by Kevin M. Sanders
As of December 2004, all
osteopathic medical students, in order to practice in this
country, must pass the Comprehensive Osteopathic Medical
Licensure Examination (COMLEX) Level 2-Performance Evaluation
(PE). The standardized patient-based clinical skills examination
is part of the COMLEX-USA, which is administered by the National
Board of Osteopathic Medical Examiners (NBOME).
Although this past year was the
first year COMLEX Level 2-PE was given, the 98 members of
OU-COM’s Class of 2005 who took the board exam achieved a
perfect pass rate on the exam.
“Congratulations! I’m proud of
the college and its students for this accomplishment,” says
State Sen. Joy Padgett.
The 100 percent success of our
students on the exam, says Dean Jack Brose, D.O., is
“remarkable.”
“Our faculty deserves a lot of
credit for preparing the students for this, and our students
deserve a lot of credit for taking this examination so seriously
and preparing for it in the way that they did. To not have a
single failure in the entire class of students is
extraordinarily unlikely. It’s a remarkable achievement,” says
Brose.
“We’re extraordinarily proud of
our students and their board performance.”
“A lot of credit should go to
our admissions office for the quality of the student that is
recruited and accepted into the college. Our admissions office
has done a remarkable job of recruiting quality students.”
“I wasn’t surprised,” says
Judith Edinger, director of predoctoral education, “by our
100 percent score.” She notes that OU-COM was one of the several
pilot sites that NBOME used to conduct its trial evaluations of
the exam.
In the seven-hour exam period
of COMLEX Level 2-PE, medical students go through 12
standardized patient encounters, during which “patients” present
problems commonly observed in primary care, outpatient or
emergency room settings. Students are evaluated for proficiency
in the Humanistic Domain (doctor-patient communication,
interpersonal skills, professional demeanor) and
Biomedical/Biomechanical Domain (history taking; physical
examination skills including osteopathic palpatory skills, OMM
and osteopathic principles; composing a Subject Objective
Assessment and Plan (SOAP) note; clinical problem-solving;
integrated differential diagnosis; formulation of a therapeutic
plan). Students have up to 14 minutes to evaluate and treat each
patient, followed up with 9 minutes to complete the SOAP note
laying out their clinical findings and suggested treatment plan.
Students receive a pass or fail for each domain.
As of 2008, all osteopathic
medical students will be required to take and pass the exam
prior to graduation, says the American Osteopathic Association
Commission on Osteopathic College Accreditation.
Clinical skills tests, such as
COMLEX Level 2-PE, says Peter Dane, D.O., associate dean
for predoctoral education, are important.
“They are a way of assessing
skills — mechanical and interpersonal. COMLEX Level 2-PE is a
way of judging not only what students know but also what they
can actually do. Paper and pencil tests can only assess your
cognitive domain but not the behavioral domain,” says Dane.
“It’s a no-brainer that this
type of testing should have been done a long time ago.”
Several factors are responsible
for the Class of 2005’s unprecedented 100 percent pass rate.
Among those are the college’s simulated patient lab, early
clinical contact, consistent clinical skills training in the
Patient Centered Continuum (PCC) and Clinical Presentation
Continuum (CPC) curricula, the implementation of the Objective
Structured Clinical Examination (OSCE) and Centers for
Osteopathic Research and Education (CORE) site clinical
training.
“OU-COM was certainly one of
the first, if not the first,” says Brose, “to have simulated
patient labs right from the beginning. When I came here in 1982,
we were already doing what amounted to an OSCE. Students not
only had simulated patients, they did all the things they now do
for the boards. What the national boards have created is a
further refinement of what we’ve been doing all along. We’ve
been fortunate enough to be way ahead of the curve.”
“Our tradition,” says Steven
Clay, D.O., associate professor of family medicine, “has
been simulated patient labs in which students begin to acquire the skills
necessary to be excellent practitioners.”
Sharla Groves,
coordinator of the simulated patient lab, prepares excellent
laboratory experiences for clinical science and learning
clinical skills, says Edinger.
“When I was at Kirksville,”
says Clay, a 1985 graduate of the osteopathic medical college,
“I never saw any simulated patients as a regular part of my
classroom medical education.”
The college’s early clinical
contact programs start in the first year of medical school.
These programs facilitate our students working with primary care
physicians in Southeastern Ohio in their practice settings by
observing and learning from them as they work directly with
patients.
“Dr. Robert Woodward, Sarah
McGrew and Rosemary Butcher are instrumental,” says
Edinger, “in preparing the way for a variety of early clinical
and community experiences with area physicians.”
Our students develop excellent
clinical skills, says Edinger, in no small part because the
faculty of both curricula has made an effort to make sure that
our students develop excellent history taking, physical
examination and interpersonal communication skills. According to
Edinger, small group work also really enhances students’
clinical thinking and interpersonal communication skills.
“Our clinical faculty
emphasizes the development of clinical skills,” says Dane.
Steven Clay, D.O.; Nicole Wadsworth; Robert Gotfried, D.O.;
Chris Simpson, D.O.; and Bill Duerfeldt, D.O. — they
were in charge of significant parts of the clinical sections of
our curricula. They, clearly, have structured their educational
programs to address those needs.”
Clay was also course
coordinator for CPC skills for quarters I–VII. Clay says the
clinical skills excellence that OU-COM students acquire is no
accident.
“When we developed the CPC
curriculum, we spent a long time working on various
instructional blocks, during which we reworked the clinical
skills part of it — history and physical exams, history taking,
etc. — in line with the new curriculum. In each block we
developed a skills component, how to do a history and physical,
for instance, as relevant to that block, whether it was blood
and immunity, cardiovascular or pulmonary. That allowed our
students to study and practice their skills. We combined that
with a little OSCE at the end, which included interaction with
simulated patients. Students were required to interview patients
and work with data, EKGs and X-rays. From their first quarter to
through their second year they were practicing OSCEs with each
block. The idea was to get them accustomed to working this way;
it’s a good way of learning.
“My hope was that when they got
the OSCE section of board exams, it wouldn’t be difficult at
all, because they had been training and thinking that way all
along. They did do well, so I feel very good about that.”
OU-COM’s incorporation of the
OSCE was not in response to the national medical boards, says
Brose, but rather a progression of what OU-COM was already doing
in the first two years of medical education and through clinical
rotations. OSCEs were first put in place in the CORE.
The college has an OSCE that is
required of its third-year students. It is a four-patient OSCE
as opposed to the 12-patient OSCE component of the COMLEX Level
2-PE.
Nonetheless, some students
believe that OU-COM’s OSCE is more rigorous and challenging than
the COMLEX, say Dane and Edinger. “They’ve said that once they
got through our OSCE, they were very well prepared. They knew
what to expect.”
Joanne Bray,
M.B.A., clinical competency assessment coordinator, who
coordinates the OSCE, has been great in helping us make
adjustments as they were needed along the way, says Dane.
OU-COM students spend two years
in clinical rotations, usually at CORE hospitals, during which
they are trained and mentored by CORE clinical faculty and
preceptors throughout the state. These two years are
instrumental in shaping and fine-tuning clinical and
interpersonal skills.
CORE assistant deans, says
Edinger, help students in areas that need more proficiency
development as identified in the OSCE.
These factors, plus the
dedication of the students themselves, are largely responsible
for the success the college has in producing capable, confident
and clinically skilled osteopathic physicians ready to serve our
state and nation.
“When NBOME came up with the idea for the COMLEX-PE,” says Brose, “we were
completely comfortable with it. I think our students could have
taken this test and been very successful a long time ago. This
is one of the strengths of this college.”
The challenge for people in
charge of curricular development is to be able to see around the
corner — to see what might need to be coming next in medical
education, says Dane.
“We were teaching and training
our students,” says Dane, “in the things necessary for success
on the national boards before those things were actually in
place on the boards.”
- 30 -
News for
the week of Sept 5 –
Sept 10
