COMLEX Step I suggestions for the NBOME

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Hello everyone!

I am currently serving as the Council of Osteopathic Student Government Presidents National Vice Chair and one of my responsibilities is to sit as the student representative to the NBOME. Last year the Vice Chair did an excellent job building a great relationship with the NBOME and was able to open some doors that had previously been out of the question. I will be meeting and speaking with the NBOME president and many of the other admistrators throughout the year and would love to have some more student input. Please try to remain civil if possible. I know the tests can be super frustrating, but the constructive criticism is really the only thing that I can present to them without regressing in our relationship. Feel free to p.m. me or post on this forum and I will be sure to keep everyone up to date on any news or changes being made.

Thanks for your comments and time in advance!

Sincerely

Cory Maughan
COSGP 1st Vice Chair
AZCOM 2010

 

[oreosandsake]

for $45 dollars they can purchase a nice little exam that comes with it's own analysis of strengths and weaknesses broken down by category.

they should take a look at how well written questions are written, and make an ernest effort to delete confusing/poorly written questions from their current question banks.

said tests can be found at:
https://apps.nbme.org/nsasweb/servlet/mesa_main

 

[BobBarker]

Please reference this thread: http://forums.studentdoctor.net/showthread.php?t=529972

 

[goinverted]

I'm sure there is more out there. Any other insights or suggestions?

 

[FutureInternist]

Hello everyone!

I know the tests can be super frustrating, but the constructive criticism is really the only thing that I can present to them without regressing in our relationship.

So I guess telling them not to use lobotomised monkeys to write the exam Qs is out

I can't imagine that they are unaware of just how vague their Qs are. The fact that they have not done anything about it for so long makes it all the more likely that anything that is presented to them will be filed under " Med Students Bitch Too Much" and they will continue w/ the status quo or we could all pitch in & buy them a subscription to UW and tell them "This is how you write Qs"

 

[cyclohexanol]

I'm sure there is more out there. Any other insights or suggestions?

I have lots. Unfortunately, the "constructive" qualifier precludes me from mentioning them.

 

[osli]

My #1 complaint about COMLEX is that a few (perhaps 20 out of 400 for me) questions were so poorly written/edited that it was impossible (at least with my knowledge set) to do one of the following:
- rule out all but one answer choice
- rule in any of the answer choices
- figure out what the question was asking so that I could start ruling in or out

I had one question that, no ****, stopped half-way through the last sentence and never got around to asking a question. I hope this was a brand new "experimental" question, as I had to infer from the stem and choices what the likely question would have been, though unfortunately there wasn't enough information to be certain, and two questions seemed equally likely given the stem and answers. I think the answers were all drugs, and there was one that was clearly contraindicated because of a side effect unsuitable for the patient, and one that was clearly the best choice for the patient presentation, and the others were most likely distractors irrelevant to the question. I think the last line was something like "Based on the physical findings and the most likely pathology." No question.

I got very frustrated at questions that had two correct answers, of which there were a few. More frustrating were the questions where all of the answer choices seemed extremely tangential to the presentation and typical management or mechanisms or whatever. I'm sure there was some connection to one of the answer choices, but there were several questions where it went way beyond USMLE connections... way beyond UWorld connections, even way beyond Big Robbins. Like if you had a patient with very obvious viral pneumonia (because it said it was a viral infection, lol), and it asked you which medicine is most appropriate, and the answers include a diuretic, muscle relaxant, SSRI, and two anti-arrhythmics.

I might be one of the few who isn't convinced however that the USMLE was a better exam. Just better written. I think the scope and focus of the COMLEX was better. More emphasis on DOC instead of detailed MOA's, more emphasis on clinical management than obscure details of pathophys. However, there were too many easy/straightforward/one-step questions on COMLEX. The mix of questions was better on USMLE, and the topics/organs/systems/subjects covered were more uniformly distributed. COMLEX asked me like four questions on ankle sprain and six on one cranial bone (four of those were damn near identical questions - the answer was the same, the stem was just worded a bit differently), and had eight or so 12-lead EKG interpretations. I think a question or two per subject is enough to know if you know it.

So, USMLE = better written, better edited, more uniform question distribution.
COMLEX = better scope, more appropriate (clinical) focus.

 

[FutureInternist]

Another suggestion would be for them to spend some money and buy software that allows for highlighting the Qs & striking out answer choices.

 

[osli]

It was easy to strike out answer choices. In fact, much much easier than the NBME/FRED interface method of highlighting the answer in grey (and not including the answer choice button when trying to do two choices at a time, lest you keep getting the annoying warning telling you to stop 🙄 ).

Didn't try highlighting anything in stem or answers though, so not sure if that worked or not.

 

[ShyRem]

WHY does it take so long to get scores back? This is a computerized exam. We should have a raw score IMMEDIATELY upon completion of our exam, or a "preliminary" score with a disclaimer that it may change and you'll get your final score once the computer has crunched it - and give in 2 or 3 weeks. Five weeks is ridiculous. I took the USMLE one week AFTER the comlex and I'm getting the score back EARLIER. Something is truly messed up here.

I agree about the questions. Some were very poorly worded. And the exam itself could have a more representative cross section of questions. I had no less than 10 cranial questions, but only 1 sacral question. Not representative of either the curriculum focus nor practice focus unless you're planning to specialize in OMM/cranial.

 

[FutureInternist]

It was easy to strike out answer choices. In fact, much much easier than the NBME/FRED interface method of highlighting the answer in grey (and not including the answer choice button when trying to do two choices at a time, lest you keep getting the annoying warning telling you to stop 🙄 ).

Didn't try highlighting anything in stem or answers though, so not sure if that worked or not.

I took step 1 & 2 and on neither exam was I able to highlight or strike out. So now we have variances in the way the test is being administered

 

[osli]

I took step 1 & 2 and on neither exam was I able to highlight or strike out. So now we have variances in the way the test is being administered

Really? I wonder if that was a recent change or something? It was a simple mouse click on the answer choice (I think it was a right click) and the choice was instantly "struck out." Very handy.

 

[DragonWell]

Really? I wonder if that was a recent change or something? It was a simple mouse click on the answer choice (I think it was a right click) and the choice was instantly "struck out." Very handy.

I actually preferred the COMLEX computer interface to the USMLE. It was easier to strike-through choices and I also liked the option at the end to quickly flip back through only your marked questions, rather than clicking on each question number on the USMLE.
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I may be in the minority on this issue, but I felt that the COMLEX Phase 1 had too many questions which required clinical knowledge which was beyond the scope of the pre-clinical years; in other words, too many Phase 2 style questions. These questions were not difficult because of their complexity or the understanding they required, but simply because I had never been exposed to that particular material before.

Without going into a forbidden level of detail, questions about the exact time particular screening tests should be performed, the details of how to perform certain clinical procedures, subtle reasons to choose one drug over another, etc. are things that I have now been reading about during third year, yet these type of questions appeared to be fair game for Phase 1. This type of information is obviously vitally important, but I feel including these type of questions on Phase 1 risks turning it more into a test of clinical knowledge than basic science understanding.

IMHO, the role of the physician is not simply to perform clinical tasks by rote, but to bring the most deep and complete conceptualization of disease and treatment possible to the health care team. To paraphrase one of my professors, "It is not enough for a physician to know what and how, they must also know why." Therefore, the role of Phase 1 should be to focus on the understanding which will form the foundation of clinical decisions. In this regard, I think the USMLE may be superior to COMLEX, as it had far fewer "buzz words" and required more extensive reasoning and application of basic science knowledge.

As an example, while memorizing a simple list of which hypertensive med works best for a particular condition might be sufficient for COMLEX, the USMLE might be more likely to ask a question about what would happen to the heart rate or pulse pressure if two different BP medications were combined, requiring one to know not only the MOAs of the drugs, but also to be able to apply the knowledge to a physiological situation. I believe an increased focus on questions which require a deeper understanding of mechanisms as opposed to clinical details and "buzzwords" would result in a more solid and adaptable basic science foundation on which to base future clinical decisions.