Failed PE, next step

[IH8ColdWeath3r]

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Hey everyone,

sorry for this long post. I did some searching and read the old posts on the matter. Most were from 2006, 2009, and 2011. I was hoping for specific advice in regard to my situation. took this test several months back, found out a few weeks ago that I failed. I have never failed a patient encounter in medical school, and we had quite a few (>15) my first two years of medical school and an OSCE before I took the real deal which I passed. I have never failed a board exam before until this.

So, I am not exactly sure why I failed? WHICH IS THE SCARIEST THING BECAUSE I AM GOING INTO THIS RETAKE BLIND, NOT KNOWING EXACTLY WHY I FAILED...since there is no rubric. Maybe I documented things that I didn't do? Maybe I wrote my HPI in an order in which deviated or was out of order with the questions that I asked to reach the diagnosis. Maybe I felt the radial pulses on one hand, but documented 2+ bilaterally?

So, did I really screw myself?

I plan on using Kauffman videos (watched them all first time) and reading the PE book in the next 1.5 months. Will also add FA USMLE CS. I have a friend willing to practice with me each day in the upcoming month. Any advice would be greatly appreciated.

PS. I finished every encounter on time. I draped every patient, washed my hands, smiled, asked patient if they had any specific questions, gave every patient a follow up and plan and left with a smile. Perhaps I need more mnemonics to organize this in a more cohesive manner, so that I literally dummy it down even more to make sure I get all the check boxes for each part? Suggestions and insight greatly appreciated.

Thanks everyone. Thank you.

 

[Drrrrrr. Celty]

On the topic, does anyone know why the COMLEX PE's pass rate has essentially gone down by a percent every year for the last 5 years?

 

[NurWollen]

Hey everyone,

sorry for this long post. I did some searching and read the old posts on the matter. Most were from 2006, 2009, and 2011. I was hoping for specific advice in regard to my situation. DO student here, took this test several months back, found out a few weeks ago that I failed. I have never failed a patient encounter in medical school, and we had quite a few (>15) my first two years of medical school and an OSCE before I took the real deal which I passed. I have never failed a board exam before until this. I have taken COMLEX Level I and I and Step I and II and passed both, currently auditioning at ACGME programs for residency.

Prior to this hurdle, I thought that I would have a decent shot at matching ACGME programs. I was planning on foregoing the AOA match. I have received good comments and feedback during my auditions, several attendings commented that I would be a good fit at their program (I'm sure they say this to many people).

Needless to say, this failure has placed a tremendous amount of stress (and doubt) on me. Worse part is, I don't really know WHY I failed this exam. I passed Humanism and Failed the Biomedical/Biomechanical domain. In the biomedical/biomechanical section, I failed "data gathering" but passed OMT & SOAP Note. But, I have no idea how I failed data gathering. I used OPQRST mnemonic and documented past medical, surgical, social, family history, allergies, medications on everyone. I would sometimes deviate from the OPQRST mnemonic when I felt it was warranted, like a psych patient, or a routine follow up, etc. I felt I asked TOO MANY questions and had 6 (requirement 3) differentials, which were pertinent for each patient. Looking back, I misdiagnosed two people, but I am not sure if that was because of my history. I just didn't think it through I guess, but I didn't think this was grounds for failure. So, I am not exactly sure why I failed for data gathering? WHICH IS THE SCARIEST THING BECAUSE I AM GOING INTO THIS RETAKE BLIND, NOT KNOWING EXACTLY WHY I FAILED...since there is no rubric. Maybe I documented things that I didn't do? Maybe I wrote my HPI in an order in which deviated or was out of order with the questions that I asked to reach the diagnosis. Maybe I felt the radial pulses on one hand, but documented 2+ bilaterally?

So, did I really screw myself? Should I cast a wider net and apply to AOA programs now also?

1. In regards to ACGME programs, do I even have to disclose this on ERAS when I submit September 15?
2. If I don't, and it's not on my deans letter, should I disclose if asked on interviews (if I am lucky enough to get any?) - my plan was to disclose if asked, and let them know that I have retaken it and am waiting on my results). I will be retaking as soon as I can in 1.5 months.
3. How should I proceed from here? I'm trying to do the best I can on my auditions and not this affect me but I'd be lying if I said I didn't think about it every night or wake up randomly in the middle of the night thinking what if I fail the retake.
4. Is Passing this exam a requirement to be ranked by a program? Or, is it possible to be ranked and match so long as you pass this prior to graduation (my understanding was this is only needed for graduation)

I plan on using Kauffman videos (watched them all first time) and reading the PE book in the next 1.5 months. Will also add FA USMLE CS. I have a friend willing to practice with me each day in the upcoming month. Any advice would be greatly appreciated.


PS. I finished every encounter on time. I draped every patient, washed my hands, smiled, asked patient if they had any specific questions, gave every patient a follow up and plan and left with a smile. Perhaps I need more mnemonics to organize this in a more cohesive manner, so that I literally dummy it down even more to make sure I get all the check boxes for each part? Suggestions and insight greatly appreciated.

Thanks everyone. Thank you.

Sorry this happened to you. It's a crap shoot I think. I felt awful coming out of mine and but passed somehow. I don't really have enough experience to comment on how it will affect your chances for residency, but I just wanted to say don't let it get you down. It's likely just bad luck and nothing wrong with you or your skills.

 

[hallowmann]

This is a tough one. Is it possible you didn't ask pertinent positives or negatives for a focused ROS? I could see that failing you if you missed most every time. OPQRST doesn't cover it. When you fail for data gathering, usually that means you missed some pertinent info that you should have included, and may even have changed your dx. It could also be that you didn't hit all the areas, lung fields, etc. for the physical exam. Definitely don't document stuff you didn't do though, that's an instant fail if you did it consistently. It sounds like you did everything else right.

The most important thing is retaking and passing ASAP. Find people you know that passed and have them practice with you.

It might also be worth the $50 to ask for a score confirmation/verification, its unlikely anything will come out of it, but you have little to lose even if there's a small chance you won't have to retake.

As far as your questions go:

1) I am under the impression that if you already released your COMLEX/NBOME scores in ERAS, it will show scores only from the date you did that. If you didn't do that yet, then yes, any program you apply to will see it. They will see all reports from the date you officially release (or re-release) your NBOME score report.

What specialty are you applying to? How are your other stats? Regardless, I would not forgo the AOA match, and I'd apply very broadly in general. You can see where you stand on interviews, but still, I think it's risky at this point.

2) Stick with your plan, if they explicitly ask about it, explain it truthfully, if they don't, don't. Retake and make sure you have the results soon. The sooner the better. If you can get a passing score early enough in the cycle and can re-release your score report, you stand a better chance than if this happened later in the cycle.

3) I mean, easier said than done, but try to make this a driving factor on auditions. Show them how ridiculous the PE is, and it is, that they could fail you of all people. Its a good sign if programs really like you, it is tough though to see if this will translate to accepting a failed PE. Just try your best not to let it get to you.

4) Some programs make passing it a requirement to be ranked. Many of the ones I've looked at explicitly mention it. Some don't require it and it might be very specialty specific. That said, you need a pass by the time ROLs are going in, so Jan for NMS and Feb for NRMP. It's more about making it clear you'll graduate on-time, so if the programs matches you, you will be there. If you are taking it in 1.5 mos, you should have the results well before ROL time, so just be sure to update your app once the pass comes in.

This is a stupid exam. 8-9% fail rate is outrageous. Don't let it get to you. It's a money grab by the NBOME, with little real world correlability.

Good luck, don't worry too much. Pass rate for repeat test takers is 98% or something. Just do what you gotta do and put this stupid test behind you.

 

[postbacpremed87]

These kinds of posts worry me. 8-9% fail rate is ridiculous. Don't fail folks - give constructive criticism for their future practice. It's all about f-ing money. This exam didn't even exist for the longest time.

 

[Drrrrrr. Celty]

These kinds of posts worry me. 8-9% fail rate is ridiculous. Don't fail folks - give constructive criticism for their future practice. It's all about f-ing money. This exam didn't even exist for the longest time.

Well hopefully that since the endstep2cs has now two major states voicing against it, JAMA being against it, and the AMA voting apparently to push against it that the PE will likely also disappear soon.
But honestly, the fact that nationally 8% are going to fail in almost a random fashion seems insane. But as I mentioned before, what's more insane is that we went from 96% passing in 2010-11 to 92% passing in 2014-15. This as opposed to every other COMLEX part going up in pass rate by about 2-3%.

 

[235009]

I obviously can't comment on the COMLEX PE since I'm not a DO but chiming in to say that yes, all of your scores will be available at the time your score report is released in eras. The advice above to retake ASAP is good but if you're really doubling down on ACGME programs you may want to consider taking Step 2 CS to bolster your argument that the COMLEX version of the exam is BS. Unfortunately it's a really expensive test and you're going to have to retake the PE anyway to graduate but it's something to consider.

Also keep in mind that "audition rotations" aren't really a thing among ACGME programs. While it's true that doing well on an away rotation may help it has also been well documented that some programs will either give you a courtesy interview with no intention of ranking you or completely snub you. Of course this depends on the what specialty were talking about and how competitive the program is.


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[IslandStyle808]

I obviously can't comment on the COMLEX PE since I'm not a DO but chiming in to say that yes, all of your scores will be available at the time your score report is released in eras. The advice above to retake ASAP is good but if you're really doubling down on ACGME programs you may want to consider taking Step 2 CS to bolster your argument that the COMLEX version of the exam is BS. Unfortunately it's a really expensive test and you're going to have to retake the PE anyway to graduate but it's something to consider.

Also keep in mind that "audition rotations" aren't really a thing among ACGME programs. While it's true that doing well on an away rotation may help it has also been well documented that some programs will either give you a courtesy interview with no intention of ranking you or completely snub you. Of course this depends on the what specialty were talking about and how competitive the program is.


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How common is it for a person to get a good letter of recommendation from a program they auditioned with, but not receive an interview from that same program?

 

[kenjixshadow]

X

 

[gyngyn]

How common is it for a person to get a good letter of recommendation from a program they auditioned with, but not receive an interview from that same program?

This happens frequently at programs where those approving the rotation are disconnected from the PD and Program co-ordinator.

 

[235009]

How common is it for a person to get a good letter of recommendation from a program they auditioned with, but not receive an interview from that same program?

Again it depends on the specialty and the program and to a certain extent how competitive your stats are at that program. In EM however they know that you're doing the away rotation to get a SLOE and away rotations are very common among US MDs as well so programs are more likely to approve people for rotations who they are seriously considering. EM is probably the specialty where "audition" rotations are most common in the ACGME world.

 

[IH8ColdWeath3r]

Thank you to everyone who posted these constructive comments and feedback and to those who personally PM'ed me. I truly appreciate it. I have been really busy with work which is the reason for my late reply.

 

[IH8ColdWeath3r]

So I guess my new strategy moving forward is to write down every single thing that I asked. I thought this would be too time consuming. I pretty much went in the room and wrote down my mnemonics but had a conversation with the patient (which is why I think I passed humanism). I was able to maintain good eye contact because I was not writing everything down frantically. Hopefully this new strategy doesn't harm me in terms of humanism. Treated it like a real clinical encounter.

@hallowmann

I definitely asked all the pertinent positives and negatives. Like I said, I feel I asked toooo much. Again, not specific examples from my exam but to give you an idea, if a patient came in because of, oh, lets say chest pain, not only would I ask them to describe it so that I could put angina/ACS in my differential, I would ask about say food association? (cholelithiasis, GERD), if it moved to their back (dissection, pancreatitis), got worse with inspiration (pleurisy), or improved with a heat pad (musckuloskeletal, costochondritis). Again, this is not an example from the real test but one I made up.

 

[Mosonik]

OP,

I highly recommend you talk with your school's department responsible for OSCE prep and if there is no one at your school with profound knowledge on PE prep, ask them to connect you to someone that does have it. It sounds like because it's specific to a certain region of your Biomedical domain you may have a blindspot on your approach that won't be corrected with just more 'memory packing' prep for your retake. This is a good example of where just studying harder may not be as constructive as asking the advice of your school's faculty whose perspective may be the key get you over that hump. Good luck!

 

[IH8ColdWeath3r]

OP,

I highly recommend you talk with your school's department responsible for OSCE prep and if there is no one at your school with profound knowledge on PE prep, ask them to connect you to someone that does have it. It sounds like because it's specific to a certain region of your Biomedical domain you may have a blindspot on your approach that won't be corrected with just more 'memory packing' prep for your retake. This is a good example of where just studying harder may not be as constructive as asking the advice of your school's faculty whose perspective may be the key get you over that hump. Good luck!

My school conducts a review of all my recorded clinical encounters as a result of my PE failure. They then provide feedback and set up a plan moving forward.

From speaking with the member who does this review and is a physician, he said myself and the other student who failed this exam had no causes for concern on our records. He said of all the people who failed this in the class above me, all but 1 had no red flags. Scary to think about that. But I get what you're saying and I like the idea because I agree that this is a definite "blindspot" as you put it and not something that can be corrected with memory packing.

 

[IH8ColdWeath3r]

Is it even worth it to try to have this prior exam score confirmed (rescore?) at this point while scheduling a retake? It only costs $50 but I am not sure if it is even worth it since it takes 120 days. It would be close to match by then.

 

[Mosonik]

Well... here's the thing. I think the remediation course isn't such a bad idea for multiple reasons. One, the more eyes they can put on your practice runs and more feedback you can get, the better you are. Also as you begin to think about how you frame this retake for future interviews and applications if it comes up, I think its important to show that you were willing to work with the school to "fix" things, otherwise it just comes across as arrogant that you know better and even it doesn't help, its a better position to be in. I don't follow SDN close enough to know your specific program but seeing how every school has its own internal OSCE/PE rubrics, the other possibility is your school's own criteria they score and prepare you based on is lacking something that NBOME thinks is important. If I were in your shoes, I try to track down other rubrics to see what their own assessment of the biomedical domain criteria is. I'd think there are schools out there with a better grasp on what to do, Id use your investigation skills here.

 

[Mosonik]

You obviously can't depend on being the exception on a rescore but if you are willing to add this cost to your bill of retake/traveling again I don't see the harm in it. Im just not sure how fruitful that will be.

 

[hallowmann]

Is it even worth it to try to have this prior exam score confirmed (rescore?) at this point while scheduling a retake? It only costs $50 but I am not sure if it is even worth it since it takes 120 days. It would be close to match by then.

If you're not allowed to reschedule while you wait, forget it, you shouldn't wait that long to retake. It most likely won't amount to anything, but I've heard of it working out for someone.

If you can reschedule and still get it and potentially cancel, then you just have to decide if an extra $50 is worth the very unlikely chance it works out for you. I mean $50 is also like 2 more programs you could apply to, so it's really up to you.

 

[IH8ColdWeath3r]

Is there anyone who has been in my shoes who would care to chime in and give their advice about how to go about a retake?

Should I do something more structured with my school as opposed to just practicing a lot with my friend and reading COMLEX PE book and USMLE STEP 2 CS book in addition to the Kauffman videos.

 

[dfib slim]

Sorry you're going through this bud. Not sure if I'd read any CS material though. Just focus on the PE book and Kauffman videos so you know exactly what the NBOME wants. Is it possible you misdocumented something and got a critical fail? To me, that seems the most plausible for someone failing just the biomechanical domain.

 

[IH8ColdWeath3r]

Sorry you're going through this bud. Not sure if I'd read any CS material though. Just focus on the PE book and Kauffman videos so you know exactly what the NBOME wants. Is it possible you misdocumented something and got a critical fail? To me, that seems the most plausible for someone failing just the biomechanical domain.

Thanks for the comments. Yes, after long reflection, I am starting to think that this is what most likely happened. I think I just tried to do much, asked too many questions, my exams varied greatly from person to person (heart & lungs on each patient). I think I just need to simplify and write down everything that I do next time.

 

[IH8ColdWeath3r]

Faculty from my school have informed me that this will go on my dean's letter. I was given advice by them to include it in my personal statement.

sorry for resurrecting the post, this has continued to weigh heavily on me.

 

[Croft305]

One the topic of the CS and PE exams
https://www.washingtonpost.com/loca...b64a56-2357-11e6-aa84-42391ba52c91_story.html

 

[melramah]

Hello Everyone. I failed Comlex 2 PE. retaking it in Sept.
COMLEX I >650
COMLEX II > 570
USMLE 1 > 250
USMLE 2 pending.
I was hoping to match in an ACGME Radiology program, is this unrealistic now because of the PE?

 

[IH8ColdWeath3r]

Could anyone provide specific advice on how to go about addressing this or whether it should be addressed in my PS seeing as now I know it will be on my deans letter?

Some have told me not to draw attention to it in my PS, saying that it could hurt me. Other have said to address it and own up to it. I am quite conflicted as to what to do and would really appreciate the advice.

Again, I don't know exactly why I failed. I have been told not to write that in my PS, because it will be perceived as me making excuses. Paraphrasing here, but I was going to say something along the lines of, " I have failed the PE exam. Truthfully, I don't know exactly why I failed, seeing as a graded rubric is not provided on the failure. But, I accept full responsibility for this and have worked closely with my school to ensure success on my repeat examination."

Thoughts would be GREATLY appreciated.

 

[NurWollen]

Could anyone provide specific advice on how to go about addressing this or whether it should be addressed in my PS seeing as now I know it will be on my deans letter?

Some have told me not to draw attention to it in my PS, saying that it could hurt me. Other have said to address it and own up to it. I am quite conflicted as to what to do and would really appreciate the advice.

Again, I don't know exactly why I failed. I have been told not to write that in my PS, because it will be perceived as me making excuses. Paraphrasing here, but I was going to say something along the lines of, " I have failed the PE exam. Truthfully, I don't know exactly why I failed, seeing as a graded rubric is not provided on the failure. But, I accept full responsibility for this and have worked closely with my school to ensure success on my repeat examination."

Thoughts would be GREATLY appreciated.

You could always reach out anonymously to program directors and ask them whether they like to see faulted addressed in personal statements or not.

 

[hallowmann]

You could always reach out anonymously to program directors and ask them whether they like to see faulted addressed in personal statements or not.

There's also PDs on SDN like @aProgDirector and @IMPD that may provide some insight in terms of mentioning a fail in COMLEX PE in the personal statement.

That said, contacting the specific programs you're interested in might be best.

 

[IH8ColdWeath3r]

There's also PDs on SDN like @aProgDirector and @IMPD that may provide some insight in terms of mentioning a fail in COMLEX PE in the personal statement.

That said, contacting the specific programs you're interested in might be best.

Would love to hear from them, as ERAS opens up very soon. I may start emailing a few programs directors myself. If I do, I would be happy to provide their responses for others who are in the same position as me.

 

[NotAProgDirector]

There isn't a right answer here.

If you release your COMLEX transcript to allo programs, they will see the fail. You can't choose which exams to release -- it's all or nothing. If you applied to Osteo programs prior to the fail being reported and released your transcript, then they will not see the fail unless you re-release your transcript. Unfortunately, I believe that re-releasing isn't program specific -- if you choose to update your transcript it is sent to all programs. Some programs may ask you to update before ranking, and you'll need to decide what to do.

But from your later posts, it looks like it will be included in your MSPE anyway, so it may not matter.

Should you talk about it in your PS? There isn't a right answer. "Probably yes" would be my answer. There are three types of programs:

1. There are some programs that won't consider you because you failed PE. In those cases, nothing you do will make any difference.
2. There are programs that don't care. For these programs, they will ignore it and focus on the rest of your application. Again, what you do will make no difference.
3. The last group are programs that might interview despite the fail. If you don't say anything about it, then they won't know what your plans are / are you taking this seriously / etc. They will probably want to see that you're addressing it.

So, I think your best bet is to address it somewhere in your application, and that means your PS. You could explain why you think you failed, or perhaps better simply focus on what you're doing to pass the next time. Feel free to keep is short.

 

[IH8ColdWeath3r]

There isn't a right answer here.

If you release your COMLEX transcript to allo programs, they will see the fail. You can't choose which exams to release -- it's all or nothing. If you applied to Osteo programs prior to the fail being reported and released your transcript, then they will not see the fail unless you re-release your transcript. Unfortunately, I believe that re-releasing isn't program specific -- if you choose to update your transcript it is sent to all programs. Some programs may ask you to update before ranking, and you'll need to decide what to do.

But from your later posts, it looks like it will be included in your MSPE anyway, so it may not matter.

Should you talk about it in your PS? There isn't a right answer. "Probably yes" would be my answer. There are three types of programs:

1. There are some programs that won't consider you because you failed PE. In those cases, nothing you do will make any difference.
2. There are programs that don't care. For these programs, they will ignore it and focus on the rest of your application. Again, what you do will make no difference.
3. The last group are programs that might interview despite the fail. If you don't say anything about it, then they won't know what your plans are / are you taking this seriously / etc. They will probably want to see that you're addressing it.

So, I think your best bet is to address it somewhere in your application, and that means your PS. You could explain why you think you failed, or perhaps better simply focus on what you're doing to pass the next time. Feel free to keep is short.

Thank you very much for the specific advice. I was planning on addressing it. Honestly, I have no idea why I failed as they do not provide a rubric as to why a student fails.

I am stuck with how to address it. If I say something like I have no idea how I failed, it will seem as though I am making excuses (which is the last thing I want to do).

The reality of the situation is, I have no idea why I failed but I did. I have accepted this and I am working diligently individually and with my school. We have developed a remediation program that allows me to retake the exam. I will pass it and receive my score before match. That is how I was hoping to address it. If you have any input/insight about that, I would greatly appreciate it.

 

[IH8ColdWeath3r]

Thanks to everyone who commented on this thread.

Some updates for those who may be in my shoes now or in the future. I called the NBOME and they told me that they could not disclose anything about my exam experience or why I failed because it would ruin the integrity of the exam. They said that if I specifically wanted to know why I failed, that I should contact the dean of my school and that they would be able to provide me with some answers. I asked my dean and he had no idea why I failed and even said that he has contacted the NBOME several times and received the same response. Really frustrating failing this exam and not knowing WHY you failed, especially when it feels like your life depends on it.

I am specifically addressing it in my personal statement. I will be taking full responsibility to for it and also mentioning what I am doing in order to ensure that I have a successful retake. I hope that programs can look past this. My advice to future students...take this exam during third year during Winter break if it is allowed by your school. That way, you will have it passed when Match rolls around and you wont be left waiting.

Because a lot of programs will not interview you if you have not passed the exam. Most interviews occur in November and December and thus, you will be screened or not given an interview by a lot of programs if you have a December date that you get your score back.

Lastly, I was informed that if I fail this again, I will be dismissed from medical school. I don't say that to place any extra burden on those who are taking the exam. However, I just say that so people are aware that some schools take this failure very seriously such that 2 failures gets you kicked out of medical school. Not sure why, since you are allowed to take it 6 times. I hope nobody ever has to go through this or the application process with a failure on this exam hanging over their head. Best of luck to everyone.

 

[felix2929]

Because a lot of programs will not interview you if you have not passed the exam.

I haven't heard this before. I've heard places won't rank you without a passing score. I'm just wondering. My school didn't allow us to take it until after third year so unfortunately that wouldn't be an option there.

 

[67552931811]

Thanks to everyone who commented on this thread.

Some updates for those who may be in my shoes now or in the future. I called the NBOME and they told me that they could not disclose anything about my exam experience or why I failed because it would ruin the integrity of the exam. They said that if I specifically wanted to know why I failed, that I should contact the dean of my school and that they would be able to provide me with some answers. I asked my dean and he had no idea why I failed.

I am specifically addressing it in my personal statement. I will be taking full responsibility to for it and also mentioning what I am doing in order to ensure that I have a successful retake. I hope that programs can look past this. My advice to future students...take this exam during third year during Winter break if it is allowed by your school. That way, you will have it passed when Match rolls around and you wont be left waiting.

Because a lot of programs will not interview you if you have not passed the exam. Most interviews occur in November and December and thus, you will be screened or not given an interview by a lot of programs if you have a December date that you get your score back.

Lastly, I was informed that if I fail this again, I will be dismissed from medical school. I don't say that to place any extra burden on those who are taking the exam. However, I just say that so people are aware that some schools take this failure very seriously such that 2 failures gets you kicked out of medical school. Not sure why, since you are allowed to take it 6 times. I hope nobody ever has to go through this or the application process with a failure on this exam hanging over their head. Best of luck to everyone.

That's such bull****. I'm so sorry man. Good luck to you on round 2. Kill it, brother!

 

[padfoot777]

I haven't heard this before. I've heard places won't rank you without a passing score. I'm just wondering. My school didn't allow us to take it until after third year so unfortunately that wouldn't be an option there.

I was also informed that programs would not rank you without a passing score, but it should not be an issue for interviews- I spoke to an advisor at my school regarding this issue.

 

[EMpty2017]

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