Must repeat fourth year due to "below expectations" on clinical evals

[Goro]

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HELP: Suspended from clinical rotations pending psych eval

Hi SDN community, I am a fourth year medical student at an osteopathic medical school in USA who is in need of some urgent help. Yesterday, I got temporarily suspended from clinical rotations pending a psychology/psychiatric assessment. BG story: I am an average student in school (no failures...

forums.studentdoctor.net

This is not making the picture better OP. I think your goose may be cooked.

Ahh. As I mentioned earlier, there are always two sides to every story.

So as public service, whenever SDNers see these types of posts, beware of the tip of the iceberg phenomenon.

 

[Mass Effect]

I didn't realize the OP was the same OP as in the thread from July.

OP, did you have the psych eval they wanted you to get? If so, was your school satisfied with the results? It seems you're struggling and you're not quite sure why so you're assuming it's because of this or that. I get it, it's hard to confront performance issues in this field. Believe me, I know. The good news is, you're smart and you know the material. There is something that's getting in your way and I don't think you're the best judge of what that is. But I don't think this is unachievable. I think you need to sit down with someone you trust and be truly, brutally honest, ego be damned and confront what's happening in clinicals and why you're not succeeding as your scores would indicate you can. Until you do this, it's going to be difficult to win an appeal or do much better next year, even if you decided to repeat the year.

 

[mathnerd88]

im curious. Have you done the PE yet? What you are saying is the goal but the truth is that’s not the reality. It’s a complete ambiguous exam where they fail people who, evidence by school OSCE videos, shouldn’t have failed and those who can’t carry a conversation in a bucket pass. The exam is hugely flawed.

I took the PE and already passed a month ago why?

My school had a 99% pass rate last year for first time test takers for the PE. I haven’t heard anyone fail from my class yet. Again, I feel like other posts on here are anecdotal and one sided and not really giving the whole picture here. My school honestly trains you hard for the PE. We have mandatory practice ones that we have to pass before we actually take the PE, which is why our class usually takes it later in our fourth year rather than most other schools who can take it in the middle of third year.

I also believe that it is pretty easy to fail the PE if you haven’t practiced for it. 14 min patient encounters and 9 minute SOAP notes isn’t really enough time.

If what you’re saying is true and the scoring is truly random then my school should have lower pass rates and not 99% no? I can guarantee you the ones who didn’t pass the PE from my school have had a history of failing OSCEs and failing the mandatory school practice ones.

 

[Sleepingdoc]

HI SDN, I need some guidance what to do based on a decision my school made telling me to repeat fourth year due to some "below expectations" I received on clinical evaluations. I received a recent "below expectations" on a family medicine sub internship; my preceptor commented how I "struggled to discuss assessments and plans with the resident team, have communication issues, and lacked confidence in presentations". I believe this is because this is only the second month I have ever done in ward-based rotations; I did not have any practise in third year discussing assessments and plans, or any experience with bedside presentations and became nervous the first time doing this in front of a healthcare team consisting of over ten people. I do not believe it is medical knowledge I am lacking: I have a USMLE Step1 of 228, Step2 220, COMLEX Level1 556, COMLEX Level2 535, passed all my NBOME shelves with honours in psychiatry, have no written exam or clinical rotation failures, average student academically in reputable DO school. However, I did have to remediate my COMLEX Level2PE (failed biomechanical domain due to running out of time for more than half the cases; will get score back Dec3). I have 3 strong LORs.
In third year rotations, I received "exceed expectations" on 3 rotations: pediatrics, gen surg and FM. "Below expectations" on 2 rotations: orthopaedic surgery, IM sub-specialty (with borderline meets expectations in PM&R).
In fourth year rotations, I received "below expectations" in EM and this past FM SubI. Meets expectations in IM SubI and exceeds expectations in current IM rotation.
The rotations at my current clinical site as well as most rotations through my school are preceptor-based (like shadowing) so I believe another year with these rotations will not directly help me "function as an intern" by improving my discussion of assessments&plans. I do not even have access to the EMRs. Plus, I am in significant financial challenges and do not know how I can afford another $50K tuition. I applied to FM residencies this year and have almost 10 interviews scheduled. I am scared being held back a year will significantly hinder my chances of matching next year.
I am allowed to appeal this decision my school made this week... I need some advice/suggestions/support/anything since my school is not able to provide me with any after asking repeatedly for help. How can I write a convincing appeals letter saying what I can do this year to be ready for intern year? What should I do personally do be ready to function autonomously as an intern? I do not have any more ward-based rotations planned for the rest of the year (it is very challenging to find any at my clinical rotation site). Should I just not appeal and accept my school's decision to repeat fourth year (after your review of my performance)?
Thank you so much for your time. I would greatly appreciate any feedback at all during this difficult time.

Talk to your school.. if you passed the shelf, I doubt you would need to redo 4th year. Some attendings can be A$* as far as evals are concerned. Some of them are tough. Comlex PE needs to be just remediated if you only failed once.

 

[Goro]

Talk to your school.. if you passed the shelf, I doubt you would need to redo 4th year. Some attendings can be A$* as far as evals are concerned. Some of them are tough. Comlex PE needs to be just remediated if you only failed once.

This is more than just about passing Boards, or any other exam.

However, I have had 4 preceptors in my third year of medical school indicating they were "concerned about me being a physician" in my clinical evaluations.

 

[PathDoctor]

Because all the patient actors obviously only live in the zip code the testing centers are in... Seriously I agree that was a ridiculous post that you quoted

The OP has never mentioned their demographics as far as I know. It can be quite relevant to grading.
Sorry but your head is in the clouds if you think SPs do not have biases.
SP biases has been well studied.
"Analyses of SPs' assessments of students' empathy indicated significant interaction effects of gender and ethnicity. Female students, regardless of ethnicity, obtained significantly higher mean JSPPPE scores than men. Female black/African American, female white, and female Asian/Pacific Islander students scored significantly higher on the JSPPPE than their respective male counterparts. Male black/African American students obtained the lowest SP assessment scores of empathy regardless of SP ethnicity."

Standardized patient assessment of medical student empathy: ethnicity and gender effects in a multi-institutional study - PubMed

The significant interaction effects of ethnicity and gender in clinical encounters, plus the inconsistencies observed between SPs' assessments of students' empathy and students' self-reported empathy, raise questions about possible ethnicity and gender biases in the SPs' assessments of medical...

www.ncbi.nlm.nih.gov

Biases, such as gender and culture, have been found to have affected examiners’ judgements, as has examiners’ familiarity with the examinees. A recent study on an OSCE used in an Exercise Physiology program found that the examiners accounted for 24.1% of the variance in technical skills scores, whereas students accounted only for 4.9% of the variance. A comprehensive meta-analysis estimated that OSCEs achieve an overall low reliability (<.60) and suggested that an OSCE ‘does not guarantee reliable scores and accurate decisions about medical students’. This substantial evidence suggests that examiners’ biases are unavoidable when OSCEs are employed. Although not explicit in the literature, the biases discussed are more likely to affect students performing at the borderline level than when their performance is a clear pass or clear fail.

Borderline grades in high stakes clinical examinations: resolving examiner uncertainty - BMC Medical Education

Background Objective Structured Clinical Exams are used to increase reliability and validity, yet they only achieve a modest level of reliability. This low reliability is due in part to examiner variance which is greater than the variance of students. This variance often represents...

bmcmededuc.biomedcentral.com

If the NBOME has NOTHING TO HIDE, then why do they never release any data on the grading of different demographic groups? What secret innovations have they employed to successfully eliminate grading bias?

 

[Chibucks15]

The OP has never mentioned their demographics as far as I know. It can be quite relevant to grading.
Sorry but your head is in the clouds if you think SPs do not have biases.
SP biases has been well studied.
"Analyses of SPs' assessments of students' empathy indicated significant interaction effects of gender and ethnicity. Female students, regardless of ethnicity, obtained significantly higher mean JSPPPE scores than men. Female black/African American, female white, and female Asian/Pacific Islander students scored significantly higher on the JSPPPE than their respective male counterparts. Male black/African American students obtained the lowest SP assessment scores of empathy regardless of SP ethnicity."

Standardized patient assessment of medical student empathy: ethnicity and gender effects in a multi-institutional study - PubMed

The significant interaction effects of ethnicity and gender in clinical encounters, plus the inconsistencies observed between SPs' assessments of students' empathy and students' self-reported empathy, raise questions about possible ethnicity and gender biases in the SPs' assessments of medical...

www.ncbi.nlm.nih.gov

Biases, such as gender and culture, have been found to have affected examiners’ judgements, as has examiners’ familiarity with the examinees. A recent study on an OSCE used in an Exercise Physiology program found that the examiners accounted for 24.1% of the variance in technical skills scores, whereas students accounted only for 4.9% of the variance. A comprehensive meta-analysis estimated that OSCEs achieve an overall low reliability (<.60) and suggested that an OSCE ‘does not guarantee reliable scores and accurate decisions about medical students’. This substantial evidence suggests that examiners’ biases are unavoidable when OSCEs are employed. Although not explicit in the literature, the biases discussed are more likely to affect students performing at the borderline level than when their performance is a clear pass or clear fail.

Borderline grades in high stakes clinical examinations: resolving examiner uncertainty - BMC Medical Education

Background Objective Structured Clinical Exams are used to increase reliability and validity, yet they only achieve a modest level of reliability. This low reliability is due in part to examiner variance which is greater than the variance of students. This variance often represents...

bmcmededuc.biomedcentral.com

If the NBOME has NOTHING TO HIDE, then why do they never release any data on the grading of different demographic groups? What secret innovations have they employed to successfully eliminate grading bias?

The conspiracy loves on!!!!! Or you know it’s almost impossible to control innate human actions and you don’t get to choose which patients you get later on...

 

[PathDoctor]

In fact, "below expectations" evaluations are affected by biases.
Are Clerkship Clinical Grades Fair? (or, “I Want That Male Intern To Evaluate Me.”)
"Grading: The authors investigated the influence of student and evaluator demographics on the summary clinical grades given to 155 clerkship students at one medical school. The possible grades were “exceptional”, “above expectations”, “meets expectations”, and “below expectations”. Newcomers to student evaluation may be startled by the strong “Lake Woebegone” effect: only 16 of 4,462 evaluations were “below expectations” and only 12-23%, depending on the clerkship, were “meets expectations”. It is not surprising, but of concern, that variables outside of the students’ control appeared to have a moderate to large effect on the clinical grade assigned. The authors focus on the gender effects: Male students were graded lower than female students, but only when being evaluated by female residents or attendings. Male evaluators , but not female evaluators, became much more stringent graders with increasing age. However, another variable had an even larger effect on grade. Observation times of >1 day were associated with a much higher rate of “exceptional” ratings. Gender effects on evaluations, including evaluations by standardized patients, have been seen in the prior studies."

Are Clerkship Clinical Grades Fair? (or, “I Want That Male Intern To Evaluate Me.”)

Grading: The authors investigated the influence of student and evaluator demographics on the summary clinical grades given to 155 clerkship students at one medical school. The possible grades were…

drmerl.wordpress.com

 

[PathDoctor]

The conspiracy loves on!!!!! Or you know it’s almost impossible to control innate human actions and you don’t get to choose which patients you get later on...

Nonsense. Do you really think SPs do not have any conscious or unconscious biases? Biases are a hot topic in med ed.
Clear example from above "Male black/African American students obtained the lowest SP assessment scores of empathy regardless of SP ethnicity."
Do you seriously believe that this is not a blatant example of bias?

Here's more evidence that there is bias in medical training. This time it's a trio of studies from JAMA Internal Medicine. If you still don't believe that any bias exists then perhaps you are biased against reality.

Three New Studies Suggest Gender And Racial Bias In Medical Training

How does this affect you...because it does.

www.forbes.com

See also:
"I’m glad to be part of an institution is taking this seriously.
For reference, clerkship grades and AOA is determined primarily or largely by instructor recommendations, and NOT primarily by objective indicators of performance.
Deeply concerned by recent national reports demonstrating racial differences in Alpha Omega Alpha nomination and clinical grading, we have begun to look at our own data at Washington University School of Medicine. Our preliminary results demonstrate similar racial differences with white students being more likely to receive honors grades in the clinical clerkships and more likely to be nominated for Alpha Omega Alpha than students of color. At AAMC this week, we heard similar reports from several peer institutions. We have discussed this with the chairs of the departments and the clerkship directors. We will be communicating this to the students today as well. We are working with the department chairs to make presentations on the data to individual departments. There is still more investigation to be done, but as a school, we are deeply committed to understanding why this is, how to address these disparities now, and how to prevent them in the future."

Racial Bias in Grading Medical School Clerkships

I’m glad to be part of an institution is taking this seriously. For reference, clerkship grades and AOA is determined primarily or largely by instructor recommendations, and NOT primarily by objective indicators of performance. Deeply concerned by recent national reports demonstrating racial...

discourse.peacefulscience.org

 

[IMGASMD]

Nonsense. Do you really think SPs do not have any conscious or unconscious biases? Biases are a hot topic in med ed.
Clear example from above "Male black/African American students obtained the lowest SP assessment scores of empathy regardless of SP ethnicity."
Do you seriously believe that this is not a blatant example of bias?

Here's more evidence that there is bias in medical training. This time it's a trio of studies from JAMA Internal Medicine. If you still don't believe that any bias exists then perhaps you are biased against reality.

Three New Studies Suggest Gender And Racial Bias In Medical Training

How does this affect you...because it does.

www.forbes.com

See also:
"I’m glad to be part of an institution is taking this seriously.
For reference, clerkship grades and AOA is determined primarily or largely by instructor recommendations, and NOT primarily by objective indicators of performance.
Deeply concerned by recent national reports demonstrating racial differences in Alpha Omega Alpha nomination and clinical grading, we have begun to look at our own data at Washington University School of Medicine. Our preliminary results demonstrate similar racial differences with white students being more likely to receive honors grades in the clinical clerkships and more likely to be nominated for Alpha Omega Alpha than students of color. At AAMC this week, we heard similar reports from several peer institutions. We have discussed this with the chairs of the departments and the clerkship directors. We will be communicating this to the students today as well. We are working with the department chairs to make presentations on the data to individual departments. There is still more investigation to be done, but as a school, we are deeply committed to understanding why this is, how to address these disparities now, and how to prevent them in the future."

Racial Bias in Grading Medical School Clerkships

I’m glad to be part of an institution is taking this seriously. For reference, clerkship grades and AOA is determined primarily or largely by instructor recommendations, and NOT primarily by objective indicators of performance. Deeply concerned by recent national reports demonstrating racial...

discourse.peacefulscience.org

Whether there is bias or not, it’s part of the reality. Is the OP in the position to change anything?

Clinical practice is more than just a cerebral endeavor, there is a lot of social components. When the OP has more than 1 warnings regarding clinical rotations, there is a bigger issue than bias.

EQ is just as important as IQ when you’re in the business of taking care of human beings.

I wish you luck OP. Perhaps thinking of a speciality with less patient interactions and let your school know that’s your intention.... (if true) maybe then you can get yourself out of this?

 

[Goro]

The OP has never mentioned their demographics as far as I know. It can be quite relevant to grading.
Sorry but your head is in the clouds if you think SPs do not have biases.
SP biases has been well studied.
"Analyses of SPs' assessments of students' empathy indicated significant interaction effects of gender and ethnicity. Female students, regardless of ethnicity, obtained significantly higher mean JSPPPE scores than men. Female black/African American, female white, and female Asian/Pacific Islander students scored significantly higher on the JSPPPE than their respective male counterparts. Male black/African American students obtained the lowest SP assessment scores of empathy regardless of SP ethnicity."

Standardized patient assessment of medical student empathy: ethnicity and gender effects in a multi-institutional study - PubMed

The significant interaction effects of ethnicity and gender in clinical encounters, plus the inconsistencies observed between SPs' assessments of students' empathy and students' self-reported empathy, raise questions about possible ethnicity and gender biases in the SPs' assessments of medical...

www.ncbi.nlm.nih.gov

Biases, such as gender and culture, have been found to have affected examiners’ judgements, as has examiners’ familiarity with the examinees. A recent study on an OSCE used in an Exercise Physiology program found that the examiners accounted for 24.1% of the variance in technical skills scores, whereas students accounted only for 4.9% of the variance. A comprehensive meta-analysis estimated that OSCEs achieve an overall low reliability (<.60) and suggested that an OSCE ‘does not guarantee reliable scores and accurate decisions about medical students’. This substantial evidence suggests that examiners’ biases are unavoidable when OSCEs are employed. Although not explicit in the literature, the biases discussed are more likely to affect students performing at the borderline level than when their performance is a clear pass or clear fail.

Borderline grades in high stakes clinical examinations: resolving examiner uncertainty - BMC Medical Education

Background Objective Structured Clinical Exams are used to increase reliability and validity, yet they only achieve a modest level of reliability. This low reliability is due in part to examiner variance which is greater than the variance of students. This variance often represents...

bmcmededuc.biomedcentral.com

If the NBOME has NOTHING TO HIDE, then why do they never release any data on the grading of different demographic groups? What secret innovations have they employed to successfully eliminate grading bias?

Enough with the thread hijacking already. You're not helping OP

 

[NITRAS]

Name and shame

Are yall trying to get the OP kicked out? It will not be hard for anyone at his school to figure out who the OP is, and badmouthing his school is a sure way to anger the people he needs to help him. The OP clearly has deficiencies.

And they will ALL say you have to do it THEIR way because that's OBVIOUSLY the ONLY way...

I put expectations on medical students. I want them to present the way I think will help them learn he best. I know its different than pretty much every other attending they have. Tough. I give some leeway. But medical students are by and large pretty smart people that should be able to adapt pretty reasonably well.

 

[PathDoctor]

Enough with the thread hijacking already. You're not helping OP

Nonsense. You are not helping the OP at all imo. I fully suppport the OPs efforts to be allowed to go on the 10 residency interviews and match into residency. Some other commentors of this thread are critical of the OP and using a "blame the victim" mentality. A student who has not failed any courses should not be compelled to repeat 4th year. In addition, we do not make students repeat 4th year due to one COMLEX 2 PE failure. I have advised the student to seek representation and discussing possible biases that may or may not be involved in this case. Nothing scares schools like a Title IX lawsuit.

 

[Neopolymath]

Are yall trying to get the OP kicked out? It will not be hard for anyone at his school to figure out who the OP is, and badmouthing his school is a sure way to anger the people he needs to help him. The OP clearly has deficiencies.



I put expectations on medical students. I want them to present the way I think will help them learn he best. I know its different than pretty much every other attending they have. Tough. I give some leeway. But medical students are by and large pretty smart people that should be able to adapt pretty reasonably well.

When they are not beholden to the school...

 

[Chibucks15]

Nonsense. You are not helping the OP at all imo. I fully suppport the OPs efforts to be allowed to go on the 10 residency interviews and match into residency. Some other commentors of this thread are critical of the OP and using a "blame the victim" mentality. A student who has not failed any courses should not be compelled to repeat 4th year. In addition, we do not make students repeat 4th year due to one COMLEX 2 PE failure. I have advised the student to seek representation and discussing possible biases that may or may not be involved in this case. Nothing scares schools like a Title IX lawsuit.

There’s no way in hell that lawsuit has any legs to stand on.

instead of complaining about the terrible bias., propose a solution. Pretty damn hard when you can’t even do that with your patients. it’s crappy, but that’s how the situation is. If you find a solution I’m all for it. Complaining for the sake of complaining is king on here

“Sorry Jim I cant treat your heart disease because I can tell you’re internally biased against me and I don’t feel that it’s fair” good luck in court with that one bud

 

[Goro]

Nonsense. You are not helping the OP at all imo. I fully suppport the OPs efforts to be allowed to go on the 10 residency interviews and match into residency. Some other commentors of this thread are critical of the OP and using a "blame the victim" mentality. A student who has not failed any courses should not be compelled to repeat 4th year. In addition, we do not make students repeat 4th year due to one COMLEX 2 PE failure. I have advised the student to seek representation and discussing possible biases that may or may not be involved in this case. Nothing scares schools like a Title IX lawsuit.

Unfortunately, the OP's faculty see things differently. That's the issue. Railing about bias is thread hijacking. Save that for the SPF.

 

[PathDoctor]

Unfortunately, the OP's faculty see things differently. That's the issue. Railing about bias is thread hijacking. Save that for the SPF.

No. I think that any post that you do not like causes you to look for reasons to label the post as "thread hijacking".
Bias is certainly possible in OP's case.

 

[Chibucks15]

No. I think that any post that you do not like causes you to look for reasons to label the post as "thread hijacking".
Bias is certainly possible in OP's case.

I strongly doubt implicit bias leads to 4 'below expectations' and a school mandated psych eval from other posts so....

 

[ciestar]

Nonsense. You are not helping the OP at all imo. I fully suppport the OPs efforts to be allowed to go on the 10 residency interviews and match into residency. Some other commentors of this thread are critical of the OP and using a "blame the victim" mentality. A student who has not failed any courses should not be compelled to repeat 4th year. In addition, we do not make students repeat 4th year due to one COMLEX 2 PE failure. I have advised the student to seek representation and discussing possible biases that may or may not be involved in this case. Nothing scares schools like a Title IX lawsuit.

I find this interesting because below expectations at my school will fail you.

 

[samac]

Y’all keep saying they didn’t fail so they could graduate but is below expectations a failing grade for their school? Our fail is anything below a 70 and below expectations is under the fail line. I’m just throwing that out there since OP fell off the face of the earth.

All the bad Evals are definitely concerning. Everywhere I’ve been if you have a pulse and you’re not a total ass you’ll at least pass.

 

[BorntobeDO?]

OP is gonna be losing money either way now.

I find this interesting because below expectations at my school will fail you.

Ditto at my program. I always tell my preceptors about this before the end of rotation cause I am not really certain what the school tells them. However even if I didn't I am pretty sure most physician's will not check the below expectations without a real reason. I could see it happening once with a surgeon or something, but not 4 times.

 

[Mass Effect]

Nonsense. You are not helping the OP at all imo. I fully suppport the OPs efforts to be allowed to go on the 10 residency interviews and match into residency. Some other commentors of this thread are critical of the OP and using a "blame the victim" mentality. A student who has not failed any courses should not be compelled to repeat 4th year. In addition, we do not make students repeat 4th year due to one COMLEX 2 PE failure. I have advised the student to seek representation and discussing possible biases that may or may not be involved in this case. Nothing scares schools like a Title IX lawsuit.

Four separate attendings from four different services during MS 3 said they had concerns about the OP being a doctor. Are you suggesting all were racially motivated in addition to the SPs on COMLEX PE? Please stop. This is a real life human being who is going through a horrible crisis and you're grandstanding with nonsense.

 

[PathDoctor]

The lack of compassion shown here by current and future physicians is stunning. I bet a lot of you would perform "below expectations" if you spent your third year doing basic shadowing like the OP has described. If you were not allowed to access medical records or write notes, then you might be behind the curve and perform "below expectations" too. Not everyone who is behind can catch up overnight.
The OP received "exceeds expectations" evaluations in multiple rotations (peds, general surgery, FM) in the third year and "exceeds expectations" in current 4th year IM rotation. I see no logic in taking a student who has 10 interviews and latest eval of "exceeds expectations" and making that student repeat an entire year, crippling their future prospects.

 

[BorntobeDO?]

The lack of compassion shown here by current and future physicians is stunning. I bet a lot of you would perform "below expectations" if you spent your third year doing basic shadowing like the OP has described. If you were not allowed to access medical records or write notes, then you might be behind the curve and perform "below expectations" too. Not everyone who is behind can catch up overnight.

Mercy, did you read the second thread also? This was more then not being able to give a presentation. The OP implied that she was unable to work with male physicians due to past 'minor' trauma. This was at least the second time she has been before the committee, and she had 4 different preceptors tell her they were concerned about her becoming a physician before she went to an audition rotation where they also had concerns.

OP is crashing and burning everywhere. You can see my first post, I am very pro-student in these situations but something is really wrong with OP and isn't being addressed by him or her. You may argue that the school should do more and I agree, but it sounds like repeating 4th year rather than tossing her out is the school trying to do more. I actually think the OP is getting a favor at this point and if I am being honest, my program would have tossed him/her long before they got to 4 below expectations much less the 5+ the OP has now. I know at my program they have done it at 2 in the past.

 

[PathDoctor]

Mercy, did you read the second thread also? This was more then not being able to give a presentation. The OP implied that she was unable to work with male physicians due to past 'minor' trauma. This was at least the second time she has been before the committee, and she had 4 different preceptors tell her they were concerned about her becoming a physician before she went to an audition rotation where they also had concerns.

OP is crashing and burning everywhere. You can see my first post, I am very pro-student in these situations but something is really wrong with OP and isn't being addressed by him or her. You may argue that the school should do more and I agree, but it sounds like repeating 4th year rather than tossing her out is the school trying to do more. I actually think the OP is getting a favor at this point and if I am being honest, my program would have tossed him/her long before they got to 4 below expectations. I know they have done it at 2 in the past.

The OP will have at least 3 years of intense residency training to improve her skills. The OPs Level 2 PE failure is also not a fair measure. I would say that many good students can fail the PE exam because it is a poor measure. NPs go right out into practice (totally unsupervised in 22 states) without any residency training and without any PE or clinical skills examination. So I find all the crowing by the NBOME that the PE exam ensures patient safety to be suspect (the NBOME says nothing about NPs practicing without a PE exam). If the school has 3rd year rotations that involve shadowing, they have no credibility to pretend they are blameless.

 

[Chibucks15]

The OP will have at least 3 years of intense residency training to improve her skills. The OPs Level 2 PE failure is also not a fair measure. I would say that many good students can fail the PE exam because it is a poor measure. NPs go right out into practice (totally unsupervised in 22 states) without any residency training and without any PE or clinical skills examination. So I find all the crowing by the NBOME that the PE exam ensures patient safety to be suspect (the NBOME says nothing about NPs practicing without a PE exam). If the school has 3rd year rotations that involve shadowing, they have no credibility to pretend they are blameless.

You completely ignored the premise of the above post. This isn’t just about “improving skills”. There Are many more screaming red flags in this situation. If attendings (multiple of them) go out of the way to say they aren’t sure you can be a physician, that’s a big issue...

And nobody is putting blame only on the student here. Also bringing the NPs in is a nice SDN touch. What are you getting at? All of us hate the PE but it’s a necessary evil because that’s what is required for board certification

 

[Mass Effect]

The OP will have at least 3 years of intense residency training to improve her skills. The OPs Level 2 PE failure is also not a fair measure. I would say that many good students can fail the PE exam because it is a poor measure. NPs go right out into practice (totally unsupervised in 22 states) without any residency training and without any PE or clinical skills examination. So I find all the crowing by the NBOME that the PE exam ensures patient safety to be suspect (the NBOME says nothing about NPs practicing without a PE exam). If the school has 3rd year rotations that involve shadowing, they have no credibility to pretend they are blameless.

The day that NPs set the bar on what is acceptable evaluation of skills is the day that DOs lose all credibility in the medical community.

 

[PathDoctor]

The day that NPs set the bar on what is acceptable evaluation of skills is the day that DOs lose all credibility in the medical community.

NBOME’S DR. GRETTA GROSS DISCUSSES COMLEX-USA LEVEL 2 PE EXAM

February 26, 2019

First and second year doctor of osteopathic medicine (DO) students were recently given an overview of COMLEX-USA Level 2 PE (performance evaluation) testing from Gretta Gross, DO ‘97, MEd, vice president for clinical skills testing for the National Board of Osteopathic Medical Examiners (NBOME). Dr. Gross, a graduate of Philadelphia College of Osteopathic Medicine (PCOM), discussed the mission of the NBOME and ways to prepare for this exam which assesses the fundamental clinical skills necessary to enter into supervised graduate medical education.

Dr. Gross explained that the exam, which tests whether or not students can demonstrate competency in the fundamental clinical skills and related competencies, is graded in two domains – the humanistic domain which tests physician/patient communication and interpersonal skills, as well as professionalism, and the biomedical/biomechanical domain which tests medical history taking and physical exam skills, documentation skills and osteopathic manipulative treatment. The exam, scored by 30 individuals, is “not designed to provide feedback,” she said as results are provided solely as pass/fail and reported one to two months following the test.

The most common ways students prepare for the test, she explained, are through clinical rotations, standardized patient encounters, books and courses on physical diagnosis, as well as a level 2 prep course. But the basics of preparation include reviewing the NBOME website, reading the orientation guide, watching the NBOME video and practicing with SOAP notes.

Dr. Gross explained that the pass rate for the exam is historically between 92 and 93 percent. She said that students usually prefer to take the exam between the spring of their third year and the summer of their fourth year while the exam is offered year round. She advised students to consider scheduling the exam, which costs $1,295, as soon as they are eligible as seats are released on a rolling basis one year in advance.

NBOME’s Dr. Gretta Gross Discusses COMLEX-USA Level 2 PE Exam

The vice president of clinical skills testing shared how PCOM Georgia osteopathic medicine (DO) students can prepare for the important exam.

www.pcom.edu

I think it is surreal that someone who never had to take the PE exam can preach to medical students about the importance of the PE exam.

 

[samac]

NBOME’S DR. GRETTA GROSS DISCUSSES COMLEX-USA LEVEL 2 PE EXAM

February 26, 2019

First and second year doctor of osteopathic medicine (DO) students were recently given an overview of COMLEX-USA Level 2 PE (performance evaluation) testing from Gretta Gross, DO ‘97, MEd, vice president for clinical skills testing for the National Board of Osteopathic Medical Examiners (NBOME). Dr. Gross, a graduate of Philadelphia College of Osteopathic Medicine (PCOM), discussed the mission of the NBOME and ways to prepare for this exam which assesses the fundamental clinical skills necessary to enter into supervised graduate medical education.

Dr. Gross explained that the exam, which tests whether or not students can demonstrate competency in the fundamental clinical skills and related competencies, is graded in two domains – the humanistic domain which tests physician/patient communication and interpersonal skills, as well as professionalism, and the biomedical/biomechanical domain which tests medical history taking and physical exam skills, documentation skills and osteopathic manipulative treatment. The exam, scored by 30 individuals, is “not designed to provide feedback,” she said as results are provided solely as pass/fail and reported one to two months following the test.

The most common ways students prepare for the test, she explained, are through clinical rotations, standardized patient encounters, books and courses on physical diagnosis, as well as a level 2 prep course. But the basics of preparation include reviewing the NBOME website, reading the orientation guide, watching the NBOME video and practicing with SOAP notes.

Dr. Gross explained that the pass rate for the exam is historically between 92 and 93 percent. She said that students usually prefer to take the exam between the spring of their third year and the summer of their fourth year while the exam is offered year round. She advised students to consider scheduling the exam, which costs $1,295, as soon as they are eligible as seats are released on a rolling basis one year in advance.

NBOME’s Dr. Gretta Gross Discusses COMLEX-USA Level 2 PE Exam

The vice president of clinical skills testing shared how PCOM Georgia osteopathic medicine (DO) students can prepare for the important exam.

www.pcom.edu

I think it is surreal that someone who never had to take the PE exam can preach to medical students about the importance of the PE exam.

This is all irrelevant to this discussion. That the PE entirely out of the equation and there’s still many concerning red flags here. If you could stop highjacking the thread into a PE discussion that would be great.

I have tons of empathy, but I don’t want to see someone who has had multiple issues throughout their clinical rotations fail when they start the even more intense, emotionally draining residency.
If you can’t form even a basic presentation/note you’re not gonna survive

 

[IMGASMD]

NBOME’S DR. GRETTA GROSS DISCUSSES COMLEX-USA LEVEL 2 PE EXAM

February 26, 2019

First and second year doctor of osteopathic medicine (DO) students were recently given an overview of COMLEX-USA Level 2 PE (performance evaluation) testing from Gretta Gross, DO ‘97, MEd, vice president for clinical skills testing for the National Board of Osteopathic Medical Examiners (NBOME). Dr. Gross, a graduate of Philadelphia College of Osteopathic Medicine (PCOM), discussed the mission of the NBOME and ways to prepare for this exam which assesses the fundamental clinical skills necessary to enter into supervised graduate medical education.

Dr. Gross explained that the exam, which tests whether or not students can demonstrate competency in the fundamental clinical skills and related competencies, is graded in two domains – the humanistic domain which tests physician/patient communication and interpersonal skills, as well as professionalism, and the biomedical/biomechanical domain which tests medical history taking and physical exam skills, documentation skills and osteopathic manipulative treatment. The exam, scored by 30 individuals, is “not designed to provide feedback,” she said as results are provided solely as pass/fail and reported one to two months following the test.

The most common ways students prepare for the test, she explained, are through clinical rotations, standardized patient encounters, books and courses on physical diagnosis, as well as a level 2 prep course. But the basics of preparation include reviewing the NBOME website, reading the orientation guide, watching the NBOME video and practicing with SOAP notes.

Dr. Gross explained that the pass rate for the exam is historically between 92 and 93 percent. She said that students usually prefer to take the exam between the spring of their third year and the summer of their fourth year while the exam is offered year round. She advised students to consider scheduling the exam, which costs $1,295, as soon as they are eligible as seats are released on a rolling basis one year in advance.

NBOME’s Dr. Gretta Gross Discusses COMLEX-USA Level 2 PE Exam

The vice president of clinical skills testing shared how PCOM Georgia osteopathic medicine (DO) students can prepare for the important exam.

www.pcom.edu

I think it is surreal that someone who never had to take the PE exam can preach to medical students about the importance of the PE exam.

You obviously have an axe to grind or chip on your shoulder. None of this has anything to do with the OP nor helping s/he in this situation.

If there was ONE maybe TWO, fine, let’s make it THREE strikes. There is something else going on.... it CANNOT be ONLY institutional problems like you’re trying to elucidate for us.

Also, OP is certainly not in a position to change anything. If they had Step 1 of 270 and just cannot be sociable, then maybe. But sounds likes they are not the greatest test taker and not doing great socially.

Clinical rotation grade is a reflection of your interaction with your preceptors and residents more than anything. I was a horrible horrible horrible test taker and public speaker. (So I do horribly with pimping and presentation) But I follow directions, I communicate with the team, never had I gotten anything less than pass for my clinical grades.

Sure you may not like what people are saying here, but without any concrete advices other than suing or take down the institution, you’re not doing the OP any favors.

 

[dangEras]

Unfortunately, the OP's faculty see things differently. That's the issue. Railing about bias is thread hijacking. Save that for the SPF.

Means squat. My prelim residency tried to pull a fast one on me and my cohort because they saw things differently. Zero help from acgme ombudsman office. Then one discussion between a lawyer representing us with the hospital lawyers had the hospital admin backtracking their steps faster than you can imagine.

School and hospital administrators are generally worst than clueless when it comes to legal matters. They're blinded by their "authority" which has them confidently and frequently breaking civil laws.

 

[BorntobeDO?]

Means squat. My prelim residency tried to pull a fast one on me and my cohort because they saw things differently. Zero help from acgme ombudsman office. Then one discussion between a lawyer representing us with the hospital lawyers had the hospital admin backtracking their steps faster than you can imagine.

School and hospital administrators are generally worst than clueless when it comes to legal matters. They're blinded by their "authority" which has them confidently and frequently breaking civil laws.

Can I get a pm from you. Tried to send a message but it wouldn't go.

 

[Goro]

Means squat. My prelim residency tried to pull a fast one on me and my cohort because they saw things differently. Zero help from acgme ombudsman office. Then one discussion between a lawyer representing us with the hospital lawyers had the hospital admin backtracking their steps faster than you can imagine.

School and hospital administrators are generally worst than clueless when it comes to legal matters. They're blinded by their "authority" which has them confidently and frequently breaking civil laws.

There's a difference between being an employee and being a student.

And reread Mass Effect's last post, and the OP's. There isn't a "fast one" going on here. The OP has some serious issues.

 

[getfat]

NBOME’S DR. GRETTA GROSS DISCUSSES COMLEX-USA LEVEL 2 PE EXAM

February 26, 2019

First and second year doctor of osteopathic medicine (DO) students were recently given an overview of COMLEX-USA Level 2 PE (performance evaluation) testing from Gretta Gross, DO ‘97, MEd, vice president for clinical skills testing for the National Board of Osteopathic Medical Examiners (NBOME). Dr. Gross, a graduate of Philadelphia College of Osteopathic Medicine (PCOM), discussed the mission of the NBOME and ways to prepare for this exam which assesses the fundamental clinical skills necessary to enter into supervised graduate medical education.

Dr. Gross explained that the exam, which tests whether or not students can demonstrate competency in the fundamental clinical skills and related competencies, is graded in two domains – the humanistic domain which tests physician/patient communication and interpersonal skills, as well as professionalism, and the biomedical/biomechanical domain which tests medical history taking and physical exam skills, documentation skills and osteopathic manipulative treatment. The exam, scored by 30 individuals, is “not designed to provide feedback,” she said as results are provided solely as pass/fail and reported one to two months following the test.

The most common ways students prepare for the test, she explained, are through clinical rotations, standardized patient encounters, books and courses on physical diagnosis, as well as a level 2 prep course. But the basics of preparation include reviewing the NBOME website, reading the orientation guide, watching the NBOME video and practicing with SOAP notes.

Dr. Gross explained that the pass rate for the exam is historically between 92 and 93 percent. She said that students usually prefer to take the exam between the spring of their third year and the summer of their fourth year while the exam is offered year round. She advised students to consider scheduling the exam, which costs $1,295, as soon as they are eligible as seats are released on a rolling basis one year in advance.

NBOME’s Dr. Gretta Gross Discusses COMLEX-USA Level 2 PE Exam

The vice president of clinical skills testing shared how PCOM Georgia osteopathic medicine (DO) students can prepare for the important exam.

www.pcom.edu

I think it is surreal that someone who never had to take the PE exam can preach to medical students about the importance of the PE exam.

This person mostly just talked about test taking strategies and how to study for this test. Mostly not treat it like a "real life scenario" but test that it is.

She actually had a lot of good pointers and knows how to pass tests. Which is exactly what this is.

 

[mathnerd88]

Nonsense. Do you really think SPs do not have any conscious or unconscious biases? Biases are a hot topic in med ed.
Clear example from above "Male black/African American students obtained the lowest SP assessment scores of empathy regardless of SP ethnicity."
Do you seriously believe that this is not a blatant example of bias?

I think the bias from SP's is irrelevant in this case, as OP's original post stated that he/she only failed BIOMEDICAL domain which doesn't hold as much weight from the SP's grading compared to the HUMANISTIC domain, which the OP did pass.

I believe the humanistic domain is mostly graded by SP's, while BIOMEDICAL is mostly graded by independent physicians.

 

[PathDoctor]

I think the bias from SP's is irrelevant in this case, as OP's original post stated that he/she only failed BIOMEDICAL domain which doesn't hold as much weight from the SP's grading compared to the HUMANISTIC domain, which the OP did pass.

I believe the humanistic domain is mostly graded by SP's, while BIOMEDICAL is mostly graded by independent physicians.

The SPs grade the data gathering (history and physical exam) portion of the biomedical domain. That is a ky part of the biomedical domain.

Candidates’ history-taking and physical examination skills are documented by the Standardized (SP) portraying the patient immediately following the encounter, as are doctor-patient communication, interpersonal skills, and professionalism. Completed e-SOAP Notes and OMT skills (via a secured electronic recording process) are rated by NBOME trained and approved osteopathic physician examiners.

Pass or fail results are reported as the overall examination outcome reflecting the osteopathic medical profession standard for undergraduate students preparing for graduation and also for each of the two examination domains.

Humanistic Domain: Measures skills in doctor-patient communication, interpersonal skills, and professionalism. Assessed skills within this domain include:

Eliciting information
Listening skills
Giving information
Respectfulness
Empathy
Professionalism

Biomedical/Biomechanical Domain: Measures skills in data-gathering, osteopathic manipulative treatment (OMT) and documentation (e-SOAP Notes).

The data-gathering component reflects skills in history-taking and physical examination.
The OMT portion represents performance in osteopathic assessment and manipulative treatment in select cases. The following areas are assessed globally for OMT:
Osteopathic examination/evaluation
Patient/physician position for treatment
OMT modality selected
OMT technique
Treatment repetition/duration
Post-treatment assessment
The completed e-SOAP Note measures communication (synthesizing information gathered in the clinical encounter), clinical problem-solving and integrated differential diagnosis and formulation of a therapeutic plan. Osteopathic principles are incorporated into each of the three areas.

In order to receive a pass outcome for the overall examination, a candidate must pass both domains.

Scoring Principles - NBOME

Scoring Principles COMLEX-USA Level 3

www.nbome.org

 

[samac]

The SPs grade the data gathering (history and physical exam) portion of the biomedical domain. That is a ky part of the biomedical domain.

Candidates’ history-taking and physical examination skills are documented by the Standardized (SP) portraying the patient immediately following the encounter, as are doctor-patient communication, interpersonal skills, and professionalism. Completed e-SOAP Notes and OMT skills (via a secured electronic recording process) are rated by NBOME trained and approved osteopathic physician examiners.

Pass or fail results are reported as the overall examination outcome reflecting the osteopathic medical profession standard for undergraduate students preparing for graduation and also for each of the two examination domains.

Humanistic Domain: Measures skills in doctor-patient communication, interpersonal skills, and professionalism. Assessed skills within this domain include:

Eliciting information
Listening skills
Giving information
Respectfulness
Empathy
Professionalism

Biomedical/Biomechanical Domain: Measures skills in data-gathering, osteopathic manipulative treatment (OMT) and documentation (e-SOAP Notes).

The data-gathering component reflects skills in history-taking and physical examination.
The OMT portion represents performance in osteopathic assessment and manipulative treatment in select cases. The following areas are assessed globally for OMT:
Osteopathic examination/evaluation
Patient/physician position for treatment
OMT modality selected
OMT technique
Treatment repetition/duration
Post-treatment assessment
The completed e-SOAP Note measures communication (synthesizing information gathered in the clinical encounter), clinical problem-solving and integrated differential diagnosis and formulation of a therapeutic plan. Osteopathic principles are incorporated into each of the three areas.

In order to receive a pass outcome for the overall examination, a candidate must pass both domains.

Scoring Principles - NBOME

Scoring Principles COMLEX-USA Level 3

www.nbome.org

Seriously. STAHP

 

[BorntobeDO?]

The SPs grade the data gathering (history and physical exam) portion of the biomedical domain. That is a ky part of the biomedical domain.

Candidates’ history-taking and physical examination skills are documented by the Standardized (SP) portraying the patient immediately following the encounter, as are doctor-patient communication, interpersonal skills, and professionalism. Completed e-SOAP Notes and OMT skills (via a secured electronic recording process) are rated by NBOME trained and approved osteopathic physician examiners.

Pass or fail results are reported as the overall examination outcome reflecting the osteopathic medical profession standard for undergraduate students preparing for graduation and also for each of the two examination domains.

Humanistic Domain: Measures skills in doctor-patient communication, interpersonal skills, and professionalism. Assessed skills within this domain include:

Eliciting information
Listening skills
Giving information
Respectfulness
Empathy
Professionalism

Biomedical/Biomechanical Domain: Measures skills in data-gathering, osteopathic manipulative treatment (OMT) and documentation (e-SOAP Notes).

The data-gathering component reflects skills in history-taking and physical examination.
The OMT portion represents performance in osteopathic assessment and manipulative treatment in select cases. The following areas are assessed globally for OMT:
Osteopathic examination/evaluation
Patient/physician position for treatment
OMT modality selected
OMT technique
Treatment repetition/duration
Post-treatment assessment
The completed e-SOAP Note measures communication (synthesizing information gathered in the clinical encounter), clinical problem-solving and integrated differential diagnosis and formulation of a therapeutic plan. Osteopathic principles are incorporated into each of the three areas.

In order to receive a pass outcome for the overall examination, a candidate must pass both domains.

Scoring Principles - NBOME

Scoring Principles COMLEX-USA Level 3

www.nbome.org

You failed the PE didnt you? And it ruined your 270 app. I think I understand the grudge.

 

[Dr. Rafiki]

Imo you are a bit off base here. Why does the NBOME never release pass rate by race and ethnicity? Could it be because the PE exam is graded by predominantly white standardized patients who are biased (either consciously or unconsciously) against minority candidates?

NBOME 101 W Elm St, Conshohocken, PA 19428
As of the 2010 census, the borough was 88.7% White, 6.5% Black or African American, 0.1% Native American, 1.8% Asian, and 1.7% were two or more races. 3.5% of the population were of Hispanic or Latino ancestry .

Conshohocken, Pennsylvania - Wikipedia

en.wikipedia.org

NBOME 8765 W Higgins Rd, Chicago, IL 60631
Zip 60631
White 26,510 92.6%
Black Or African American 130 0.5%
American Indian Or Alaskan Native 37 0.1%
Asian 852 3.0%
Native Hawaiian & Other Pacific Islander 5 0.0%
Other Race 612 2.1%
Two Or More Races 495 1.7

ZIP Code 60631 Map, Demographics, More for Chicago, IL

Interactive and printable 60631 ZIP code maps, population demographics, Chicago IL real estate costs, rental prices, and home values.

www.unitedstateszipcodes.org

The US is predominantly white.... and the PE was originally instituted to ensure foreign grads could practice medicine in this country without killing people.

If you wanna be a doctor in the US then you'd better quit griping about being graded by white people.

Also, that PA site has demographics awfully close to the demographics of our country as a whole....

 

[Epilepsy365]

The US is predominantly white.... and the PE was originally instituted to ensure foreign grads could practice medicine in this country without killing people.

If you wanna be a doctor in the US then you'd better quit griping about being graded by white people.

Also, that PA site has demographics awfully close to the demographics of our country as a whole....

ugh... what??? LOL

 

[ciestar]

The US is predominantly white.... and the PE was originally instituted to ensure foreign grads could practice medicine in this country without killing people.

If you wanna be a doctor in the US then you'd better quit griping about being graded by white people.

Also, that PA site has demographics awfully close to the demographics of our country as a whole....

Every been to Conshy?

 

[BorntobeDO?]

The US is predominantly white.... and the PE was originally instituted to ensure foreign grads could practice medicine in this country without killing people.

If you wanna be a doctor in the US then you'd better quit griping about being graded by white people.

Also, that PA site has demographics awfully close to the demographics of our country as a whole....

Nope no it doesn't, maybe you ment Philadelphia as a whole?

 

[PathDoctor]

The US is predominantly white.... and the PE was originally instituted to ensure foreign grads could practice medicine in this country without killing people.

If you wanna be a doctor in the US then you'd better quit griping about being graded by white people.

Also, that PA site has demographics awfully close to the demographics of our country as a whole....

Congratulations!! Hard to be this far off base.
Foreign grads do not take the PE test, only DO students take it. So it was not " originally instituted to ensure foreign grads could practice medicine in this country without killing people."
The demographics of Conshohocken are NOT awfully close to the country as a whole.
Conshochocken
As of the 2010 census, the borough was 88.7% White, 6.5% Black or African American, 0.1% Native American, 1.8% Asian, and 1.7% were two or more races. 3.5% of the population were of Hispanic or Latino ancestry .
USA 2010 census

White alone 72.41%	Black alone 12.61%	Mixed* 9.11%	Asian alone 4.75%	American Indian and Alaska Native alone 0.95%	Native Hawaiian and Other Pacific Islander alone 0.17%

 

[Goro]

Enough with the thread hijacking already!

 

[Neopolymath]

Congratulations!! Hard to be this far off base.
Foreign grads do not take the PE test, only DO students take it. So it was not " originally instituted to ensure foreign grads could practice medicine in this country without killing people."
The demographics of Conshohocken are NOT awfully close to the country as a whole.
Conshochocken
As of the 2010 census, the borough was 88.7% White, 6.5% Black or African American, 0.1% Native American, 1.8% Asian, and 1.7% were two or more races. 3.5% of the population were of Hispanic or Latino ancestry .
USA 2010 census

White alone 72.41%	Black alone 12.61%	Mixed* 9.11%	Asian alone 4.75%	American Indian and Alaska Native alone 0.95%	Native Hawaiian and Other Pacific Islander alone 0.17%

We made PE to be more like the MDs. MDs made the CS exam to do what my boy Born said. So yeah... He's not wrong.

 

[BorntobeDO?]

We made PE to be more like the MDs. MDs made the CS exam to do what my boy Born said. So yeah... He's not wrong.

Wasnt me who said it, but I do agree. Its funny that ours fails people more often when it had no legimate reason to exist in the first place. However, sometimes the PE does fail people who it should.

 

[Dr. Rafiki]

Congratulations!! Hard to be this far off base.
Foreign grads do not take the PE test, only DO students take it. So it was not " originally instituted to ensure foreign grads could practice medicine in this country without killing people."
The demographics of Conshohocken are NOT awfully close to the country as a whole.
Conshochocken
As of the 2010 census, the borough was 88.7% White, 6.5% Black or African American, 0.1% Native American, 1.8% Asian, and 1.7% were two or more races. 3.5% of the population were of Hispanic or Latino ancestry .
USA 2010 census

White alone 72.41%	Black alone 12.61%	Mixed* 9.11%	Asian alone 4.75%	American Indian and Alaska Native alone 0.95%	Native Hawaiian and Other Pacific Islander alone 0.17%

If you don't even know an accurate history of why we have the exams we have, then all your points are moot. You should try educating yourself before replying next time.

And yes, the white population is >70% for the US and >80% for the PA site so how am I wrong exactly? You speak as if foreign-born people of color are the great majority here when in reality they are not. White Americans are the vast majority. Get used to being judged by them, either as SPs or as patients.

Oh and btw, I am a 1st generation, person of color, bilingual American. Just to clear up any "racist!" come backs you may think of

 

[mathnerd88]

The SPs grade the data gathering (history and physical exam) portion of the biomedical domain. That is a ky part of the biomedical domain.

Candidates’ history-taking and physical examination skills are documented by the Standardized (SP) portraying the patient immediately following the encounter, as are doctor-patient communication, interpersonal skills, and professionalism. Completed e-SOAP Notes and OMT skills (via a secured electronic recording process) are rated by NBOME trained and approved osteopathic physician examiners.

Pass or fail results are reported as the overall examination outcome reflecting the osteopathic medical profession standard for undergraduate students preparing for graduation and also for each of the two examination domains.

Humanistic Domain: Measures skills in doctor-patient communication, interpersonal skills, and professionalism. Assessed skills within this domain include:

Eliciting information
Listening skills
Giving information
Respectfulness
Empathy
Professionalism

Biomedical/Biomechanical Domain: Measures skills in data-gathering, osteopathic manipulative treatment (OMT) and documentation (e-SOAP Notes).

The data-gathering component reflects skills in history-taking and physical examination.
The OMT portion represents performance in osteopathic assessment and manipulative treatment in select cases. The following areas are assessed globally for OMT:
Osteopathic examination/evaluation
Patient/physician position for treatment
OMT modality selected
OMT technique
Treatment repetition/duration
Post-treatment assessment
The completed e-SOAP Note measures communication (synthesizing information gathered in the clinical encounter), clinical problem-solving and integrated differential diagnosis and formulation of a therapeutic plan. Osteopathic principles are incorporated into each of the three areas.

In order to receive a pass outcome for the overall examination, a candidate must pass both domains.

Scoring Principles - NBOME

Scoring Principles COMLEX-USA Level 3

www.nbome.org

Okay so basically the data gathering is scored by the SP's...which is basically a checklist of what questions you asked. You either asked or you didn't ask the appropriate question and you earn points that way. There's no in between. How can there be 'bias' when scoring this particular section?

 

[serendipity424]

Thanks for all the advice everyone! Update: I passed my COMLEX Level2PE retake last year after practising a week with faculty. Realized my only issue was not explaining my assessment and plan to my SPs causing me to fail the biomechanical (i.e., data gathering) domain since they couldn't check those boxes off on every case. (I didn't know we had to explain the assessment and plan to the SPs in the room since I never did this at school and passed my school's SP encounters.) I still have to repeat 4th year: another 12 months of clinical rotations but I passed all my exams so no exams left to study for. Just going to concentrate on feeling comfortable and confident in the clinic/hospital for the next 1.5 years.
Things are going really well though- My two last evals were both "exceeds expectations". I think the two "below expectations" evals (btw, yes we do also have a checkbox for "recommend fail" and I didn't get any of that) I got in 3rd year were because I was feeling very nervous in front of some strict demeaning preceptors I had in combination with never having worked in a clinic ever before + going through some tough changes in life. But I feel a lot more confident now in the clinic setting after 1+ years of experience and have built a strong support system. I am also getting counselling to help me build strong relationships with the cocky/demeaning preceptors and to not let them get in my head... and it's helping a lot! 🙂
Thank you for all your support. If you have any more advice on anything, I'd appreciate it!