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Initial Core Competency Capstone for Osteopathic Physicians (C3DO) Pilots Completed; Attestations accepted through Class of 2027

July 18, 2023

Initial analysis of pilot studies in 2023 at six colleges of osteopathic medicine (COM) campuses show promising results regarding the feasibility of on-campus standardized assessment of fundamental osteopathic clinical skills of osteopathic medical students.

In particular, initial reliability estimates for assessment of patient-physician communication and respectfulness skills exceeded expectations (r > 0.80). More than 775 students participated in the program and had the opportunity to provide insights on the activity from their perspective, including both positive and constructive advice for future research.

The faculty and staff at these COMs worked hard during the entire process, and there were many opportunities to explore how standardized assessments can be delivered as part of a distributed administration model.

One faculty member stated, “Thank you so much! This has been an amazing experience. Your team has been wonderful to work with throughout this Pilot. We truly believe in the importance of this work and look forward to all that we learn. We look forward to feedback and improving our process. It is a great time to be a DO!”

Planning for Phase 2 of on-campus clinical skills testing pilots in 2024 is underway, with details and information for interested stakeholders to be announced by September 30, 2023. This phase will include rolling preparation times, a longer administration window, simplified case content, and new technology collaborations.


COM Dean Attestation of Clinical Skills Competencies Accepted Until 2027

The NBOME will continue to accept attestations from COM deans through the Class of 2027. This verification from the dean indicates that a COM graduate has demonstrated fundamental osteopathic clinical skills at the level required for graduation, and fulfills this eligibility requirement for COMLEX-USA Level 3.

Extending the attestation pathway provides the NBOME additional opportunities to modify and enhance the prototype assessment model used in these initial pilot studies by exploring other administrative models, developing and field testing new content, enhancing the scoring tools and quality assurance, and gathering additional evidence to support validity. As part of the ongoing validation of the C3DO, we will continue to seek stakeholder input regarding the pilot administrations and the potential role of COM-based assessment in the licensure arena.

What remains constant is the dedication of the NBOME to protect the public by ensuring the osteopathic physicians who care for them have demonstrated competency in foundational osteopathic clinical skills that meet a national standard for licensure.

For classes graduating in 2028 and beyond, the NBOME will communicate any changes to the eligibility pathway for COMLEX-USA Level 3, including attestation of clinical skills standards and further potential enhancements to the overall COMLEX-USA program, by July 2025.



Will the COMLEX-USA Level 2-PE exam at NBOME National Centers return?
No. The objective of a national clinical skills program is to provide information for state medical and osteopathic medical licensing boards with respect to the osteopathic clinical skills of DOs who apply for state licensure. The NBOME is working on alternative standardized ways to provide this information to the licensing authorities with more direct involvement of the colleges of osteopathic medicine. This also provides the COMs a temporary recognized pathway to meet a national standard for clinical skills assessment.
Why is the timetable for attestation being moved to include the Classes of 2026 and 2027?
This new timeline allows for additional research through extended pilots and collaboration of stakeholders across the profession. That research will help with the creation of a process that is feasible and valid as part of the licensure process and is a trusted milestone in becoming an osteopathic physician. This new timeline will also allow for innovation in the approach to assessing these competencies to a national standard and quality assurance. This decision also provides more lead time for COMs and their students to become familiar with any changes to COMLEX-USA and eligibility moving forward.
Why does the NBOME want to test clinical skills competencies when others don’t have a clinical skills examination?
The Special Commission on Osteopathic Licensure Assessment affirmed that certain competencies are essential to the practice of osteopathic medicine, and recommended the NBOME work to preserve assessment of these skills as part of osteopathic physician licensure assessment. The NBOME Board of Directors agreed and provided funding for research in this area. The NBOME has met with numerous state medical and osteopathic medical licensing boards who remain interested in our approach. Further engagement from across the profession and from patient safety/public advocates continues via the C3DO Advisory Panel and other initiatives.
What about the cost for this? Who will pay for this?
Providing a standardized clinical skills assessment in some form will require resources – in the form of time, effort, and money. Some of these resources are already being invested at the COMs in capstone assessment of clinical skills employed by most of the schools. How this assessment is and could be resourced is part of what is being studied. The NBOME has prioritized minimizing financial burden and other stresses to students, while at the same time contributing meaningfully to clinical skills competency assessment and osteopathic physician licensure. The NBOME will continue to seek input from stakeholders, including students and COMs, to help inform the outcome through the C3DO Advisory Panel.
Why must a new exam be formed if the current attestation fulfills this need?
The temporary attestation pathway has satisfied the requirements of regulatory authorities for the time being, while also highlighting the importance of these competencies to our patients and other stakeholders. Many of those stakeholders have also indicated that a more ideal long-term solution is a national standardized assessment that includes validation of the competencies by external evaluators and features quality assurance, similar to what is being piloted in C3DO.

About the NBOME:
The NBOME is an independent, non-governmental, nonprofit 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.

Renee Cree, MA
Director for Communications