of ATA procedures has alleviated the workload of test developers by allowing computer programs to create multiple parallel test forms with relative ease. ATA procedures provide an efficient and cost-effective alternative to assembling parallel test forms simultaneously. The integral psychometric goal of ATA is the minimization of the SEM and maximization of the test score reliability (van der Linden, 2005). However, ATA is not only a question of computer programs easing the workload, but rather if computer programs improve the psychometric quality of assembled test forms. The results presented in this research study provide empirical evidence of the improvement in psychometric qualities of ATA forms. Whenever testing organizations newly implement test development practices, it is important to evaluate the outcomes (AERA, APA, & NCME, 2014). Assessing the adequacy of score outcomes of various equating methods is one way to investigate the relationship between psychometric quality and new implementation of ATA programs. In this research study, I evaluated the adequacy of different equating methods by estimating the bias, error, and decision consistency associated with score outcomes of newly developed ATA forms.

The context of evaluating equating methodologies with respect to test assembly procedures is important in today’s operational psychometric work as many testing organizations move towards ATA. Although testing organizations may utilize item parameters estimated using the Rasch model or IRT models for ATA, no previous research has connected differences in test assembly procedures to outcomes of equating methods. The results of this study further support the importance of planning and aligning the psychometric procedures to the test development procedures. The findings of this study suggest that the error and consistency of scores were related to the similarity in statistical test specifications. ATA led to the development of parallel forms that had better psychometric properties and less variation in content and statistical specifications than test forms assembled manually.

The results indicated that despite the differences in statistical specifications, the mean/mean preequating method performed the most favorably. This finding may be explained by the alignment among the mean/mean preequating method, psychometric framework of the Rasch model, and that ATA utilizes the same item difficulties to build each form. Conceptually, the mean/mean preequating method is similar to the Rasch equating method, which anchors known item difficulties. Therefore, the mean/mean preequating method is aligned with the Rasch anchored equating method. Furthermore, because ATA utilizes the same known item difficulties to build forms that have similar TIFs that peak at the cut-score of the examination, all of these methods are complimentary and work in tandem. Future research should expand on these findings by investigating the outcomes from similar equating methodologies when ATA forms are used as the base forms.

 

 

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APPENDIX B

 

TABLE XVII

COMPLETE RESULTS FROM DECISION CONSISTENCY ANALYSES

Form Equating Scale Linking  Error  Error
Baseline Comparison 0.949 0.006 0.682 0.033
OS MM 0.958 0.007 0.764 0.035
OS MS 0.955 0.007 0.736 0.035
OS SL 0.948 0.008 0.743 0.035
TS MM 0.958 0.007 0.763 0.035
TS MS 0.955 0.007 0.734 0.035
TS SL 0.948 0.008 0.745 0.035
PE MM 0.971 0.007 0.633 0.063
PE MS 0.971 0.007 0.641 0.061
PE SL 0.972 0.007 0.646 0.061
Baseline Comparison 0.958 0.006 0.657 0.040
OS MM 0.958 0.007 0.649 0.049
OS MS 0.967 0.006 0.714 0.048
OS SL 0.963 0.007 0.651 0.052
TS MM 0.958 0.007 0.652 0.049
TS MS 0.966 0.006 0.712 0.047
TS SL 0.963 0.007 0.651 0.052
PE MM 0.971 0.006 0.697 0.053
PE MS 0.969 0.006 0.697 0.052
PE SL 0.970 0.006 0.699 0.052
Baseline Comparison 0.947 0.006 0.647 0.034
OS MM 0.960 0.006 0.617 0.044
OS MS 0.954 0.007 0.631 0.040
OS SL 0.965 0.006 0.587 0.050
TS MM 0.960 0.006 0.612 0.044
TS MS 0.954 0.007 0.623 0.040
TS SL 0.965 0.006 0.580 0.051
PE MM 0.959 0.006 0.699 0.037
PE MS 0.958 0.006 0.709 0.036
PE SL 0.958 0.006 0.701 0.037
Baseline Comparison 0.935 0.009 0.719 0.034
OS MM 0.955 0.007 0.791 0.029
OS MS 0.955 0.007 0.793 0.029
OS SL 0.950 0.007 0.802 0.026
TS MM 0.956 0.007 0.803 0.028
TS MS 0.958 0.007 0.814 0.027
TS SL 0.952 0.007 0.818 0.025
PE MM 0.963 0.007 0.678 0.044
PE MS 0.963 0.007 0.697 0.042
PE SL 0.963 0.007 0.686 0.044

Note. Boldface signifies maximum value. MM represents mean/mean scale linking, MS represents the mean/sigma scale linking, and SL represents the Stocking and Lord TCC scale linking procedure. OS represents IRT observed score equating, PE represents IRT preequating, and TS represents IRT true score equating.

Association of Standardized Patient Annual Conference, June 9-11, 2019

RESEARCH PRESENTATION:
Standardizing Judgment: A Qualitative Study of How SPs Co-Construct Meaning

This presentation reported on the results of a discourse analysis of 22 Standardized Patient (SP) interviews. The research received IRB approval through the University of California, San Diego. The research questions were: 1) How do SPs maintain “standardization” in role performance and assessment, 2) to what degree to SPs adhere to standardization? The results concluded that 1) the term “standardization” is co-constructed by test developers, psychometricians, SP trainers, and SPs, 2) SP trainers employ non-standardized approaches in their training, and 3) SPs are highly invested in maintaining a standard of role portrayal and assessment but the personal resources they bring to it are highly subjective.

PHILADELPHIA, PA. The National Board of Osteopathic Medical Examiners (NBOME), an independent, not-for-profit organization that provides testing for osteopathic medical licensure and related healthcare professions, is excited to mark 2019 as the 85th anniversary of its founding.

Since its founding in 1934, and particularly in recent years, the NBOME has experienced substantial growth and opportunities given the many changes in healthcare, medical education and medical regulation. The NBOME’s assessment portfolio has grown to encompass the continuum of education, training, and continuous professional development for osteopathic medicine and a number of other healthcare professions, both in the United States and in other countries.

“We continue to be steadfast in our commitment to the NBOME’s mission and producing valid, reliable, and defensible national standardized assessment tools, and acknowledging the critical role that osteopathically distinctive assessment plays in protecting the public,” said John R. Gimpel, DO, MEd, NBOME President and CEO, “We are thankful for the strategic direction and leadership our Board of Directors has provided throughout our history, and the unparalleled support NBOME receives from the osteopathic medical community and our numerous other partners in health care.”

Coinciding with the 85 year celebration is the launch of NBOME’s enhanced blueprint for the COMLEX-USA examination series. This multi-stage update to the organization’s flagship exam series is the culmination of nearly 10 years of work in evidence-based design led by NBOME’s National Faculty, including subject matter experts from the education, licensure and clinical practice communities. In addition, NBOME has expanded the COMAT product portfolio with the Foundational Biomedical Sciences exam series, and also introduced the CATALYST longitudinal assessment platform for formative testing and continuous professional development.

A provisional logo and accompanying information resources focused on NBOME’s 85 year legacy, including as a dedicated webpage and social media campaign, are planned for the remainder of the year.

About the NBOME 

NBOME is an independent, non-governmental, non-profit assessment organization committed to protecting the public by providing the means to assess competencies for osteopathic medicine and related health care professions. NBOME’s COMLEX-USA examination series is a requirement for graduation from colleges of osteopathic medicine and provides the pathway to licensure for osteopathic physicians in the United States and numerous international jurisdictions.

The NBOME congratulates former board member Ronald Burns, DO, on his new appointment as president of the American Osteopathic Association on Saturday, July 27th 2019.

Dr. Burns assumed the presidency before an estimated 500 osteopathic physicians (DOs) at the American Osteopathic Association’s annual business meeting in Chicago. The organization represents the professional interests of the nation’s more than 145,000 DOs and osteopathic medical students.

From 2009-2018, Dr. Burns served on the NBOME Board and participated in the COMLEX-USA Level 3 Advisory Committee, Executive Committee, and chaired the Nominating Committee. He has also previously served on the Cognitive Testing Advisory Committee.

Dr. Burns is a board-certified family medicine physician, with a private practice in Orlando, Florida. He has represented the state of Florida in the AOA House of Delegates for the past 19 years. He has also been a member of the Florida Osteopathic Medical Association for over 29 years and served as its president from 2004­–2005.

“My goal is to ensure the AOA is ready to meet the current and future needs of its ever-growing body of constituents,” said Dr. Burns. “By necessity, that means having strong collaborative relationships with AOA’s affiliate organizations.”

We wish Dr. Burns best of luck, and look forward to working with our longtime colleague in his new position.

Read more about Dr. Burns’ role as AOA President.

 

 

Mathematical programming has been widely used by professionals in testing agencies as a tool to automatically construct equivalent test forms. This study introduces the linear programming capabilities (modeling language plus solvers) of SAS Operations Research as a platform to rigorously engineer tests on specifications in an automated manner. To that end, real items from a medical licensing test are used to demonstrate the simultaneous assembly of multiple parallel test forms under two separate linear programming scenarios: (a) constraint satisfaction (one problem) and (b) combinatorial optimization (three problems). In the four problems from the two scenarios, the forms are assembled subjected to various content and psychometric constraints. Assembled forms are next assessed using psychometric methods to ensure equivalence about all test specifications. Results from this study support SAS as a reliable and easy-to-implement platform for form assembly. Annotated codes are provided to promote further research and operational work in this area.

 

To read this article as it was initially published in Applied Psychological Measurement click here.

 

Contributed by:

Can Shao | Research Scientist | Curriculum Associates

Hongwei “Patrick” Yang | Assistant Professor | The University of West Florida

 Silu Liu | Epidemiological Research Manager | DCHealth Technology

Tsung-Hsun “Edward” Tsai, PhD | Associate Vice President of Assessment Services and Research | NBOME

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