Addressing PE

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GoCards05 said:
What is your opinion about those of us in the class of 2022 taking it later? Do you think that will be an issue for PDs?
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Jackaleauxpe said:
Yes, it will. Why should they choose us when they can choose an FMG or IMG who will not have any licensing issues.
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My general take this interview season has been that PDs have not cared about a lack of PE. Applicants that have failed prior to the delay swear that their invites are slimmer than they otherwise would be, however. This is probably largely specialty dependent. I'm aiming for IM/FM and it has never once been an issue and whenever mentioned it was glossed over to other, seemingly more important, things. Competitive fields looking for excuses to filter applicants may want it, but generally the absence of something means you can draw their attention to other things.

When you go on a date, would you rather it be someone who you know has a red flag or someone that you're not sure has it? If it's really important to you, you'd find a way to bring it up but maybe you found something else that more than compensates for it. It's about getting your foot in the door first.
Same deal with residency interviews.


Overall though, our need to have to strategize about how to handle this manure of an exam only hurts us. That isn't up for debate.
 
Alkaidius said:
My general take this interview season has been that PDs have not cared about a lack of PE. Applicants that have failed prior to the delay swear that their invites are slimmer than they otherwise would be, however. This is probably largely specialty dependent. I'm aiming for IM/FM and it has never once been an issue and whenever mentioned it was glossed over to other, seemingly more important, things. Competitive fields looking for excuses to filter applicants may want it, but generally the absence of something means you can draw their attention to other things.

When you go on a date, would you rather it be someone who you know has a red flag or someone that you're not sure has it? If it's really important to you, you'd find a way to bring it up but maybe you found something else that more than compensates for it. It's about getting your foot in the door first.
Same deal with residency interviews.


Overall though, our need to have to strategize about how to handle this manure of an exam only hurts us. That isn't up for debate.
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None of that matters if the class of '22 can't graduate without it.
 
Jackaleauxpe said:
None of that matters if the class of '22 can't graduate without it.
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Dates are open now January and on. So get a date now and hold on to it if you're concerned again. If it becomes so backlogged, COCA will waive the requirement. Graduating shouldn't be a concern, it's interviews and residency applications that's the issue.
 
EMTAB said:
I honestly don't know if this is feasible, but why doesn't the NBME just meet with a couple of DO's and create an OMT portion? Make it a separate 1-2 hour written exam like a COMAT that costs an additional $100, lobby the school to allow USMLE OR COMLEX as graduation requirement, and just push NBOME out? It sounds like most of the laws require completion of the "USMLE or COMLEX series", and this would just be part of the series. Isn't that why the CS was able to be removed without having to change any state medical laws? Perhaps someone more knowledgeable about that could let me know.

Edit: COCA accreditation element 6.12 States that all students must successful pass COMLEX-USA Level 1, Level 2 CE, and Level 2 PE prior to graduation.
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COCA suspended this requirement for medical schools for the class of 2021 back in June and then reaffirmed it in November -- our school has waived Level 2 PE for graduation already. If your schools haven't, it's not because of accreditation

 
I have collected a survey of over 500 osteopathic students, 79% of whom say that if they are in the 44 states that allow USMLE licensure for DOs that they will plan to take Step 3 instead. Our school has a webinar thing for students to talk to the NBOME on Tuesday and I hope to present this data for their consideration (alongside data on how students ~feel~ about it [very negatively] and ask whether it makes sense for our licensing boards to be fomenting this much ill will during what has already been a traumatizing year)
 
yumpopink said:
I have collected a survey of over 500 osteopathic students, 79% of whom say that if they are in the 44 states that allow USMLE licensure for DOs that they will plan to take Step 3 instead. Our school has a webinar thing for students to talk to the NBOME on Tuesday and I hope to present this data for their consideration (alongside data on how students ~feel~ about it [very negatively] and ask whether it makes sense for our licensing boards to be fomenting this much ill will during what has already been a traumatizing year)
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I appreciate the work you guys are doing. But frankly, the Pathos aspect of your argument will fall on deaf ears. What you need to do is draw out information. Logistics (hard numbers!) on their estimates of how many students have not taken the exam and the amount of students these sites will accommodate every month. Question how they plan to address the allegations that this is purely financial given their federal loans last year. Since this is no longer just affecting medical students but disrupting the work of actual physicians what is their opinion on flying across the country during a pandemic and endangering patients lives (DO NOT BRING UP OUR SAFETY. They don't care. And they'll shift over to that instead of addressing the real question. We are young and they have milked the "when you're comfortable" point long enough).

My point is, you can't walk out of this with no new information. Gimpel is a master of spewing vague nonsense, so your questions need to be concise with no leeway for him to slither around. You guys need to plan have these questions written and reviewed ahead of time by people comfortable speaking up to a bully. Don't allow this to be chat-based if you have the option, because he'll get bombarded by a dozen questions and answer the easiest one. My point is, this takes more planning than you probably think it does.

Anybody know what the rules are for recording? From people that have spoken to him before, was there any sort of agreement that needed to be signed?
 
yumpopink said:
I have collected a survey of over 500 osteopathic students, 79% of whom say that if they are in the 44 states that allow USMLE licensure for DOs that they will plan to take Step 3 instead. Our school has a webinar thing for students to talk to the NBOME on Tuesday and I hope to present this data for their consideration (alongside data on how students ~feel~ about it [very negatively] and ask whether it makes sense for our licensing boards to be fomenting this much ill will during what has already been a traumatizing year)
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Maybe my school is the exception, but I would be shocked if 50% of the student body took both Step 1 and 2. I would say >60% took Step 1, but not a chance that >50% also took Step 2. Some also skipped Step 1, but only took Step 2. For reference, about 50% of the graduating seniors usually go into a "primary care" specialty (FM, IM, psych, peds).

People are all over this thread and elsewhere stating "just take Step 3 and forget about PE" like it's gospel. As y'all know from my previous posts on this thread, I'm by no means a Gimpel-truther. If your data and angle are enough to convince the NBOME to drop PE, I'm all for it. But I'm not for "getting-mine" and leaving the M4/3s that just took Level 1 and 2 out to dry.
 
yumpopink said:
I have collected a survey of over 500 osteopathic students, 79% of whom say that if they are in the 44 states that allow USMLE licensure for DOs that they will plan to take Step 3 instead. Our school has a webinar thing for students to talk to the NBOME on Tuesday and I hope to present this data for their consideration (alongside data on how students ~feel~ about it [very negatively] and ask whether it makes sense for our licensing boards to be fomenting this much ill will during what has already been a traumatizing year)
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Excellent work and thank you for taking initiative. I would also present this to your school and state osteopathic board. I would recommend putting this information up on Twitter or other social media as well. Also, prepare to be promptly dismissed by the NBOME when you present this.
 
Alkaidius said:
I appreciate the work you guys are doing. But frankly, the Pathos aspect of your argument will fall on deaf ears. What you need to do is draw out information. Logistics (hard numbers!) on their estimates of how many students have not taken the exam and the amount of students these sites will accommodate every month. Question how they plan to address the allegations that this is purely financial given their federal loans last year. Since this is no longer just affecting medical students but disrupting the work of actual physicians what is their opinion on flying across the country during a pandemic and endangering patients lives (DO NOT BRING UP OUR SAFETY. They don't care. And they'll shift over to that instead of addressing the real question. We are young and they have milked the "when you're comfortable" point long enough).

My point is, you can't walk out of this with no new information. Gimpel is a master of spewing vague nonsense, so your questions need to be concise with no leeway for him to slither around. You guys need to plan have these questions written and reviewed ahead of time by people comfortable speaking up to a bully. Don't allow this to be chat-based if you have the option, because he'll get bombarded by a dozen questions and answer the easiest one. My point is, this takes more planning than you probably think it does.

Anybody know what the rules are for recording? From people that have spoken to him before, was there any sort of agreement that needed to be signed?
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Absolutely. Prepare for this meeting well and do your best to have it recorded or have someone in your class transcribe the conversation.
 
Alkaidius said:
Anybody know what the rules are for recording? From people that have spoken to him before, was there any sort of agreement that needed to be signed?
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PA is a two party state

"Pennsylvania's wiretapping law is a "two-party consent" law. Pennsylvania makes it a crime to intercept or record a telephone call or conversation unless all parties to the conversation consent. See 18 Pa. Cons. Stat. § 5703 (link is to the entire code, choose Title 18, Part II, Article F, Chapter 57, Subchapter B, and then the specific provision).


The law does not cover oral communications when the speakers do not have an "expectation that such communication is not subject to interception under circumstances justifying such expectation." See 18 Pa. Cons. Stat. § 5702 (link is to the entire code, choose Title 18, Part II, Article F, Chapter 57, Subchapter A, and then the specific provision). Therefore, you may be able to record in-person conversations occurring in a public place without consent. However, you should always get the consent of all parties before recording any conversation that common sense tells you is private."
 
morningmedicine said:
Maybe my school is the exception, but I would be shocked if 50% of the student body took both Step 1 and 2. I would say >60% took Step 1, but not a chance that >50% also took Step 2. Some also skipped Step 1, but only took Step 2. For reference, about 50% of the graduating seniors usually go into a "primary care" specialty (FM, IM, psych, peds).

People are all over this thread and elsewhere stating "just take Step 3 and forget about PE" like it's gospel. As y'all know from my previous posts on this thread, I'm by no means a Gimpel-truther. If your data and angle are enough to convince the NBOME to drop PE, I'm all for it. But I'm not for "getting-mine" and leaving the M4/3s that just took Level 1 and 2 out to dry.
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I put that as an option on the survey--so far, 13.7% of respondents said they haven't taken Step 1 and/or 2 and 80% said that they strongly agree or agree that they will take Step 3 if they can, and 6% are unsure.

EDIT: The point is not to leave those who can't take it out to dry, it's to provide data that shows that the NBOME will suffer a massive financial loss if they continue to double down on this
 
Alkaidius said:
I appreciate the work you guys are doing. But frankly, the Pathos aspect of your argument will fall on deaf ears. What you need to do is draw out information. Logistics (hard numbers!) on their estimates of how many students have not taken the exam and the amount of students these sites will accommodate every month. Question how they plan to address the allegations that this is purely financial given their federal loans last year. Since this is no longer just affecting medical students but disrupting the work of actual physicians what is their opinion on flying across the country during a pandemic and endangering patients lives (DO NOT BRING UP OUR SAFETY. They don't care. And they'll shift over to that instead of addressing the real question. We are young and they have milked the "when you're comfortable" point long enough).

My point is, you can't walk out of this with no new information. Gimpel is a master of spewing vague nonsense, so your questions need to be concise with no leeway for him to slither around. You guys need to plan have these questions written and reviewed ahead of time by people comfortable speaking up to a bully. Don't allow this to be chat-based if you have the option, because he'll get bombarded by a dozen questions and answer the easiest one. My point is, this takes more planning than you probably think it does.

Anybody know what the rules are for recording? From people that have spoken to him before, was there any sort of agreement that needed to be signed?
Click to expand...
Definitely--I am creating that document right now and trawling SDN to research what questions he has already answered so I can dig deeper into his reasoning at the outset. One thing I'm planning on asking is if the NBME and the NBOME have the same duty to professional self-regulation, then why is the NBOME not sounding the alarm to the public regarding the fact that from hereon out all MD physicians will be a danger to the public by their own reasoning.
 
yumpopink said:
Definitely--I am creating that document right now and trawling SDN to research what questions he has already answered so I can dig deeper into his reasoning at the outset. One thing I'm planning on asking is if the NBME and the NBOME have the same duty to professional self-regulation, then why is the NBOME not sounding the alarm to the public regarding the fact that from hereon out all MD physicians will be a danger to the public by their own reasoning.
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The reason Gimpel and NBOME have shut down communication is because they have no leg to stand on. The more they talk, the more obvious it becomes they haven't thought this through. To be blunt, you need to go into this expecting to accomplish nothing. He's not going into this to answer questions or to hear opinions. He's going into this to shut people up and demoralize them in private and in small numbers because he's the only one in that organization that can lie through his teeth with a smile on his face. Don't make this an argument, you won't win. Get his official stances so that they can be used on social media either through recording or transcriptions. Does anyone know if all transcriptions written by hand (vs. digital devices) are legal?
 
Alkaidius said:
The reason Gimpel and NBOME have shut down communication is because they have no leg to stand on. The more they talk, the more obvious it becomes they haven't thought this through. To be blunt, you need to go into this expecting to accomplish nothing. He's not going into this to answer questions or to hear opinions. He's going into this to shut people up and demoralize them in private and in small numbers because he's the only one in that organization that can lie through his teeth with a smile on his face. Don't make this an argument, you won't win. Get his official stances so that they can be used on social media either through recording or transcriptions. Does anyone know if all transcriptions written by hand (vs. digital devices) are legal?
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Thanks for the heads up--I can't imagine hand transcription could possibly be illegal, considering that this is an informational session in the middle of clinical hours that not everyone can attend. I will try to ensure that someone transcribes his answers.
 
yumpopink said:
Thanks for the heads up--I can't imagine hand transcription could possibly be illegal, considering that this is an informational session in the middle of clinical hours that not everyone can attend. I will try to ensure that someone transcribes his answers.
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Good on you for doing all this. Get more of your class on board. Build solidarity.
 
Alkaidius said:
The reason Gimpel and NBOME have shut down communication is because they have no leg to stand on. The more they talk, the more obvious it becomes they haven't thought this through. To be blunt, you need to go into this expecting to accomplish nothing. He's not going into this to answer questions or to hear opinions. He's going into this to shut people up and demoralize them in private and in small numbers because he's the only one in that organization that can lie through his teeth with a smile on his face. Don't make this an argument, you won't win. Get his official stances so that they can be used on social media either through recording or transcriptions. Does anyone know if all transcriptions written by hand (vs. digital devices) are legal?
Click to expand...
I agree with your position here, just wanted to add the NBOME has many legs to stand on. They don’t need to communicate with students beyond the pitiful attempts they make because they have state laws and boards to support their miserable position. That doesn’t negate anything we students try to do, but it is good to keep this in mind.
 
Yaldabaoth said:
Looks like the twitter discourse has shifted towards a social justice angle in regards to the origins of the PE. Could be a viable strategy in this climate.
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It’s an argument that has valid points. Carmody has some good writings about it on his blog. It’s a part of the vast spectrum of reasons this test should not exist.
 
yumpopink said:
Thanks for the heads up--I can't imagine hand transcription could possibly be illegal, considering that this is an informational session in the middle of clinical hours that not everyone can attend. I will try to ensure that someone transcribes his answers.
Click to expand...

I didn't read this was a group meeting. I believe if there is more than 2 parties in a meeting, such a class conference with gimple, it can be recorded for future use.

The laws I posted are only used for 2 party talks.
 
Since we only get 10 minutes to ask questions, these are the points I'm hoping to hit:
  • I want to first acknowledge the legitimate steps the NBOME have taken to ensure our safety during this pandemic, including postponing Level 2 PE as well as working with COCA to eliminate it as a graduation requirement. This shows us that you are indeed paying attention to our concerns.
  • However, the decision to pour huge amount of time and resources into expanding Level 2 PE testing with additional safety measures completely misses the forest for the trees. This does NOT show that you hear us or our concerns. Why are DOs being held to a different standard than our MD peers? Does NBOME have an official statement stating that by cancelling Step 2 CS, the NBME is placing the public in danger by not having MDs undergo a standardized clinical skills exam?
  • How does the NBOME respond to accusations that by not cancelling PE, it fuels a false narrative that DOs are inferior clinicians who require additional checkpoints relative to our MD peers?
  • According to a survey I personally took of over 566 osteopathic students, 80% agree or strongly agree that they plan to take USMLE Step 3 if it is allowed in their state for licensure. Many feel that they are being forced into this decision by the NBOME’s stance on Level 2 PE. How does the NBOME respond to concerns that this will de-incentivize students from training in those six states that require the COMLEX series?
  • If there was a campaign to educate the public on what Level 2 PE is and surveys showed that the public agreed with the vast majority of medical students and physicians that Level 2 PE is not an effective or necessary measure for public safety, would the NBOME reconsider its stance?
 
yumpopink said:
If there was a campaign to educate the public on what Level 2 PE is and surveys showed that the public agreed with the vast majority of medical students and physicians that Level 2 PE is not an effective or necessary measure for public safety, would the NBOME reconsider its stance?
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I would not mention this. It will be hard to have most of the public understand the intricacies of these things, and I can't see the public voting for less testing for physicians.
 
fldoctorgirl said:
I would not mention this. It will be hard to have most of the public understand the intricacies of these things, and I can't see the public voting for less testing for physicians.
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Ironic since they willfully vote for less testing and requirements for midlevels. This country is so messed up.
 
Noisewater-TDX said:
I didn't read this was a group meeting. I believe if there is more than 2 parties in a meeting, such a class conference with gimple, it can be recorded for future use.

The laws I posted are only used for 2 party talks.
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This is correct. If it's supposed to be a large meeting with dozens of listeners then your expectation of privacy will be lost. Plus, what if one of your listeners is tuning in from a public place where the video and audio are going?
 
fldoctorgirl said:
I would not mention this. It will be hard to have most of the public understand the intricacies of these things, and I can't see the public voting for less testing for physicians.
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I disagree, I think the public understands fairness and the concept of money-grubbing medical corporations (eating up mostly federal funds, it should be mentioned) quite well. It would require some skill in the writing of it, but I believe it's totally do-able especially with the testimony of already practicing physicians. But the concerns are valid. I'm not necessarily advocating for such a campaign, but I'm curious about what the NBOME's response to it would be.
 
msnbc2020 said:
I have only found one study asserting that OMT on standardized patients is a valid and reliable assessment.
jaoa.org

Home - Journal of Osteopathic Medicine

jaoa.org
Do you think the PE exam is necessary to protect the public?
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OK, so I had the misfortune of actually reading that entire article and here are my notes/comments:

1) "Traditionally, medical students use OMT on volunteer patients or their peers and are assessed accordingly. This process, albeit of some value for formative feedback, generally lacks standardization and has limited fidelity. Potential differences in patient/subject conditions combined with variable, often subjective, assessment criteria render this strategy of limited use for summative assessments, especially where the stakes may be high. "

But isn't the point of OMT to diagnose somatic dysfunction first? How are standardized patients supposed to fake their own somatic dysfunction? Rule #1 of OMT: do not use OMT if there is no somatic dysfunction. The same SP with x complaint after having been treated with OMT from x number of examinees should no longer have the supposed somatic dysfunction by the end of the exam day.

2) "Likewise, for OMT, the candidates are not directly prompted to perform a particular maneuver. Instead, the standardized patients are trained to elicit some form of treatment through conversations about their medical histories. When prompted, candidates are required to select an appropriate treatment modality. For example, a standardized patient may say that, in the past, OMT was effective for treating his or her back pain."

See #4

3) "A total of 121 fourth-year medical students were tested at Western University of Health Sciences College of Osteopathic Medicine of the Pacific in Pomona, Calif. Within this sample, there were two students from Touro University College of Osteopathic Medicine in Vallejo, Calif."

I'm not a big research or statistics kind of person but I don't think taking your sample from two (if you can call two students from a school in the same state) schools is really what you would call a random or even diverse sample set.

4) "The specialties of the osteopathic physician examiners were as follows: family medicine (7), internal medicine (7, including 2 gastroenterologists, 1 women's health specialist, 1 geriatrician), pediatrics (1), and general surgery (1). Full-time osteopathic manipulative medicine faculty members were excluded from this particular study. The students were primarily recruited from the study site, and the osteopathic physician examiners were from the immediate region. Because osteopathic physician examiners were being used to rate OMT skills, we believed that the presence of recognized osteopathic manipulative medicine faculty members would cue the examinees that they were to be evaluated for OMT at those stations. The more natural cue that was incorporated was the prompt from the standardized patients within the clinical interaction. All osteopathic physician examiners were trained in the use of the assessment scales and were board-certified osteopathic physicians with at least 3 years of clinical practice experience."

Why not just get OMM faculty who are not from the immediate region? Or maybe use those "recognized" OMM faculty for all assessments? If they were present for all stations, that wouldn't serve as a cue. Also, not sure how the SP mentioning the effectiveness of OMT in previously treating his/her back pain is any more "natural" then having all OMM faculty present.

5) "This may have been due to examinee queuing (only OMT cases had an osteopathic physician observer in the room) or student preparation activities (eg, practicing maneuvers before the assessment)."

I think there was a typo...queuing should be cuing. Anyway, they made it obvious to do OMT right from the beginning! Either put a physician in all the rooms or not at all, not just in the OMT cases!

6) "Therefore, taking the osteopathic physician raters out of the room and substituting scoring done via monitors or videotape should be possible and will add to the verisimilitude of the assessment. This would eliminate the possibility of students being prompted to do OMT"

Well, duh.

7) "In addition, given the simulated nature of the encounter, it is often difficult to use palpatory diagnosis as the basis for initiating a treatment program involving manipulation. Here, it may be possible to use standardized patients with actual physical findings."

And how are you going to find these SPs with the actual physical findings?? Article doesn't say.

Also, I tried looking for any disclaimers noted in the article but couldn't find any.
 
msnbc2020 said:
I find it interesting that Dr. Gimpel was an author of this article in 2004 that gives justification for the PE test. He then is appointed as President & CEO of NBOME in 2010. Coincidence?
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As did I, which was why I was curious to see what the disclaimer/disclosure said, but alas, I couldn't find one.

Also, I wouldn't want to give him the honor or respect of being called a doctor. He deserves neither
 
If we live in one of the 6 states that requires DOs take COMLEX for licensure, who would we contact to voice our concerns about this? How did that decision even get made? Has anyone tried contacting their state about this, especially regarding the fact that all states disproportionately rely on DO trainees to care for their underserved populations and the NBOME's actions are incentivizing us to practice in states that don't have this requirement?
 
yumpopink said:
If we live in one of the 6 states that requires DOs take COMLEX for licensure, who would we contact to voice our concerns about this? How did that decision even get made? Has anyone tried contacting their state about this, especially regarding the fact that all states disproportionately rely on DO trainees to care for their underserved populations and the NBOME's actions are incentivizing us to practice in states that don't have this requirement?
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Write an official letter to your state osteopathic board
 
AnatomyGrey12 said:
It means they are getting desperate. They can’t test everyone in a reasonable time frame and they know it.
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It’s funny, because one of the COMS offered their sim center for FREE last year for this very purpose and was ignored. The sim center is a near replica of the NBOME testing centers.
 
I don't remember if we had a consensus on this. My graduation date is late May. Can I still take Step 3 in June?

Can I ask my school to produce a document or something so I can take it earlier? I heard there's a lag time from your actual graduation date to when you actually get to take it because there are other formalities you need to get done
 
Prehealth1011 said:
I don't remember if we had a consensus on this. My graduation date is late May. Can I still take Step 3 in June?

Can I ask my school to produce a document or something so I can take it earlier? I heard there's a lag time from your actual graduation date to when you actually get to take it because there are other formalities you need to get done
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So you register for Step 3 on the FSMB website. I’m sure you could go there and see what the exact requirements are.
 
AnatomyGrey12 said:
So you register for Step 3 on the FSMB website. I’m sure you could go there and see what the exact requirements are.
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I can't tell by the wording of "must have MD or DO" if you have to wait to actually have your degree to register or just abide by entering an eligibility period after graduation.
 
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