COMLEX USA Level 2-PE

UPDATED July 22, 2021

Please note that the COMLEX-USA Level 2-PE has been suspended indefinitely.

MARCH 18, 2021

This week, we closed the individual survey for Phase 1 of the Special Commission on Osteopathic Medical Licensure Assessment and COMLEX-USA Level 2-PE, after extending the deadline to March 16. Over 5,000 individuals completed the survey, providing input regarding fundamental osteopathic clinical skills and assessment thereof, and we thank you for your feedback. We also appreciate the organizations who submitted formal position statements.

Following their endorsement of the NBOME pathways for the Classes of 2020 and 2021 (below), the Special Commission has turned their focus to addressing pathways to Level 3 Eligibility for the Class of 2022, the second of their Phase 1 objectives. Considerable research, is being done including review of the Phase 1 survey results and submitted position statements to investigate all options, and the Special Commission meets again multiple times in the next several weeks. Recommendations regarding fundamental osteopathic clinical skills and pathways for the Class of 2022 will be submitted to the NBOME Board of Directors in late April, and we anticipate a public announcement by April 30, 2021.

We understand you are busy and we will continue to distribute updates as they are available and meaningful, but we do not feel the weekly updates are needed at this time. Know that the Special Commission is continuing it’s important work, and further updates on their progress will be posted on their webpage.

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MARCH 11, 2021

NBOME Temporary Eligibility Pathways for COMLEX-USA Level 3 for the Classes of 2020 and 2021

UPDATED MARCH 11, 2021

The first goal for the Special Commission on Osteopathic Medical Licensure Assessment was the review and endorsement of temporary pathways for the Class of 2021 and 2020 to be eligible for the COMLEX-USA Level 3. For these graduates, eligibility to take COMLEX-USA Level 3 will be based on an attestation of their fundamental clinical skills from Deans and Residency Program Directors as outlined below. Phrases in italics are changes from current required attestations for examination eligibility.

These temporary pathways have been endorsed by the Special Commission on Osteopathic Medical Licensure Assessment and approved by the NBOME Board of Directors.

Eligibility for the COMLEX-USA Level 3 can be earned by the following pathways:

Pathway 1: for the Classes of 2020 and 2021 who have taken and passed COMLEX-USA Level 2-PE (as for prior DO graduates):

• Passing both COMLEX-USA Level 2-CE and Level 2-PE
• Graduation from an accredited college of osteopathic medicine (COM) with a DO degree as attested by the COM Dean
• Attestation by the Residency Program Director of an ACGME accredited program that you are in good academic and professional standing
• 6 months of GME completion prior to taking COMLEX-USA Level 3 (Recommendation ONLY)

Pathway 2: for the Class of 2021, who have never taken COMLEX-USA Level 2-PE:

• Passing COMLEX-USA Level 2-CE
• Attestation by COM Dean that you have graduated and have demonstrated the fundamental osteopathic clinical skills necessary for graduation
• Attestation by the Residency Program Director of an ACGME accredited program that you are in good academic and professional standing
• 6 months of GME completion prior to taking COMLEX-USA Level 3 (Recommendation ONLY)
• There is no requirement to travel to take COMLEX-USA Level 2-PE and there is no fee

Pathway 3: for the Classes of 2020 and 2021, who have unsuccessfully attempted (failed) COMLEX-USA Level 2-PE:

• Passing COMLEX-USA Level 2-CE
• Attestation by COM Dean that you have graduated and have demonstrated the fundamental osteopathic clinical skills necessary for graduation
• Attestation by the Program Director of an ACGME accredited program that you are in good academic and professional standing
• 6 months of GME completion prior to taking COMLEX-USA Level 3 (Required)
• There is no requirement to travel to take COMLEX-USA Level 2-PE and there is no fee

Frequently Asked Questions

1. Is there a change to the Program Director attestation?

No, the attestation from the Program Director of an ACGME accredited program is the same in all three pathways, namely, that the resident is in good professional and academic standing. The difference at the graduate level is the requirement of 6 months of GME for Pathway 3.

2. What about someone in the Classes of 2020 and 2021 who has failed the PE multiple times?

They would follow Pathway 3 above, provided they have not exceeded the maximum attempt limits for the examination.

3. I am a member of the Class of 2021 who never took the COMLEX-USA Level 2-PE. What do I need to do?

You will not need to do anything just now. Your Dean will complete the attestation for you at graduation provided you qualify. When you begin your residency, you will need to enter your Program Director information into the NBOME Portal. Your Program Director will then be able complete the required Program Director attestation for your eligibility to take COMLEX-USA Level 3. This has been required in the COMLEX-USA program since 2018, so Program Directors are quite accustomed to this straightforward and user-friendly process.

4. What about the Class of 2019 and previous classes?

These pathways are temporary and for the Classes of 2020 and 2021 only. As passing COMLEX-USA Level 2-PE was a graduation requirement per accreditation standards for the Class of 2019 and earlier, these pathways do not apply (as graduation is part of these pathways). Further review of special circumstances for candidates who were formerly in the Classes of 2019 and earlier, had failed COMLEX-USA Level 2-PE, and did not graduate is underway.

5. I have a previous failure on the COMLEX-USA Level 2-PE. Will this be erased from my transcript?

As COMLEX-USA is recognized by all U.S. state licensing boards for granting licenses, it is NBOME’s responsibility to provide comprehensive transcripts that include all exam history and results of COMLEX-USA examinations for state medical and osteopathic medical licensing boards. Therefore, we cannot remove examination results from official COMLEX-USA transcripts. We will annotate COMLEX-USA transcripts to note that the COMLEX-USA Level 2-PE was suspended on March 7, 2020 due to the pandemic, that temporary alternate pathways were provided, and that eligible candidates who complete the COMLEX-USA series of examinations via any of these pathways will be considered to have successfully completed the NBOME COMLEX-USA licensing examination program.

6. I graduated in the Class of 2020 but am not in a residency program. How can I complete the pathway?

First, you would be classified into either Pathway 2 or 3, depending on your COMLEX-USA Level 2-PE status. Your dean would provide an attestation as noted in these pathways if you qualify. Then, if you are not in a residency program, you could seek eligibility for COMLEX-USA Level 3 though the NBOME’s Temporary Alternate Pathway for COMLEX-USA Level 3 Attestation (TAPA) program.

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MARCH 4, 2021

We continue to process refunds for both scheduled COMLEX-USA Level 2-PE examinations that were cancelled and for vouchers that candidates still had in our Portal for the Level 2-PE.

On February 26, we announced the inaugural members for the Phase 1 work of the Special Commission on Osteopathic Medical Licensure Assessment on our new site for the Special Commission. The Special Commission leadership has already met and is preparing for the first meeting, scheduled to take place today! The first two public communications about the Special Commission’s progress and recommendations are scheduled for March 11 and April 30, as outlined in prior weekly updates.

On Monday March 1, we sent out a request for organizational statements to over 100 organizations, from osteopathic student groups to AOA and affiliate organizations, state medical and osteopathic boards and associations, osteopathic specialty colleges and patient safety organizations. This first request for input asks for information and opinions regarding assessment of fundamental clinical skills.

We also sent a stakeholder survey out to capture feedback from individuals with an interest in licensure assessment, also particularly as it relates to the assessment of fundamental clinical skills. We understand that how these competencies are assessed has an impact on learners, educators, regulators, members of the profession and patients, and input from these stakeholders is critically important to the work ahead.

Didn’t get yours? Take the survey here.

FEBRUARY 25, 2021

REFUNDS!

Earlier this week, an automated refund process went into effect. What this means is that the NBOME staff has begun cancelling all scheduled Level 2-PE examinations that were scheduled to begin on April 1, 2021. This will trigger an automatic refund to the payment method used to purchase the examination. If that payment method is no longer active (such as an inactive credit card), the candidate will receive a follow up email from the NBOME. We are cancelling ALL Level 2-PE examinations for all classes. For the candidates who have a Level 2-PE voucher, the refund process is the same. We expect to have all currently scheduled COMLEX-USA Level 2 PE examinations cancelled by the end of next week.

Remember that details for the temporary alternate pathway will be announced for the Classes of 2020 and 2021 by March 11, 2021. The Special Commission will release details for the Class of 2022 by April 30, 2021.

Thank you for your patience and understanding.

SHARE YOUR INSIGHTS ON CLINICAL SKILLS ASSESSMENT/VERIFICATION

Phase 1 work for the Special Commission on Osteopathic Medical Licensure Assessment will begin next week. This will include your input from an initial survey that will focus on feedback regarding the verification, documentation, and assessment of fundamental clinical skills for the pathway for licensure for osteopathic medical practice.

Stakeholder Organizations: Within this next week organizations from across the UME-GME continuum, licensure and practice, including learners and public member/patient advocates, will receive a letter with a request for Stakeholder organizational feedback, and instructions for how to provide information on the Phase 1 work for the Special Commission. This first round of input will be requested by March 12, 2021.

Individuals: Check your email in the next week for an individual stakeholder survey which will provide an opportunity for individuals to answer questions to inform the Phase 1 Special Commission objectives related to clinical skills assessment/verification.

We do anticipate a more in-depth survey may be requested from the Special Commission when they move into Phase 2.

SPECIAL COMMISSION APPOINTMENTS

Finally, we appreciate the quick responses from the numerous Stakeholder Organizations asked to nominate individuals for the Special Commission for Osteopathic Medical Licensure Assessment. We are reaching out to those selected for appointment this week, and hope to announce the initial appointments for the approximately 21-member Special Commission by 2/26/21. We have received a very enthusiastic response and are so fortunate to have so much expertise, talent and passion for the importance of osteopathic medical licensure assessment, in support of our profession and the patients we have the privilege to serve. While additional members may be appointed in the coming weeks and for phase 2 of the work, this initial group is comprised of a diverse, representative, and high quality group of individuals. Phase 1 of the Special Commission work will commence next week.

Updates for the Special Commission will be found in a new location under “Resources” on our home page.

FEBRUARY 18, 2021

The NBOME continues to work diligently on the impact of the suspension of the COMLEX-USA Level 2-PE. Earlier this week, we released a joint statement with the AOA and the AACOM that reflects a unified view on the importance of osteopathic assessment for licensure and the Special Commission on Osteopathic Medical Licensure. This will help to ensure that COMLEX-USA continues to evolve in a manner that reflects the changing practice of osteopathic medicine.

In the past week we have responded to over 1,300 inquiries from students who have been unable to take their scheduled Level 2-PE due to the pandemic. We have processed over 642 refunds and are working to update our Portal system so that moving forward examination fees can be automatically refunded for scheduled candidates in a manner that keeps the Portal operational for all users. Thank you for your patience.

We have begun the nomination process for the Special Commission on Osteopathic Medical Licensure, and have invited the following organizations to submit nominees:

COMMISSION REPRESENTATION*
Accreditation Council on Graduate Medical Education (ACGME)
American Association of Colleges of Osteopathic Medicine (AACOM) Board of Deans
American Association of Osteopathic Examiners (AAOE) / licensure
American Osteopathic Association (AOA)
AOA-Bureau of Emerging Leaders (BEL) / Student Osteopathic Medical Association (SOMA) / (student or resident)
Assembly of Osteopathic Graduate Medical Educators (AOGME)
Commission on Osteopathic College Accreditation (COCA)
Council of Osteopathic Student Government Presidents (COSGP) / (student)
Educational Council on Osteopathic Principles (ECOP)
National Board of Osteopathic Medical Examiners (NBOME) Board of Directors & National Faculty
Organization of Program Director Associations (OPDA)

*Invited

As we move forward expeditiously with this important work, remember that our first and most acute objective is to establish defensible pathway(s) for verification of clinical skills competencies in the licensure pathway for the Class of 2021 (and earlier), which will be announced no later than March 11, 2021. This will NOT require that students travel to a center to test, nor will it include any fees for these candidates. We want to ensure pathways for progression and licensure for our students and residents, while not losing the trust earned from patients, the public, licensing authorities and others that DOs have demonstrated their competencies.

Our second objective is to clarify defensible pathways for the Class of 2022, which will be announced no later than April 30, 2021. As a reminder, the phases of the Special Commission and deliverable dates can be found in last week’s update below.

We want you to be a part of the solution! We will be publishing information on how both organizations and individuals may provide input into the Special Commission’s work. Organizations will have the opportunity to provide a structured position statement regarding assessment of fundamental clinical skills in the licensure assessment pathway and individual stakeholders will receive a survey. The response period will run from February 25-March 12, 2021. The details on how input will be collected is in development and will be included in next Thursday’s update and widely distributed via email. Later in the year, we will have an additional call for position statements and public commentary, ensuring ample opportunity for everyone to be heard for each Phase of the Special Commission’s work.

Continue to look for weekly updates here and for a new website location for periodic updates related to the work of the Special Commission.

FEBRUARY 11, 2021

The NBOME Board of Directors held a special session earlier this week and has made the following decisions related to the global pandemic and COMLEX-USA:

• 1. The COMLEX-USA Level 2-PE is postponed indefinitely and will not resume on April 1, 2021.
• 2. We are deferring work on a temporary clinical skills testing site in California.
• 3. For the Class of 2021 (and earlier), we are developing a temporary alternative pathway to meet the eligibility requirements for the COMLEX-USA Level 3 examination.
• a. This new pathway will allow for the verification of the competencies assessed in Level 2-PE without the need to travel to an NBOME National Center for Clinical Skills Testing.
• b. We are working diligently to determine exactly what this temporary alternative pathway will look like for the Class of 2021 (and earlier) including options for those who have not yet taken Level 2-PE and others. We expect to release additional details within the next 4 weeks.
• 4. For the Class of 2022, we are convening a Special Commission that will review the future of Level 2-PE and determine potential alternative pathways. Detailed information about alternate pathways will be available by April 30, 2021.
• 5. The Special Commission and its charge will be expanded to consider and identify new ways to evaluate fundamental competencies currently assessed in the Level 2-PE. This will include a full review of the COMLEX-USA program, to ensure it continues to provide a defensible pathway to osteopathic medical practice and licensure. The Special Commission will include members from across the UME-GME-Licensure continuum, including student representatives and public members/patient representatives. This work will occur in two phases:
• a. Phase 1 will address points number three and four above, and will include structured feedback opportunities from all stakeholders, from students to educators to licensing authorities to professional organizations, and public members/patient representatives.
• b. Phase 2 will focus on long-term solutions to assess competencies for osteopathic medicine in the COMLEX-USA program, with an eye on our collective duty to ensure quality care for the public and our patients.

A general timeline is as follows:

Action	Time
Commission begins its phase 1 work- clinical skills assessment	Week of February 22, 2021
Details on temporary alternate pathway (For classes of 2021 and earlier)	Announced by March 11, 2021
Feedback period - organizations	February 25, 2021 –March 12, 2021
Feedback period - individuals	February 25, 2021- March 12, 2021
Details on pathway options for Class of 2022 (Phase 1)	Announced by April 30, 2021
Expanded Commission-phase 2 begins- COMLEX-USA	May 2021
Final Commission report release	July 1, 2022

We have compiled a list of Frequently Asked Questions to answer as many of your pressing questions as possible, but there is much we still need to determine about this process. We vow to be transparent as we work with our learners and other stakeholders across our profession. Weekly NBOME Updates on Thursdays will continue. NBOME Client Services is available from 7AM-7 PM ET M-F and at clientservices@nbome.org to try and answer additional questions.

We have carefully considered all of the feedback we have received from you during this pandemic year and we are grateful for your input. While we are sorry for the widespread misinformation that circulates, we understand the extraordinary challenges we have all faced in the global emergency. Enthusiasm regarding the COMLEX-USA and the importance of osteopathically distinctive assessment is a testament to how much we all care about the osteopathic profession, its learners and physicians, and our patients.

We at the NBOME have always been, and continue to be, committed to maintaining the excellence of our profession through high quality assessment and professional self-regulation. Given the unique circumstances presented by the pandemic, we have the opportunity to continue to evolve COMLEX-USA in a manner that meets the changing practice of osteopathic medicine and its physicians.

Our focus on COMLEX-USA includes input from stakeholders across the osteopathic medical profession to ensure its continued excellence for our patients, and we don’t take these decisions lightly. Decisions made by the NBOME as part of this process and outcomes related to our testing methods continue to be made carefully and with valued input from all of our stakeholders, and are not to be meant as commentary about assessment and testing decisions made by other organizations or professions.

Please look for our next weekly update with more information on Thursday, February 18, 2021.

FEBRUARY 5, 2021

Dear Osteopathic Medical Family and Friends:

We would like to thank the osteopathic medical community and those across the entire house of medicine who have reached out to us with their thoughts, feedback, and concerns this past week—we appreciate your insights.

In particular, leaders from the governing boards of the American Osteopathic Association, the American Association of Colleges of Osteopathic Medicine, and the American Association of Osteopathic Examiners, as well as others, have been very responsive and engaged in the process.

The pandemic has presented us all with unprecedented challenges, but also a unique opportunity to further reimagine how we ensure the continued high quality of care for our patients and the success of the DO profession through the very necessary evaluation of students, residents, and physicians who serve as stewards of osteopathic medicine and its philosophy.

Education, training, accreditation, licensure, and continuous professional development are interrelated in our goal of protecting the public and providing our patients with the highest levels of care.

We know that all members of the osteopathic medical profession, including DO students, recognize the importance of keeping the patient front and center in all that we do.

To that end, we must assure that our osteopathically distinctive licensure assessment pathways—in whatever form they take—in no way compromise:

• patient safety and high quality patient care through assessment of fundamental competencies integral to osteopathic medicine,
• the patient-centered approach to care, integral to what patients expect from DOs,
• the ability of DO students to graduate, and efficiently progress into and complete residency training, and
• the ability of DOs to earn the privilege of licensure wherever they choose to practice.

We believe we can DO all four.

Next week, the NBOME Board of Directors will continue reviewing an expedited, structured, and comprehensive process for formal stakeholder input on how we can further reimagine this course.

This will require a defined but expedited period of time on our part to consider thoroughly, comprehensively, and carefully, all of the aspects associated with changes to assessment for licensure.

The NBOME Board does not act unilaterally in major decisions that involve many others and which might yield unintended consequences. We have already held meetings with many organizational leaders including those across osteopathic medical education, osteopathic professional practice and self-regulation and accreditation and licensure communities.

We have engaged AOA and AACOM to provide timely information to all our stakeholders as we gather insights to our work in progress. In addition, we will pursue active contributions from a number of student organizations, including SOMA and COSGP, and the AOA’s Bureau of Emerging Leaders, to provide further opportunities for valuable input from students and residents.

We are asking for your patience to work through what is a complicated process, ensuring we can fairly consider all of the factors required to make the most informed decision possible—one that has great potential to benefit learners, the educational programs, our profession and most importantly, our patients.

As we move forward, we are committed to being transparent as we consider not only all options and outcomes, but also protecting the integrity of the process along the way to assure the best possible solution. Each Thursday, we plan to share weekly public updates on our website.

With next Thursday’s update, we will provide a timeline and method for all interested parties—both organizations and individuals—to share their thoughts, ideas and concerns with us. This will ensure that your valuable and professional feedback is shared directly with those of us who are committed to finding the best path forward. Please continue to check our website for updates.

Thank you for your trust as we navigate this journey together.

Sincerely,

John R. Gimpel, DO, Med, President & CEO on behalf of the Board of Directors, Staff, and National Faculty

JANUARY 28, 2021

The NBOME is committed to its mission of protecting the public via assessment, and providing osteopathic physician candidates with the means to demonstrate their fundamental competencies for licensure for all of the state medical and osteopathic medical licensing boards. COMLEX-USA, including the valid and reliable Level 2-Performance Evaluation, is designed to assess the fundamental competencies for osteopathic medical practice, helping the licensing boards to protect the public. These include distinctive skills in osteopathic assessment, OMM and OMT.

Our plans to provide access to Level 2-PE again in April 2021 are progressing along well, of course, contingent on local and national conditions with the pandemic and our ability to provide safe access. Further plans for a temporary satellite clinical skills testing site for Level 2-PE near Fresno, California to expand access are likewise on target (estimated May 2021).

As always, we will continue to incorporate input from the licensure, education, and practice communities across the profession, helping to assure that COMLEX-USA keeps up with the evolving practice of osteopathic medicine and its primary purpose related to licensure and protecting the public. We continue to ensure that each examination and the entire program continue to benefit from opportunities and advances in technologies, psychometrics, and collaboration across the continuum; attending to candidate needs in the test-taking experience; and our continuous quality improvement measures that exceed industry standards, including those for validity, reliability, and fairness.

DECEMBER 15, 2020

This update is in regards to the NBOME’s ongoing exploration of a temporary satellite testing site for COMLEX-USA Level 2-PE in the western region of the United States.

With the extension of the exam hiatus through March 31, the timeline on this project has shifted and we now anticipate being able to offer exam administrations in the satellite testing site from May through September 2021. We expect to make more than 1200 testing spots available in addition to those at NBOME’s two National Centers for Clinical Skills Testing in Chicago and Philadelphia for those eligible candidates who are ready to test.

Prioritization for these spots, as with those at the NCCSTs, will be given to candidates with 2021 (or earlier) graduation dates. We may potentially offer availability at the satellite testing site to eligible students in the Class of 2022 once those with priority have had ample opportunity to schedule. As previously described, the NBOME has frozen COMLEX-USA exam fee increases and eliminated rescheduling fees to support the continued flexibility and choice of when to test, leaving that in the hands of the candidates and their schools. We anticipate these spots opening for registration in early February 2021.

With everyone’s well-being in mind, the NBOME continues to monitor safety recommendations with respect to the pandemic. We are monitoring the vaccination efforts and are actively exploring options to incorporate rapid testing for SARS-CoV-19 in an effort to mitigate risk as we look to resume testing.

Further updates on testing capacity and potential satellite testing opportunities will be released by the end of January 2021. We appreciate your patience and understanding as we work to assure testing administrations meet needs for safety and reliability.

OCTOBER 23, 2020

NBOME is temporarily suspending all administrations of COMLEX-USA Level 2-PE previously scheduled to restart in November 2020.

The documented recent increases in COVID-19 disease activity at both the national and local level, as well as related travel restrictions put into effect in recent weeks, along with our focus on candidate, staff and community wellness and safety, were defining factors in this decision. NBOME plans to resume testing in April 2021 at both NBOME National Centers for Clinical Skills Testing.

Please visit COVID-19 FAQ Page for additional information on rescheduling, refunds, test center and spot availability, and further details on how and why we have made this difficult decision.

We apologize for the inconvenience and any undue anxiety this suspension may create for candidates. Please know this decision was not an easy one, but was firmly motivated by our continued commitment to the health, wellness and safety of our candidates, our staff, and our communities. Thanks to everyone across the profession who has supported NBOME’s efforts to continue to meet our mission, help to keep everyone safe, and support our learners on their paths to medical licensure.

We will continue to stand ready to safely provide opportunities for candidates to take this important licensure examination and to demonstrate fundamental osteopathic medical competencies for the unrestricted license to practice in all United States and territories. We will remain committed to supporting otherwise qualified learners to progress through graduation, into residency training and on towards medical licensure.

OCTOBER 2, 2020

This update is in follow-up to the announcement on September 2, 2020 on NBOME’s exploration of a temporary contingency satellite testing site for COMLEX-USA Level 2-PE in the western region of the United States.

We have continued to listen to the feedback from students, particularly from the Class of 2021, including the many stressors they have encountered with taking or planning to take their licensure exams. We understand these students have been faced with numerous uncertainties and challenges with their clinical learning/clinical rotations, applications for GME/residencies, etc. Providing access to safe testing that remains valid, reliable and defensible has remained our priority, for those students who feel they are ready to test and would like to have the opportunity to do so in the upcoming months. We have surveyed Colleges of Osteopathic Medicine and DO students and have found an interest in availability to take Level 2-PE in 2021 in a temporary satellite testing location near Fresno, CA. In addition, our team has been working to identify a partner that would be able to work with us to assure that the additional availability for testing in this temporary satellite site would ensure the same NBOME standards for everyone’s safety, test security, and standardization for the valid, reliable, defensible assessment of fundamental osteopathic medical competencies.

At present, it is anticipated that Level 2-PE testing availability at this satellite site would begin in March of 2021 and run through July 2021, adding opportunities to the NBOME’s two National Centers for Clinical Skills Testing in Chicago and Philadelphia for those ready to test. We anticipate that once eligible candidates with graduation dates in 2021 (or earlier) have been provided priority-opportunity to test, availability would be offered to eligible students in the Class of 2022. As previously described, the NBOME has frozen COMLEX-USA exam fee increases and eliminated any rescheduling fees to support the continued flexibility and choice of when to test, leaving that in the hands of the students and their schools.

We will continue to provide updated communications regularly and are committed to providing another more comprehensive update on Level 2-PE test availability and the contingency planning for clinical skills testing delivery on or about November 2, and further details and possibly the opening of test center appointment dates at a temporary satellite testing site as early as December 15, 2020.

SEPTEMBER 2, 2020

In response to the COVID-19 pandemic, the NBOME has accelerated research, development and piloting of temporary contingency test delivery options for NBOME assessments -- including the COMLEX-USA Level 2-PE examination which assesses fundamental clinical skills including physical exam skills and OMT. Since exam suspension in March of 2020, we have been working hard to implementing procedures for everyone’s safety such as rigorous and frequent cleaning protocols and health screens for both candidates and staff, and are also investigating the potential role for SARS-CoV-2 testing. External public health and infectious disease consultants have been integrally involved in our plans for test resumption, currently targeted for November 1, 2020 at both NBOME National Centers for Clinical Skills Testing (NCCSTs; Chicago and Philadelphia.)

We understand and appreciate the ongoing concerns related to travel to test. Approximately 56% of the DO students the Class of 2021 are enrolled at a college of osteopathic medicine located within an 8 hour drive of one of our current testing locations, and 25% of the anticipated graduating DO Class of 2021 have already passed the exam. While considerable capacity remains in our two NCCSTs to test the remaining graduating seniors, our team is actively exploring options for a temporary satellite testing center located in the western portion of the country, potentially for a testing window in 2021.

Our objective is to provide candidates the opportunity to complete their COMLEX-USA examination and demonstrate their competency for licensure, when they are ready to do so, as promptly and as safely as possible. As COMLEX-USA is a licensing examination, it is imperative that we maintain the integrity of the examination program, and that the administration of the exam remains valid for this purpose, and preserves the reliability, defensibility and fairness of the examination. COMLEX-USA is entrusted in every state for medical licensure for DOs, therefore the integrity of the examination is of paramount concern. We have appreciated the overwhelming support of the colleges of osteopathic medicine and other stakeholders in sharing constructive feedback and ideas for administration solutions, in particular appreciating the concerns and input from DO students and student organizations. We have reached out to residency program associations including the Organization of Program Director Associations (OPDA) and the Assembly of Osteopathic Graduate Medical Educators (AOGME) and received formal statements from both that they understand that many residency program applicants in the Class of 2021 will not have results of COMLEX-USA Level 2-PE (DO applicants) or USMLE Step 2-CS (MD applicants) when they apply, and that applicants should not be held accountable for results of exams they have been unable to take due to exam suspensions and the pandemic. We have advocated for other organizations across the house of medicine to acknowledge this reality in 2020-2021.

NBOME has continued to work tirelessly to assist exam candidates, colleges of osteopathic medicine (COMs), and other stakeholders since the pandemic emerged in March, when we implemented COMAT-Self-Proctored test form options for COMs, and launched COMSAE Phase 2 (self-assessments) on our CATALYST longitudinal assessment platform. In late July the first satellite testing center for administration of COMLEX-USA Level 1, Level 2-CE, and Level 3 opened on the campus of the University of North Texas Health Science Center-Texas College of Osteopathic Medicine, Fort Worth, TX and in mid-August a similar center opened at Michigan State University College of Osteopathic Medicine, East Lansing, MI. These strategies and Prometric test center-delivered exams have put COMLEX-USA testing totals over the 16,000 mark since testing resumed in May.

In conjunction with identifying a potential contingency site for clinical skills testing, we continue to listen and collaborate with organizations and individuals in the medical education and medical regulatory communities to address this disruption and its effects, both professionally and personally, on candidates. We empathize with the unique circumstances of osteopathic medical students and residents, and indeed all of us in healthcare, medical education, and our world. Your support and input remains critical to our ability to meet our mission, relied upon by the state medical and osteopathic medical licensing boards and the patients in the communities we serve.

We will continue to provide updated communications regularly, and are committed to a formal update on the contingency planning for clinical skills testing delivery by October 1.

JULY 23 2020

As we monitor evolving challenges related to the pandemic, we are concerned with the surge in disease activity across the county and the impact this has on safe candidate travel. While we believe we can ensure a safe testing experience once students are onsite, we are not able to ensure their safety during travel. The health and safety of our candidates and staff continues to be of the utmost importance. As such, exams up through October, 2020 have been cancelled and we anticipate resuming testing on November 1, 2020. Candidates directly impacted by this cancellation decision will be notified directly and we will assist them with any rescheduling needs.

We realize the stress this decision creates and know that everyone is facing significant challenges at this time. We apologize for the inconvenience but ask for your understanding during this time of uncertainty. Once we return to normal operations, we will add additional exam sessions in an effort to provide as much opportunity to access the exam.

We continue to monitor the situation daily and will make informed decisions about resuming testing and impact on the exam based on how the pandemic evolves. Thank you for your patience as we all look for signs of hope in the public health crisis improving.

Our portal is open to reschedule exams at this time. The NBOME is very committed to assisting students as much as possible with testing opportunities while looking to monitor safety.

Score release dates for all November and December examinations will now be included in the February 1-9, 2021 window. All score release dates for 2021 are unchanged at this time.

For information on travel advisories or making changes to your current travel itinerary, please contact your airline or rail service directly. If any alteration in your travel plans results in a change fee, please reach out via our client services system for assistance.

We will continue to update this site as the situation evolves. Please contact the NBOME directly if you have any additional questions or concerns.

P: 866.479.6828
E: ClientServices@nbome.org

JULY 16 2020

On July 11, infectious disease epidemiologists from the Johns Hopkins School of Public Health were onsite to review NBOME’s enhanced safety policies and procedures for the administration of the COMLEX-USA Level 2-Performance Evaluation. This was the second infectious disease expert NBOME has engaged related to our plans to resume testing.

This latest group of experts reviewed both candidate and staff processes from the standpoint of the examination day and provided notes regarding the safety policies and procedures to be used once we resume clinical skills testing. They expressed confidence that our interventions are grounded in sound medical knowledge and provide risk mitigation for the exam. We anticipate receiving their full report within the next few weeks.

We are also looking forward to sharing our new safety video with you early next week. This video provides a visual overview of the myriad modifications and enhancements NBOME has made to protect candidates, staff and standardized patients. Stay tuned!

JUNE 25, 2020

As osteopathic medical schools begin to resume educational activities, including clinical rotations, the Clinical Skills Testing Department at the NBOME is also preparing for the resumption of the COMLEX-USA Level 2-PE, currently slated for September 1.

With a keen sensitivity to the pressures and challenges of testing during these uncertain times, we are taking every precaution to ensure a safe and comfortable testing experience for candidates, as well as for our staff and standardized patients.

We have taken a methodical approach to analyzing the exam administration process, looking critically at each onsite step of the exam experience, from the moment a candidate enters the building until they depart. Our commitment to the health and wellness of our candidates guides us as we identify opportunities for improvement, and as we adjust our processes and procedures to address any safety gaps that may exist - all while maintaining the validity and reliability of the clinical skills exam.

We will be sharing our comprehensive safety measures more fully in the next few weeks, as well as guidelines for candidates regarding the exam encounters with standardized patients. In the meantime the following items serve as a starting point:

• Candidate and Staff health screening. Exam staff will assess candidates during the check-in process and conduct thermal screenings of all candidates.
• Social distancing. These protocols will be rigorously enforced throughout the NCCST. However, patient encounters will still require direct contact / interaction.
• Staggered exam start times. On days with more than 1 exam scheduled we will stagger times to start about an hour apart. Start times will be communicated via email received in the weeks leading up to their exam.
• Larger capacity rooms. Large rooms have been reserved for registration and breaks to further support social distancing protocols.
• Hand sanitizer. This will be available in all common areas throughout the NCCST, in all examination rooms, and at all SOAP note terminals.
• Clear face masks issued to all candidates and standardized patients. These masks provide protection from spreading respiratory droplets while allowing viewing of the full face. Please note, these are not face shields, but actual face masks that fully cover the nose and mouth of the wearer.
• Enhanced cleaning procedures. Hospital-grade disinfectant will be used to periodically wipe down high-touch surfaces both in exam rooms and at SOAP note terminals, plus daily deep-cleaning before each testing session.

Risk Management. Scenario Planning. Pilot Testing. Independent Review. Incredible thanks go out to the students, residents and attending physicians who joined us on Saturday June 13 as part of our first Level 2-PE pilot exam with COVID-19 protocols in place. The intent of the pilot was to pressure-test the various physical distancing and safety modifications put in place and to gain further insight on what else needs to be done to prepare for a safe and successful exam re-start.

We were also joined on-site by a local board-certified infectious disease specialist with training in hospital epidemiology and investigating outbreaks. She monitored the pilot exam from candidate and staff wellness screening, to physical distancing implementation, to enhanced cleaning protocols. She provided valuable feedback on our processes and expressed confidence in the steps we have taken to make the exam a safe experience. The pilot provided us clearer insight on the integrity of our enhanced health and safety policies and procedures and reassured us that we are on the right track as we prepare to relaunch the exam.

As a follow-up to the pilot, NBOME will be hosting a team of public health officials from Johns Hopkins University on July 11. This group will provide further review of the exam and our approach to enhanced safety.

While the input and recommendations received from subject matter experts in the public health sector will directly guide our path forward, we also feel it is important to engage the student community to ensure they feel safe in this environment. As such, we have invited a fourth-year DO student leader who has already completed the clinical skills exam to visit our NCCST, review the safety enhancements we are putting in place, and provide their thoughts as it relates to the comfort level of incoming candidates.

Once this 360-degree analysis is complete, we will incorporate our learnings into a safety report and video that will be available on our website in mid-July.

Our re-start plan will continue to evolve as we monitor the rapidly growing medical knowledge surrounding the virus and the implications of public health and safety guidelines in the Chicago and Philadelphia regions where our NCCSTs are located, as well as other key regions. While we are optimistic about our plans to safely resume testing on September 1, and are looking forward to again engaging with candidates, please be assured that we do not plan to resume testing until we have made the testing environment as safe as possible, given the unique circumstances. We also encourage students to continually evaluate their own personal circumstances regarding location and personal situations. We currently have exam openings through June 2021 for those who would feel more comfortable coming at a later time.

We remain dedicated to the importance of assessing the fundamental clinical skills of DO candidates and support the safe return of clinical learning opportunities as we all move forward during these uncertain times, together.

JUNE 5, 2020

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. Read our joint statement in support of COMLEX-USA Level 2-PE and COCA’s temporary modification of graduation.

JUNE 3, 2020

We appreciate all of the students who have very professionally provided their feedback and made us aware of their concerns. We heard your views about availability and access to testing as well as the safety of testing and travel to testing centers since the challenges with COVID-19 emerged. We have continued our considerable efforts to listen to the opinions of DO students, but particularly over the past several months in the COVID-19 era. And we continue to hear you, and share in your frustrations and anxieties caused by this pandemic. In addition to countless information sessions with other stakeholder groups, we have held multiple videoconference meetings with the Council of Osteopathic Student Government Presidents (COSGP), their Executive Board, and two open Webinars for DO students in the past 2 months. We have also held a similar number of updates and Question and Answer sessions for COM Deans, who often reflect the concerns expressed by their students.

Specifically related to COMLEX-USA Level 2-PE and clinical skills testing in our two National Centers for Clinical Skills Testing, we initially suspended all testing back in March, and have not given a test since March 6, 2020. We did so out of concern for the health and safety of students, staff and our communities, and in compliance with local, state and federal expert and governmental authorities. We continue our outreach for further input from the licensure and medical regulatory community, the leadership of the AOA and the AACOM, and others across the patient advocacy community. They all reiterate the importance of the examination as a part of the licensure examination series and of our mission to protect the public- the patients we have the privilege to serve.

We had announced a suspension of Level 2-PE test sessions until July 1 and we were on track with examination modifications that could have made this possible. However, out of an abundance of caution we have elected to further suspend resumption of testing until September 1, 2020. We have engaged external public health/infectious disease experts on the significant modifications to test administration that would enhance safety. We will continue to monitor local and state opening guidelines, travel restrictions, and guidelines for return to campuses and clinical rotations. We will continue to use these indicators to help guide the safe resumption of testing, and will be sharing further detailed materials and a video tour of the modified testing center environment and test administration features. We have reached out to student leaders who will be visiting our National Centers for Clinical Skills Testing to walk through a center and see the examination and physical center modifications.

We know there will be different circumstances for each candidate. Some will more easily be able to come to take the examination at first- those who can travel more easily to the locations, for example. We continue to suggest that anyone who would like to postpone testing for any reason, be it personal safety, that of loved ones, travel concerns, etc., that they do so. Candidates who have been impacted with this further suspension have been personally notified, and we apologize for the inconvenience and frustrations exam cancellations cause. For any additional cancellations, we will supplement our normal systems and processes with telephone access to client services support who can help to troubleshoot rescheduling challenges. As always, candidates who are impacted with additional financial hardship due to travel cancellation fees are also encouraged to contact NBOME Client Services at Clientservices@nbome.org or 866.479.6828.

These decisions are not made by the NBOME in a silo, but with the input of many stakeholders, including medical regulatory and educational organizations in the osteopathic medical community. Our collective decision to further suspend the examination and not provide testing opportunities until September 1 may not be a popular one, but we continue to do everything we can to provide safe testing opportunities for students and residents to meet licensure requirements and demonstrate their competencies. At the same time, we will honor our commitment to the patients and communities who entrust us with the responsibility of professional self-regulation that ultimately helps to keep them safe.

MAY 18, 2020

In an effort to assist candidates impacted by cancellations of the COMLEX Level 2-PE examination due to the ongoing COVID-19 pandemic, we are releasing additional testing sessions for later this year and early 2021.  New sessions have been made available on the NBOME portal and more will be released once we resume normal operations.

NBOME continues to evaluate recommendations related to how long social distancing will be in effect to determine when additional opportunities for more sessions might best be added. Currently almost 3200 candidates have been impacted by exam cancellations and we appreciate your understanding as we look to offer rescheduling options. Our portal is open and remains the fastest means to reschedule exams.

We often hear student and school concerns about residency program applications and the desire to have Level 2-PE results before applying in ERAS. Please know residency program directors are well aware that many applicants in the Class of 2021 will not have a chance to receive a test score by the new October 2020 ERAS opening. We appreciate your understanding during this stressful time and please be assured we are very cognizant of the importance of providing ample opportunities for this exam.

Once the National Centers for Clinical Skills Testing resume exams, we will be able to determine the best avenues for the additional sessions.  We hope you are staying safe during these challenging times.

MAY 14, 2020

The health and safety of our staff and candidates is of the utmost importance to the NBOME. Governors in both states (PA and IL) have mandates in place that have made it impossible to deliver the June exams. Therefore, NBOME has extended our COMLEX-USA Level 2-PE hiatus through June 30 and hope to resume testing on Wednesday, July 1. We apologize for the inconvenience this creates but ask for your understanding during this time of national emergency and uncertainty. Candidates scheduled in June will be notified individually and we will work with them to assist with rescheduling their exam. Once we return to normal operations, we will add a considerable number of additional exam sessions in an effort to provide as much opportunity to test and receive results in a timely manner.

We continue to monitor the situation daily and will make informed decisions about testing and impact on the exam based on how the pandemic unfolds. We will resume testing when it is as safe as possible to do so. Prior to resuming, we will provide information regarding any impact COVID-19 has on how the exam unfolds, including modifications to exam administration for social distancing and accounting for this novel disease in the context of exam cases. The NBOME remains committed to a valid, reliable, defensible and fair assessment of the fundamental clinical skills required for licensure as an osteopathic physician and by residency program directors. Thank you for your understanding during this stressful time.

Our portal is open to reschedule exams and at this time, score release dates are unchanged for exams taken from July 1 onward. The NBOME is very aware of the need to have Level 2-PE results in a timely manner for rotation, residency application, and graduation requirements. As circumstances, guidelines and governmental mandates continue to vary across the nation, we recommend that those uncomfortable with travel for a July, August or September test session (or any time) reschedule their session. There will be sessions added to accommodate candidate demands through the winter and spring months of 2020-2021.

We often hear student and school worries about residency program applications and the desire to have Level 2-PE results before applying in ERAS. Please know that residency program directors are well aware that many or most applicants in the Class of 2021 will not have had a chance to receive a test score by the new October 2020 ERAS opening. We appreciate your understanding during this stressful time and please be assured we are very cognizant of the importance of providing ample opportunities for this exam.

We will continue to update schools, accreditors, and residency program director groups, reminding them that many 2021 graduates will not have Level 2-PE results by the new ERAS opening date in October 2020 or even by rank order list submission deadlines in February 2021, helping to advocate for students so they are not held accountable for test results of examinations they were unable to complete due to the pandemic.

We will continue to update this site as the situation evolves. Please contact the NBOME directly if you have any additional questions or concerns.

P: 866.479.6828
E: ClientServices@nbome.org

APRIL 8, 2020

The health and safety of our staff and candidates is of utmost importance to the NBOME. With this in mind and in order to carry out our mission of protecting the public, NBOME has extended our exam hiatus through May 31 and hope to resume testing on Monday, June 1. We apologize for the inconvenience this creates but ask for your understanding during this time of national emergency and uncertainty.

Our portal is open to reschedule exams and the score release dates are unchanged for exams taken from June 1 onward. The NBOME is very aware of the need to have Level 2-PE results in a timely manner for rotation, residency application, and graduation requirements.  We are committed to assisting students as much as possible during this challenging time.

Once we return to normal operations, we will add exam sessions in an effort to provide as much opportunity to access the exam.  We continue to monitor the situation daily and are looking to make informed decisions based on how the pandemic unfolds.  Thank you for your understanding during this stressful time.

For information on travel advisories or making changes to your current travel itinerary, please contact your airline or rail service directly. We will continue to update this site as the situation evolves.  Please contact the NBOME directly if you have any additional questions or concerns.

P: 866.479.6828
E: ClientServices@nbome.org