PE comlex(garbage)

[apellous]

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Anyone else out there thinks this is a bunch of crap. I feel that this is just another money making scheme hatched by the NBOME and AOA. They are basing this need off a crap survey of the general population that stated people want us to this as part of the boards. First of all what kind of people fill out surveys anyway. People with nothing to do better; like work, go to school, have a life. Second if the people want it let them pay for it 2000 buck for the test, travel (one test site that's bull$hit),lodging. I am not sure how other schools are but at CCOM they were are saying $hit like "we need to make sure doctors are able to talk/interact with their pts"1) you can not teach that and they dont try to anyway 2)This can not be a new Phenomenon, doctors that cant do a PE, are social ******ed, and can not communicate with pts.

So if some of the Drs are inept why not test us all since they are the ones teaching us wouldnt it be logical to start at the top. The only reason they are starting with us is that we have no choice but to take the &%!@ing test.

In my book if you cant manage a H&P by fourth year it is b/c you cant walk to the room on your rocker-bottom feet.

They have NO statistic proving the tests efficacy or predictions on how this $1500 exam will improve the quality of physicians.


All comments are welcome. If I am completely off base please let me know .

 

[Jim Picotte]

Blame the USMLE and FSMB who organized and is making this a requirement. IMG grads have had to take it for awhile. I'm against it (although I'm grandfathered), the AMA is against it (shows you how much power they really have) and so are nearly every medical student I know. I still think this is a job that medical schools should be doing but it looks like there is nothing you can do. Once the USMLE made it a requirement, the AOA really didn't have a choice. Sounds like they really need more than one testing site though.

 

[DD214_DOC]

You can't communicate with us, can you communicate with patients?

 

[Shinken]

I actually think that the exam is a good idea. I know it's a lot of money, but there has to be a "standard" exam to test clinical skills. We already have textbook knowledge exams (USMLE and COMLEX) that test everyone the same way. We need a clinical skills exam that tests everyone the same way.

I do believe you can teach someone how to communicate with patients better. This exam will make people more serious about developing more real patient skills. As much as people hate to admit it, it's easy to lock yourself in the library and memorize a pathology book, but it's something entirely different to treat and diagnose a patient in a finite timeframe.

There is actually some data that this type of exam helps you develop better patient skills. There was a study a few months ago in JAMA that compared US medical grads with foreign medical grads. It was embarrasing. In almost every category the foreign grads trounced the US ones. As you know, foreign medical grads need to prepare for a clinical skills exam to be licensed in the US. American students don't...until now.

You have to show your social skills before being admitted to medical school via an interview with several people. Now you have to show your patient skills before graduating. It kind of makes sense, don't you think?

 

[Goofyone]

It all sounds fine and dandy, but I think we all know why this is happening: The almighty dolla'

There's no reason this thing should cost that much money.

Is it going to make better doctors, realistically? Pleeeeeease 🙄

I would think our third year attendings will find out real quick if we are competent H&Pers.

 

[DermpathDO]

look the big issue here is this.....
the current Board exams...NBOME and USMLE...when you pass.....all they show is that you know some facts and more importantly, they show that you know how to take a test. I know some great physicians with wonderful people skills and that are excellent diagnosticians, who failed thier boards at least once.

The clinical skill exam will test you not only on your ability to communicate with a patient, but also that you know how to follow up on clues and come up with the right diagnosis or a reasonable facsimile thereof. Most medical schools now have intiated at least some form of clinical skills lab. If your school hasn't perhaps you should be questioning WHY.😕

 

[bigmuny]

This new part of the test is nothing but a money making scheme.

 

[Goofyone]

Originally posted by bigmuny
This new part of the test is nothing but a money making scheme.

mmm hmm

 

[SM-UCLA tech]

this test doesn't even count for us though......it's just an extra expense and travel time.

correct me if i'm wrong, but from what i understand it's the class of 2008 that will have to pass it.

 

[NDESTRUKT]

so i'll have to pass it and you don't? can i somehow graduate with you, kris?

 

[SM-UCLA tech]

hehehe

 

[joaquin13]

is it true that the only testing site is philadelphia?

 

[Amra]

...last I heard there (heard = key word) there was 2 projected on the east coast (Philly and Atlanta) - not sure if that is for USMLE or COMLEX or both though...

Unfortunately, this is like beating our heads against the wall. Last year, COSGP did a petition against the PE addition - to no avail. AOA doesn't want to seem to listen to anything but what the AMA says.

Didn't the AMA initially oppose the exam, then later change their mind? It's been a while, yet isn't there a state licensing board (or two?) that rejected the proposal?

Bottom Line: COMPEX-PE is a reality for us (and an expensive one at that).

My question though - with the thoughts that the PE is designed to teach/test our patient communication skills... isn't that the job of our respective medical school? Ya gotta figure that 2 years worth of simulated patients, standardized patients, and now OCSE's... well, we should know something...


-A

 

[DOtobe]

Originally posted by joaquin13
is it true that the only testing site is philadelphia?

So far, yes. I believe they won't be adding additional sites until 2007.

If you go to the NBOME website, there is a fact sheet about the COMLEX-PE. I think you click on "performance exam."

And I just found out that we have to pass it to graduate from LECOM. But honestly, if you can't do an H&P by the end of MS-III, you have problems.

 

[Goofyone]

Originally posted by Amra
My question though - with the thoughts that the PE is designed to teach/test our patient communication skills... isn't that the job of our respective medical school? Ya gotta figure that 2 years worth of simulated patients, standardized patients, and now OCSE's... well, we should know something...


-A

It's simply a money-making scheme, and an attempt at keeping up with the Jones (the AMA)

1. Anyone without adequate communication skills shouldn't get into med school in the first place.
2. As you said, most schools address this with standardized patients and their own CSAs.
3. If you don't have the basics down, it would seem like your 3rd-year attending is going to rip you anew very quickly and you will either acquire the skills or fail your clerkships.

In short, while is sounds all peaches 'n' cream, it's totally bogus and this one test isn't going to make any difference in what kind of doctor we are.

I wouldn't be so against it (after all, it's just another of many hoops we have to leap through), if it didn't cost so damn much money.
Seems that if they really wanted to do it for the right reasons, it's something that could be done for a much more reasonable amount of money or even for free.

😡

 

[Amra]

"performance exam."

haha...🙄

BTW, what ever happened to the lawsuit v. NBME that was in NEJM back in the Spring? Any ever hear anything more? I (gasp!) haven't been reading The Journal (not Wall St) much lately...

-A

P.S. I feel I should have added some more acronyms in that sentence to be considered fully medical-ese.

 

[Idiopathic]

There will be $$ changing hands, but you dont set something like this up for a measly ~3 million a year. Medicine is a multi-billion dollar industry, and the AOA swears that they are pulling no profit from this deal.

 

[muonwhiz]

Last year the AOA pres came to our school and attempted to justify the PE exam by saying that 45,000 people died of medical error in the year before and that this exam would help put a stop to that. He was specifically asked exactly how many of the claimed 45,000 deaths resulted because a med student missed something on an H&P or SOAP note. Of course, he could not answer the question so it is evident that the emperor has no clothes. The AOA just caved without any question because it doesn't affect the practicing docs, they don't have to put up the bucks for this meaningless exercise. But med students are also at fault, for the most part they have bought into the line of "I'm a med student so I can't do anything about it." Once you buy that one, the system owns you. SOMA actually voted in favor of taking the exam! On the other hand, if this had been attempted on all of the law students in the country with absolutely no evidence of any practical necessity, those students would have been debating on which jurisdiction to file the first class action lawsuit against the test should be filed in and it would have been done. Don't want to take the exam? Think it is just another rip off? Then stop bitching and do something about it. Talk is cheap.

 

[oceandocDO]

A few points here....

First, the AOA has no official say whether the exam happens or not. The NBOME are the folks in charge, and they dont take orders from the AOA... two separate organizations with a loose association.

Second, the AMA also isnt in charge of offering this exam to MD students. Similarly, the NBME is in charge for the allopathic exam. Again, a loose affiliation, not official. When the AMA came out against the exam this summer, it was a huge black eye for them as USA Today and the New York Times came out harshly against them for "not protecing patients".... yada yada. The AMA is actually in trouble, only about 25% of MDs even belong to it anymore compared to almost 60% of D.O.s for the AOA. The AMA cant afford the embarrasment any longer. Supposedly at the current rate of growth, by the year 2012 the AOA will be a larger body than the AMA.

Third, in reality, we actually cant blame the NBOME or the NBME for this. It's the state licensing boards, who are not affiliated with either organization, who are going to require a clinical skills exam for the ability to get a license. The NBOME and NBME are simply trying to keep up with their requirements, which are changing under heavy political pressure as these licensing boards are mostly elected officials.

I dont like it the idea any more than anyone else. It's a BS exam which has no prayer at proving competency....overall a nice political jewel which will be here whether we like it or not.

 

[Goofyone]

Originally posted by oceandocDO
Third, in reality, we actually cant blame the NBOME or the NBME for this. It's the state licensing boards, who are not affiliated with either organization, who are going to require a clinical skills exam for the ability to get a license. The NBOME and NBME are simply trying to keep up with their requirements, which are changing under heavy political pressure as these licensing boards are mostly elected officials.

I dont like it the idea any more than anyone else. It's a BS exam which has no prayer at proving competency....overall a nice political jewel which will be here whether we like it or not.

Ocean:

Excellent post. The true enemy has reared its ugly head. POLITICS.

It's all about perceptions. 😡

 

[texdrake]

My two cents:

1. I am against it. It's crap and its an extra expense.

2. It has been proven not to improve the quality of physicians. In Canada and other countries that have had these tests for sometime, statistics have shown that these tests do nothing for quality control and can not guarantee fairness. In otherwords we are implementing a costly test that has no validity or reliability.

3. The reason these tests don't work is simple time. To evalutate patient interaction skills one would need a long term evaluation (LIKE IN RESIDENCY, HELLO). Anyone can be a perfect angel for 30 minutes. Hell, how do you think date rapeist and murders get their victims? You think some girl says "hey I wanna go out on a date with that psychopathic child molester with the knife in his back pocket" Hell no. They play their part, they pass the "test" and then they slip into the old routine so to speak.

4. Its an f'ing joke. Really. Its a test who sole purpose is to produce warm fuzzies in that 1% of patients that might actually even know you take a test like this. One little news broadcast about physcians not being "tested" over beside manner and someone got their panties in a bunch and made it a goal. I liken it to the old email that use to circulate about the horrors of dihydrogen mono-oxide and all the horrible things that the chemical could cause. Uneducated are astounded untill someone snicker and explains to them that dihydrogen mono-oxide is water.

 

[Idiopathic]

If physicians are so excellent at reading and responding to patients, why is rapport so poor and why do docs get sued every day? Dont tell me its outcome, because it isnt...it IS rapport.

 

[texdrake]

Well idio, I assume your post wasn't in response to me as I never implied that physicians are good at reading and responding but I would like to re-iterate that I was merely explaining that the test does not do what it claims to do. I think it would be great to have a test that would teach physicians to be better but their isn't. In fact it isn't possible. A test merely guages ability, it doesn't teach you.

 

[DireWolf]

Originally posted by Idiopathic
There will be $$ changing hands, but you dont set something like this up for a measly ~3 million a year. Medicine is a multi-billion dollar industry, and the AOA swears that they are pulling no profit from this deal.

And you believe the AOA? 🙄

 

[Idiopathic]

I think everyone realizes that tests do not teach, the schools are supposed to teach. Tests are there for quality control. While I am not in support of the test, per se, I do feel that the need is there to renovate the way the industry as a whole deals with patients. As far as trusting the AOA, I do know that an industry the size of the AOA does not go to all this trouble for a measly 3 mil a year. BUT, the benefits received by the profession might be greater than that in value...anyone?

 

[Molly Maquire]

Anyone have any idea about how this thing is being graded??

Obviously, there has to be some large subjective component, like if I smile twice I get a 90, but if I only smile once I get an 80? This makes me nervous. Sounds like this test will have the intellectual integrity of an OMM practical. Scary.

Anyone know why it is only given in one location? Dosen't every school have clinic facilities?

 

[Idiopathic]

P/F grading, I believe...anyone know for sure?

 

[oceandocDO]

It's going to be pass/fail. No number grades involved. Supposedly you'll have about 13 patients to see, you'll have about 10-15 minutes to do an H&P and about 10 minutes to write a SOAP note. They supposedly estimate a fail rate of about 4-7% the first year, so you REALLY have to do something stupid to fail this test. OMM will be incorporated, but as far as grading it, it's more your willingness to use it rather than your technical skill at manipulation, from what I was told.

Second, I'm not trying to defend the AOA here, but please stop implying the AOA is making money off this test. The AOA is NOT offering or creating this test, the NBOME is, and the two organizations are not linked to one another officially. This past summer the AOA Board of Trustees actually voted to NOT endorse, although not outright reject either, the implementation of the test. However, later the AOA House of Delegates, the supreme voice of the AOA, voted to go forth with the implementation, basically learning from the mistakes of the AMA and the large political black cloud that is still following the AMA around after they voted to denounce the clinical skills exam.

The test may be expensive, but these tests are expensive to implement, especially since they have to provide standardized facilities, train standardized patients, etc and only 3000 people a year will be taking the test. If the NBOME does make money off this, they'll have to explain it to the feds as they're a non-profit organization.

Lastly, to the poster that alluded to the Canadian test and the results, or lack-there-of from it, actually there's been several papers published which somehow work the statistics to show the test is valid and correctly weeds out young physicians who are not competent. These papers are most of the fuel the state medical boards are using to drive this train. I read one awhile ago which had more statistical crap in it that I could understand, but to the people in the know on these things, the test is supposedly validated, on paper at least. The court of public opinion is the real judge and jury for this matter and we all know how the public feels about more testing for physicians.
😡

Like it or not, it's happening. There's no stopping this train, as without it you wont get a license according to the federation of state medical boards. Grin and bear it is my advice.