PE exam knocking students out of residency programs

[V5RED]

They might not, but every medical student goes through the same pathway to become a doctor and at least 92-93% pass every year. I'm sure there are people out there who have failed Level 1 or Level 2 CK who would make great doctors, but are screened out of many residency programs and some will never become a doctor because of that. Some people are just bad test takers. Does that mean they shouldn't be doctors too?

The topic is whether the CS/PE standardized patient exams have merit. Pointing out that everyone is forced to take them does not address that question. Concerns about the other board exams also do not address that question. Unless there is data showing that performance on these exams correlates with performance with real patients, the continued existence of these exams is indefensible. They have had long enough to collect data on this very expensive exam.

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[bananafish94]

At least from what I heard from our school, generally the people who have been failing the Level 2 PE have traditionally been doing poorly on their OSCEs and SP labs.

We can trade anecdotes all day long. I personally know people who are smart, great with people and patients, matched into impressive academic programs, and who also failed CS. If you have any actual data I'm happy to look at it though.

There are plenty of students who are rock stars when it comes to exams and medical knowledge, but have terrible bedside manner or are just not professional when it comes to patients.

I agree! But why do we need CS/PE? These people will be identified through so many different redundant measures. OSCEs, for one. Third and fourth year, for another. Interviews. The list goes on. I don't understand how somebody could have such poor people skills and bedside manner that they could get through all of that without incident or somebody raising some concern at some point. It goes back to the fundamental question. Why do we need this exam to exist?

We will never know exactly how these exams are graded, but we also have to understand that chances are that the students who failed the PE/CS probably had some deficiencies in their patient encounter. It is not so random as this thread is making it out to be. We only hear from one side of the story from the students who failed, but we also don't know exactly what they did during the patient encounter. Also, understand that students who failed will most likely complain that they did nothing wrong during their encounter and did everything correctly.

I'm sorry, that's just not good enough for me. I'm one of the lucky ones. I live in one of the five cities where CS takes place and it cost me $1300. If I didn't I'd have to pay hundreds more for a flight and a hotel. I had to wait months waiting for them to grade me, and if I had failed I would have had to wait another several months hoping to get a date before ROL submission. If I fail and need to fork over $4000 in total for this exam, only for them to tell me that my "error bar" in one of the domains is a little too low for reasons that they don't disclose based on a grading schema that they don't release, and all somebody can offer me is that I "probably had some deficiencies," that is Not. Good. Enough.

This is not acceptable, and we deserve better than this.

 

[mathnerd88]

The topic is whether the CS/PE standardized patient exams have merit. Pointing out that everyone is forced to take them does not address that question. Concerns about the other board exams also do not address that question. Unless there is data showing that performance on these exams correlates with performance with real patients, the continued existence of these exams is indefensible. They have had long enough to collect data on this very expensive exam.

I'm just going to throw this out there. How about we administer the Level 1/Step 1 exam to all M3's and above, including residents and attending physicians. Let's see how many pass Level 1/Step 1 now. Or how about we give them the MCAT now? Do you understand where I'm coming from? Nobody is talking about abolishing the MCAT. The exam may not have any real use in performance with real patients. They're just steps to becoming a physician, even if there's really no use in clinical practice for them.

 

[mathnerd88]

I'm sorry, that's just not good enough for me. I'm one of the lucky ones. I live in one of the five cities where CS takes place and it cost me $1300. If I didn't I'd have to pay hundreds more for a flight and a hotel. I had to wait months waiting for them to grade me, and if I had failed I would have had to wait another several months hoping to get a date before ROL submission. If I fail and need to fork over $4000 in total for this exam, only for them to tell me that my "error bar" in one of the domains is a little too low for reasons that they don't disclose based on a grading schema that they don't release, and all somebody can offer me is that I "probably had some deficiencies," that is Not. Good. Enough.

This is not acceptable, and we deserve better than this.

I would say you are not one of the lucky ones, but rather, the norm. I agree that the PE isn't perfect by any means, but the exam is not as random as you make it out to be. If you followed the Kauffman videos or read the Step 2 CS book from Kaplan AND PRACTICED you are pretty much guaranteed to pass. Our school had a 99% pass rate on the PE last year and consistently above the national average for the past 7 years.

Medicine, like any other career, has many hoops to jump through, even if it was deemed useless and unfair and biased. Clinical evals and the MSPE is another example of this. I wish I could do a retrospective study between genders in how clinical evals are scored.

 

[AnatomyGrey12]

I'm just going to throw this out there. How about we administer the Level 1/Step 1 exam to all M3's and above, including residents and attending physicians. Let's see how many pass Level 1/Step 1 now. Or how about we give them the MCAT now? Do you understand where I'm coming from? Nobody is talking about abolishing the MCAT. The exam may not have any real use in performance with real patients. They're just steps to becoming a physician, even if there's really no use in clinical practice for them.

I would say you are not one of the lucky ones, but rather, the norm. I agree that the PE isn't perfect by any means, but the exam is not as random as you make it out to be. If you followed the Kauffman videos or read the Step 2 CS book from Kaplan AND PRACTICED you are pretty much guaranteed to pass. Our school had a 99% pass rate last year, well above the national average.

Medicine, like any other career, has many hoops to jump through, even if it was deemed useless.

So now your argument has spiraled to "because this is how it is."

1. Residents and attendings would easily pass Step/Level 1.

2. Step 1/Level 1 are direct correlations to your pre-clinical medical knowledge, this is documented in the literature. Step 2 CK/Level 2 CE are directly correlated to clinical medical knowledge, this is also documented in literature. MCAT functions as an aptitude test for medical school and actually performs that function pretty well up to the national median, also documented in the literature. CS/PE have no validity, and there has never been a good reason proffered as to why this exam mutated from what was essentially an FMG English aptitude test to a test delivered to every medical student. "Protecting the public" is the party line by both the NBOME and the NBME for these exams, which we all know is a complete sham. If they really were protecting the public and concerned about the student learning what they needed to learn then they would give detailed grading sheets out highlighting exactly why someone failed and what they needed to work on. What they are supposed to be grading already has a multitude of checkpoints in this process.

These tests have existed for 17 years, and in all that time not a single robust study has been done that actually gives validity to these exams. The rest of the existing exams have documented validity.

 

[mathnerd88]

So now your argument has spiraled to "because this is how it is."

1. Residents and attendings would easily pass Step/Level 1.

2. Step 1/Level 1 are direct correlations to your pre-clinical medical knowledge, this is documented in the literature. Step 2 CK/Level 2 CE are directly correlated to clinical medical knowledge, this is also documented in literature. MCAT functions as an aptitude test for medical school and actually performs that function pretty well up to the national median, also documented in the literature. CS/PE have no validity, and there has never been a good reason proffered as to why this exam mutated from what was essentially an FMG English aptitude test to a test delivered to every medical student. "Protecting the public" is the party line by both the NBOME and the NBME for these exams, which we all know is a complete sham. If they really were protecting the public and concerned about the student learning what they needed to learn then they would give detailed grading sheets out highlighting exactly why someone failed and what they needed to work on. What they are supposed to be grading already has a multitude of checkpoints in this process.

These tests have existed for 17 years, and in all that time not a single robust study has been done that actually gives validity to these exams. The rest of the existing exams have documented validity.

I don't know how many of us physicians/residents/M3 and M4 students actually remember all of the biochemistry that was tested on Step 1. I will be honest and tell you I pretty much forgot almost all my biochemistry I learned in medical school except some specific factoids.

I can also tell you that sometimes I am even sometimes on occasion be teaching the attending when it comes to M1 material.

And yes, it has always been "how it always has been." There will always be room for improvement.

 

[AnatomyGrey12]

I don't know how many of us physicians/residents/M3 students actually remember all of the biochemistry that was tested on Step 1.

Trust me, you can miss all of the biochem questions on both exams and still pass comfortably.

 

[bananafish94]

Medicine, like any other career, has many hoops to jump through, even if it was deemed useless and unfair and biased. Clinical evals and the MSPE is another example of this.

So we should just lie down and accept everything that's wrong? Shouldn't we strive to make it better? I agree that clinical evaluations have issues, let's improve them. Not just accept it for what it is and call it a day.

 

[mathnerd88]

I just want to make things clear here. I was just offering my insight on why PE was instituted and in no way do I offer any scientific data. Do I agree that it's fair that they don't disclose how they grade? No. I wish they would. I agree things can be improved and the components of what they look at be shown except of just showing a humanism and data gathering component.

There will always be an aspect of bias in this type of exam because humanism is a big component of the grading scheme. This is true throughout all of M3 when you have clinical evals and OSCEs.

I believe the PE is an exam that is extremely stressful to take and will net some unhappy results. Nobody wants to be put into a high stress setting and stuck in a room with cameras all pointing at you and making you feel they're analyzing your every move.

However, I believe that the exam is very simple to study for and not as nearly intensive as any of the other board exams, as all you need to do is follow the Kaufman videos and/or Kaplan CS book and practicing. For those people that have failed, I am sorry that it happened to you, but it MOST likely is due to some deficiency that has been repeated on multiple stations. Given that at least 93% pass every year, and this includes many students who haven't even finished all their M3 rotations yet, I believe it isn't as 'bad' as some on here are making it out to be. (Level 2 CK is taken at the end of M3, but the PE can be taken as early as December of M3 for some schools from what I've heard.)

 

[V5RED]

I'm just going to throw this out there. How about we administer the Level 1/Step 1 exam to all M3's and above, including residents and attending physicians. Let's see how many pass Level 1/Step 1 now. Or how about we give them the MCAT now? Do you understand where I'm coming from? Nobody is talking about abolishing the MCAT. The exam may not have any real use in performance with real patients. They're just steps to becoming a physician, even if there's really no use in clinical practice for them.

You aren't making any sense. Can you stick to the question of whether the CS/PE is valid? You keep throwing out red herrings and then concluding that we should keep these exams. If they predict performance, we should. If they don't we shouldn't. It does not matter if I can still pass Step 1. If Step 1 scores predict clinical performance, then it is a useful test. If they don't, it isn't. Whether I still remember the things I memorized for it is irrelevant to the question of whether it is a valid predictor of clinical performance.

 

[bananafish94]

On a different note, imagine how completely absurd it would be if any of us acted like we do on CS with a real patient.

"So what brings you in today?"
"I have a stomach ache."
"I AM SO SORRY THAT THIS IS HAPPENING TO YOU. I AM HERE FOR YOU. WE ARE HERE FOR YOU. WHAT DO YOU HOPE TO GET OUT OF THIS APPOINTMENT."
"...what?"
"Just gonna WASH MY HANDS REAL QUICK HERE. How is this affecting your life?"
"Well, you know, it hurts a little"
"GOD IN HEAVEN, I CAN'T EVEN IMAGINE WHAT YOU MUST BE GOING THROUGH."

 

[sunshinefl]

On a different note, imagine how completely absurd it would be if any of us acted like we do on CS with a real patient.

"So what brings you in today?"
"I have a stomach ache."
"I AM SO SORRY THAT THIS IS HAPPENING TO YOU. I AM HERE FOR YOU. WE ARE HERE FOR YOU. WHAT DO YOU HOPE TO GET OUT OF THIS APPOINTMENT."
"...what?"
"Just gonna WASH MY HANDS REAL QUICK HERE. How is this affecting your life?"
"Well, you know, it hurts a little"
"GOD IN HEAVEN, I CAN'T EVEN IMAGINE WHAT YOU MUST BE GOING THROUGH."

Lmaoooo thanks for my only laugh of the day. I’ve read this 10 times now and it only gets better.

 

[mathnerd88]

You aren't making any sense. Can you stick to the question of whether the CS/PE is valid? You keep throwing out red herrings and then concluding that we should keep these exams. If they predict performance, we should. If they don't we shouldn't. It does not matter if I can still pass Step 1. If Step 1 scores predict clinical performance, then it is a useful test. If they don't, it isn't. Whether I still remember the things I memorized for it is irrelevant to the question of whether it is a valid predictor of clinical performance.

Nobody can provide the answer to your question. There hasn't been any studies done. It's either likely, or not likely.

 

[V5RED]

Nobody can provide the answer to your question. There hasn't been any studies done.

Then nobody can honestly say that the test is fit for purpose and nobody can justify making student pay the absurd fee for taking it. If they haven't gotten the data by now, then it looks like a pretty clear money grab with no value to anyone outside of the NBME.

 

[mathnerd88]

Then nobody can honestly say that the test is fit for purpose and nobody can justify making student pay the absurd fee for taking it. If they haven't gotten the data by now, then it looks like a pretty clear money grab with no value to anyone outside of the NBME.

You can translate your argument into a million things involved in training a student into becoming a doctor.

 

[V5RED]

You can translate your argument into a million things involved in training a student into becoming a doctor.

Again, red herring. The question is whether this expensive test should be thrown out. Saying what about (insert anything that is not this test)? Is not an answer.

 

[mathnerd88]

Again, red herring. The question is whether this expensive test should be thrown out. Saying what about (insert anything that is not this test)? Is not an answer.

Not really, because it's not as simple as how you're making it to be. I was just pointing out the flaws in your argument. There's skills obtained from doing the PE that is translatable to becoming a successful resident, regardless of how big or small it may be. You can't scientifically quantify these type of life skills.

The reasons why I believe the MCAT/Step 1, etc are administered is to translate how a student can efficiently learn and/or absorb vast amounts of material in a specific amount of time even if it may not be related to practicing medicine. This is a life skill that is important in success of becoming a physician and it can't be quantified. There's a lot of subjectivity that goes into medicine; one doctor's management will be different than another for the same patient. It isn't cut and dry as what you're making it out to be.

You're treating PE like a medication when it's not.

 

[V5RED]

Not really, because it's not as simple as how you're making it to be. I was just pointing out the flaws in your argument. There's skills obtained from doing the PE that is translatable to becoming a successful resident, regardless of how big or small it may be. You can't scientifically quantify life skills that may be subjective.

The reasons why I believe the MCAT/Step 1, etc are administered is to translate how a student can efficiently learn and/or absorb vast amounts of material in a specific amount of time. This is a life skill that is important in success of becoming a physician and it can't be quantified.

Prove it. Show data to back up that claim. Things like administrative action, program evaluations, and malpractice cases should correlate to the CS performance if your claim is true.

 

[mathnerd88]

Prove it. Show data to back up that claim. Things like administrative action, program evaluations, and malpractice cases should correlate to the CS performance if your claim is true.

You know as well as I do there will be no resident that doesn't pass the PE. Can't prove it. There's also too many confounding factors if this were to happen and cannot be done in a controlled environment.

 

[V5RED]

You know as well as I do there will be no resident that doesn't pass the PE. Can't prove it. There's also too many confounding factors if this were to happen and cannot be done in a controlled environment.

You are making claims that it is useful. If you can't provide data to back that up, then your belief in this test is basically just faith.

 

[ERK123]

Again, red herring. The question is whether this expensive test should be thrown out. Saying what about (insert anything that is not this test)? Is not an answer.

You are asking for data on a measurement that is not possible to perform. We don’t even know how to standardize what makes a physician “good” let alone have objective metrics that can predict who will meet such a threshold. At the end of the day the medical establishments makes decisions about what is necessary to join their club.

Program directors could easily decide that the PE is a worthless indicator for predicting resident performance or that other board scores are poor measure to as well. Overwhelmingly program directors have mostly decided that performance on these exams matter, likely due to poor experiences with past residents who did not do well on these metrics.

This might not be true forever. The importance of various metrics change over time. Step 1 scores were of much much less importance 25 years ago, and are set to become less important again shortly. Maybe the PE will go the same way one day, but to get there I think we need to explore more about the value PD’s currently feel the exam provides and how this value can perhaps be obtained by another method. At the end of the day, PD’s are looking for protection from potential residents with **** personalities and probably see the PE as at least some help in evaluating this.

 

[V5RED]

You are asking for data on a measurement that is not possible to perform. We don’t even know how to standardize what makes a physician “good” let alone have objective metrics that can predict who will meet such a threshold. At the end of the day the medical establishments makes decisions about what is necessary to join their club.

Program directors could easily decide that the PE is a worthless indicator for predicting resident performance or that other board scores are poor measure to as well. Overwhelmingly program directors have mostly decided that performance on these exams matter, likely due to poor experiences with past residents who did not do well on these metrics.

This might not be true forever. The importance of various metrics change over time. Step 1 scores were of much much less importance 25 years ago, and are set to become less important again shortly. Maybe the PE will go the same way one day, but to get there I think we need to explore more about the value PD’s currently feel the exam provides and how this value can perhaps be obtained by another method. At the end of the day, PD’s are looking for protection from potential residents with **** personalities and probably see the PE as at least some help in evaluating this.

You can compare performance on the exam to program evaluations, administrative actions, and/or malpractice cases. It is not impossible to do a study to check whether the test is predictive of performance in residency and beyond.

 

[Ho0v-man]

So my take is that the PE actually does need to exist.

Not because there’s anything valuable about it lol. But simply because the CS exists on the MD side. I could actually see having less “standardized” checks of our performance than our MD counterparts be a point of discrimination against us.

We all know that if a new MD intern sucks it’s because he/she sucks but if a DO intern sucks it’s because all DOs suck. So when a new DO intern shows up deficient at the skill set tested on the PE (writing notes/doing an exam) I could definitely see our lack of a formal exam like CS being pointed out as a reason not to take DOs in the future. I know how stupid this sounds, but that’s literally how stupid the bias is sometimes.

So I don’t blame nbome for making this test. I do blame them for making us do it with one minute less for SOAP notes and one minute less for exam even though we have to do omm 3-4 times. Also, it’s complete BS that MDs can put “wnl” for vitals while we have to type them all out despite having less time.

I thought this was actually a good review of writing notes and doing a physical exam. Like most things with the word “comlex” in it, if it wasn’t for omm and the lack of time it wouldn’t be that bad.

 

[Neopolymath]

So my take is that the PE actually does need to exist.

Not because there’s anything valuable about it lol. But simply because the CS exists on the MD side. I could actually see having less “standardized” checks of our performance than our MD counterparts be a point of discrimination against us.

We all know that if a new MD intern sucks it’s because he/she sucks but if a DO intern sucks it’s because all DOs suck. So when a new DO intern shows up deficient at the skill set tested on the PE (writing notes/doing an exam) I could definitely see our lack of a formal exam like CS being pointed out as a reason not to take DOs in the future. I know how stupid this sounds, but that’s literally how stupid the bias is sometimes.

So I don’t blame nbome for making this test. I do blame them for making us do it with one minute less for SOAP notes and one minute less for exam even though we have to do omm 3-4 times. Also, it’s complete BS that MDs can put “wnl” for vitals while we have to type them all out despite having less time.

I thought this was actually a good review of writing notes and doing a physical exam. Like most things with the word “comlex” in it, if it wasn’t for omm and the lack of time it wouldn’t be that bad.

Yes, this gets at the base reason this exam exists. It exists because the NBOME must show we are equal but distinct (hence the less time and more work). Otherwise, why does this exam exist? There are no FMGs to need it in the first place. It exists solely to copy the NBME and you can bet your money that it will not go away unless the NBME gets rid of CS as the NBOME is full of followers not leaders.

 

[Dr.Bruh]

I would have thought based on SDN that the PE/CS was gunna be the worst hell of an exam and that like 1/4 of people fail. Was suprised when I started asking as many 4ths years for advice as I could and the overwhelming advice i got was basically "just speak English and you'll pass" or "Just dont be a weirdo". After taking it and passing I can say I agree at least partially.

It sucks because, no doubt that some otherwise amazing great student will slip through the cracks and fail for some unfortunate reason. But that said, the people that fail the PE at my school are by in large the people who everyone expected to fail it. Mostly the "strange" kids. There are definetly people who fail that really suprise us but its by far the minority. Curious what its like at you schools. At mine, the exam is just a joke everyone says just take a few days to prep and practice and get it overwith.

 

[mathnerd88]

Yes, this gets at the base reason this exam exists. It exists because the NBOME must show we are equal but distinct (hence the less time and more work). Otherwise, why does this exam exist? There are no FMGs to need it in the first place. It exists solely to copy the NBME and you can bet your money that it will not go away unless the NBME gets rid of CS as the NBOME is full of followers not leaders.

There are no FMGs but there are students in which English is their second language and not US citizens in DO schools. The percentage may be small but it is still there. This may be true for even some US MD schools.

And yes, I agree that NBOME probably did it to copy the MD counterpart.

 

[km93]

I would have thought based on SDN that the PE/CS was gunna be the worst hell of an exam and that like 1/4 of people fail. Was suprised when I started asking as many 4ths years for advice as I could and the overwhelming advice i got was basically "just speak English and you'll pass" or "Just dont be a weirdo". After taking it and passing I can say I agree at least partially.

It sucks because, no doubt that some otherwise amazing great student will slip through the cracks and fail for some unfortunate reason. But that said, the people that fail the PE at my school are by in large the people who everyone expected to fail it. Mostly the "strange" kids. There are definetly people who fail that really suprise us but its by far the minority. Curious what its like at you schools. At mine, the exam is just a joke everyone says just take a few days to prep and practice and get it overwith.

I personally know two people who failed. I wouldn't call either one "strange". It's easy to make comments like this on the internet after passing it, but really, we have no idea how close we were to failing (or even what the standard is for passing).

 

[Cryc_to_the_point]

I was thankful to get the "P," but I know of a guy 1 year ahead of me that just matched into his first choice university IM program and he failed the PE. He did not have a good level 1. He crushed level 2 and is a hard-working decent person. Don't despair.

 

[Neopolymath]

There are no FMGs but there are students in which English is their second language and not US citizens in DO schools. The percentage may be small but it is still there. This may be true for even some US MD schools.

And yes, I agree that NBOME probably did it to copy the MD counterpart.

These students did about 3 years of school in America. Your point is moot. The point of CS was to screen foreigners not people living in America and obviously possessing the language and cultural skills to complete almost 3 years of written and verbal evaluation in America.

 

[mathnerd88]

Let's see...Step 1/Level 1, Step 2/Level 2, shelf scores, MSPEs, letters of recommendation, performance on sub-Is and aways, performance on interview day, the list goes on and on and on and on and on. Why, you think CS should be scored so as to better compare students?

I would like to point this out from NBOME.

Why did I fail the COMLEX-USA Level 2-PE examination? My medical school course grades and test scores, COMLEX-USA Level 1, Level 2-CE scores, and/or my clerkship ratings are very good.

Candidates should be aware that cognitive knowledge is measured principally by the COMLEX Level 1, Level 2-CE and Level 3 examinations, whereas clinical skills and performance are measured by COMLEX-USA Level 2-PE. The assessment formats of Level 2- CE and Level 2-PE examinations are different, and the examinations therefore are designed to measure different competencies. Numerous published studies show that there is only a very modest correlation between national clinical skills examinations (such as COMLEX-USA Level 2-PE) and other measures of academic performances (i.e., academic grades in medical school years 1 and 2, COMLEXUSA multiple choice cognitive examinations such as COMLEX-USA Level 1, Level 2-CE, USMLE scores, MCAT scores, and clerkship ratings). Consequently, the fact that a student may have performed satisfactorily or even quite well in an academic or other setting may not predict achievement in clinical skills. There is extensive literature that documents the low correlation between clerkship global rating forms and other academic measures (e.g., Multiple Choice Question- MCQ- examinations) as well as with national clinical skills examinations including COMLEX-USA Level 2-PE. For research related to the COMLEX-USA Level 2-PE, please see the Research and Resources link on the website.

http://8.41.202.67/docs/COMLEX_L2PE_Post_Exam_FAQ.pdf

Here is the Research and Resources Link:

http://www.nbome.org/docs/Articles_Published_By_Clinical_Skills_Testing.pdf

 

[mathnerd88]

These students did about 3 years of school in America. Your point is moot. The point of CS was to screen foreigners not people living in America and obviously possessing the language and cultural skills to complete almost 3 years of written and verbal evaluation in America.

Even so, there are also US MD students who fail the CS exam. I believe the answer is much more complicated than what you're making it seem. Or the point really of the CS exam is to make sure all incoming residents have some basic biomedical/humanistic proficiencies and not to just screen foreigners?

 

[V5RED]

I would like to point this out from NBOME.

Why did I fail the COMLEX-USA Level 2-PE examination? My medical school course grades and test scores, COMLEX-USA Level 1, Level 2-CE scores, and/or my clerkship ratings are very good.

Candidates should be aware that cognitive knowledge is measured principally by the COMLEX Level 1, Level 2-CE and Level 3 examinations, whereas clinical skills and performance are measured by COMLEX-USA Level 2-PE. The assessment formats of Level 2- CE and Level 2-PE examinations are different, and the examinations therefore are designed to measure different competencies. Numerous published studies show that there is only a very modest correlation between national clinical skills examinations (such as COMLEX-USA Level 2-PE) and other measures of academic performances (i.e., academic grades in medical school years 1 and 2, COMLEXUSA multiple choice cognitive examinations such as COMLEX-USA Level 1, Level 2-CE, USMLE scores, MCAT scores, and clerkship ratings). Consequently, the fact that a student may have performed satisfactorily or even quite well in an academic or other setting may not predict achievement in clinical skills. There is extensive literature that documents the low correlation between clerkship global rating forms and other academic measures (e.g., Multiple Choice Question- MCQ- examinations) as well as with national clinical skills examinations including COMLEX-USA Level 2-PE. For research related to the COMLEX-USA Level 2-PE, please see the Research and Resources link on the website.

http://8.41.202.67/docs/COMLEX_L2PE_Post_Exam_FAQ.pdf

Here is the Research and Resources Link:

http://www.nbome.org/docs/Articles_Published_By_Clinical_Skills_Testing.pdf

Weird how they can numerically compare it to other measures like clerkship evaluations, but somehow just can't fathom comparing it to residency performance evaluations, administrative actions, and malpractice cases. It is almost like they already believe the results would show it is worthless so they don't run the study.

 

[mathnerd88]

Weird how they can numerically compare it to other measures like clerkship evaluations, but somehow just can't fathom comparing it to residency performance evaluations, administrative actions, and malpractice cases. It is almost like they already believe the results would show it is worthless so they don't run the study.

As mentioned before, it would be almost impossible to run the study you want. You would need to have students who have failed the PE go into residency programs.

 

[km93]

As mentioned before, it would be almost impossible to run the study you want. You would need to have students who have failed the PE go into residency programs.

there are students who fail the PE on 1st try, pass on the retake, and match into residency programs EVERY year. i'm not sure why you are arguing so strongly in favor of the PE. an exam that you either passed by a sliver or a wide margin (you'll never know).

 

[bananafish94]

Numerous published studies show that there is only a very modest correlation between national clinical skills examinations (such as COMLEX-USA Level 2-PE) and other measures of academic performances (i.e., academic grades in medical school years 1 and 2, COMLEXUSA multiple choice cognitive examinations such as COMLEX-USA Level 1, Level 2-CE, USMLE scores, MCAT scores, and clerkship ratings).

At this moment I don't have the time to do a deep dive into the literature but I will later. Still, let's beg the question and say that this is true - PE has no correlation with any of these exams. Doesn't this actually support the argument that it's a random, capricious exam? At least in theory, this is a measure of your clinical acumen and communication and professionalism skills. So if you're telling me that there's no correlation between any of the other measures used in medical education? That suggests that there's something deeply wrong with this exam. If there was a good study that said that there's no correlation whatsoever between preclinical grades, Step 1, and Step 2, I would think that there is something completely wrong with the exams because there should be some correlation between these things. If you have a cohort of superstar students who did well on the boards and excelled clinically, and a cohort of students who barely passed the boards and got questionable professionalism and communication scores, should we not expect a difference on this exam that is ostensibly supposed to assess these factors?

Consequently, the fact that a student may have performed satisfactorily or even quite well in an academic or other setting may not predict achievement in clinical skills.

Interesting that this is the one sentence you didn't bold.

 

[mathnerd88]

there are students who fail the PE on 1st try, pass on the retake, and match into residency programs EVERY year. i'm not sure why you are arguing so strongly in favor of the PE. an exam that you either passed by a sliver or a wide margin (you'll never know).

I am just saying the PE is a necessary evil, like all the other board exams. Failing the PE on the first try and then passing on the retake is different than just taking a student who would have failed the PE (without ever taking it) and entering residency and evaluating their performance to compare to those who have passed the PE.

 

[mathnerd88]

Interesting that this is the one sentence you didn't bold.

Didn't bold it because I didn't want to create a giant blob bolded mess in the middle. Sorry.

 

[bananafish94]

There's this pit of alligators and piranhas right outside my front door that I have to climb over everyday. I'm personally opposed to it, but it's been there for 15 years so what can I do? At least it may or may not build character.

 

[V5RED]

As mentioned before, it would be almost impossible to run the study you want. You would need to have students who have failed the PE go into residency programs.

It seems like you are trying to be deliberately obtuse or have a failure of imagination. You can compare the performance(meaning their performance in their residencies and beyond) of residents who had to retake to those who did not. You can use the actual numerical scores (or more accurately the NBME can since they have that info) and see if there is a relationship between the score and the performance. This is not hard to figure out. There is a reason such a simple study has never been run. As long as people have an intractable faith-like belief in the exam, they don't need to prove it has merit.

I am just saying the PE is a necessary evil, like all the other board exams. Failing the PE on the first try and then passing on the retake is different than just taking a student who would have failed the PE (without ever taking it) and entering residency and evaluating their performance to compare to those who have passed the PE.

You say that despite having no evidence it is true and insisting that it is not possible to come up with evidence.

 

[mathnerd88]

It seems like you are trying to be deliberately obtuse or have a failure of imagination. You can compare the performance(meaning their performance in their residencies and beyond) of residents who had to retake to those who did not. You can use the actual numerical scores (or more accurately the NBME can since they have that info) and see if there is a relationship between the score and the performance. This is not hard to figure out. There is a reason such a simple study has never been run. As long as people have an intractable faith-like belief in the exam, they don't need to prove it has merit.

You can’t because they’ve already passed and met the competencies. You would need to compare those who would have failed the PE who haven’t taken it to those who have passed the PE.

Your position is to abolish the PE because it doesn’t produce better performance during residency. The only way to test it for sure without adding confounding factors is to take a student who would have failed the PE and put them through residency.

 

[V5RED]

You can’t because they’ve already passed and met the competencies. You would need to compare those who would have failed the PE who haven’t taken it to those who have passed the PE.

Your position is to abolish the PE because it doesn’t produce better performance during residency. The only way to test it for sure without adding confounding factors is to take a student who would have failed the PE and put them through residency.

If the test has value, someone who could not pass on the first attempt should be less likely to be a good physician. If it has value, then someone who passes with flying colors should be more likely to make a good physician than someone who borderline passed or had to retake. Obviously you can't compare people who never passed, but to then say that means it can't be tested is absurd. You are hung up on this idea that its value can't be measured when it very clearly can.

Do you work for the licensing boards? Why are you so hung up on insisting the test has value but refuse to consider trying to prove it has value or even the possibility that its value could be evaluated?

 

[AnatomyGrey12]

I would like to point this out from NBOME.

Why did I fail the COMLEX-USA Level 2-PE examination? My medical school course grades and test scores, COMLEX-USA Level 1, Level 2-CE scores, and/or my clerkship ratings are very good.

Candidates should be aware that cognitive knowledge is measured principally by the COMLEX Level 1, Level 2-CE and Level 3 examinations, whereas clinical skills and performance are measured by COMLEX-USA Level 2-PE. The assessment formats of Level 2- CE and Level 2-PE examinations are different, and the examinations therefore are designed to measure different competencies. Numerous published studies show that there is only a very modest correlation between national clinical skills examinations (such as COMLEX-USA Level 2-PE) and other measures of academic performances (i.e., academic grades in medical school years 1 and 2, COMLEXUSA multiple choice cognitive examinations such as COMLEX-USA Level 1, Level 2-CE, USMLE scores, MCAT scores, and clerkship ratings). Consequently, the fact that a student may have performed satisfactorily or even quite well in an academic or other setting may not predict achievement in clinical skills. There is extensive literature that documents the low correlation between clerkship global rating forms and other academic measures (e.g., Multiple Choice Question- MCQ- examinations) as well as with national clinical skills examinations including COMLEX-USA Level 2-PE. For research related to the COMLEX-USA Level 2-PE, please see the Research and Resources link on the website.

http://8.41.202.67/docs/COMLEX_L2PE_Post_Exam_FAQ.pdf

Here is the Research and Resources Link:

http://www.nbome.org/docs/Articles_Published_By_Clinical_Skills_Testing.pdf

It's almost like it doesn't correlate to, well, anything at all.....

Or the point really of the CS exam is to make sure all incoming residents have some basic biomedical/humanistic proficiencies and not to just screen foreigners?

The CS exam was quite literally built to screen foreigners.

 

[Ho0v-man]

I would like to point this out from NBOME.

Why did I fail the COMLEX-USA Level 2-PE examination? My medical school course grades and test scores, COMLEX-USA Level 1, Level 2-CE scores, and/or my clerkship ratings are very good.

Candidates should be aware that cognitive knowledge is measured principally by the COMLEX Level 1, Level 2-CE and Level 3 examinations, whereas clinical skills and performance are measured by COMLEX-USA Level 2-PE. The assessment formats of Level 2- CE and Level 2-PE examinations are different, and the examinations therefore are designed to measure different competencies. Numerous published studies show that there is only a very modest correlation between national clinical skills examinations (such as COMLEX-USA Level 2-PE) and other measures of academic performances (i.e., academic grades in medical school years 1 and 2, COMLEXUSA multiple choice cognitive examinations such as COMLEX-USA Level 1, Level 2-CE, USMLE scores, MCAT scores, and clerkship ratings). Consequently, the fact that a student may have performed satisfactorily or even quite well in an academic or other setting may not predict achievement in clinical skills. There is extensive literature that documents the low correlation between clerkship global rating forms and other academic measures (e.g., Multiple Choice Question- MCQ- examinations) as well as with national clinical skills examinations including COMLEX-USA Level 2-PE. For research related to the COMLEX-USA Level 2-PE, please see the Research and Resources link on the website.

http://8.41.202.67/docs/COMLEX_L2PE_Post_Exam_FAQ.pdf

Here is the Research and Resources Link:

http://www.nbome.org/docs/Articles_Published_By_Clinical_Skills_Testing.pdf

Bruh, is this the hill you’re gonna die on? An official statement that shows the comlex 2 PE literally correlates to nothing else in med school? This actually disproves your point about it’s relevance.

 

[mathnerd88]

Bruh, is this the hill you’re gonna die on? An official statement that shows the comlex 2 PE literally correlates to nothing else in med school? This actually disproves your point about it’s relevance.

There is relevance in the exam for PD's. There's a positive correlation between PD competency ratings and the PE. Argue what you want, but there is still relevance here for the PE, however big or small. It is difficult to be quantifiable. Saying that the PE has absolutely no relevance into becoming a competent physician is short-sighted. It's not about medical school; it's about training to become a competent physician.

Relationships between high-stakes clinical skills exam scores and program director global competency ratings of first-year pediatric residents

Responding to mandates from the Accreditation Council for Graduate Medical Education (ACGME) and American Osteopathic Association (AOA), residency programs have developed competency-based assessment tools. One such tool is the American College of Osteopathic ...

www.ncbi.nlm.nih.gov

Conclusions
Results of this study support the view that program director global assessments, like those used by most AOA and ACGME-accredited residency training programs, correlate with high-stakes clinical skills examination performance. Results specifically supported three major outcomes. First, biomedical/biomechanical domain and SOAP note component scores correlated positively with overall program director competency ratings. Second, humanistic domain scores correlated with program director competency ratings for interpersonal and communication skills. Third, three competency assessment factors were identified using principal component analysis, rather than the six ACGME or seven AOA general competencies. Exploring relationships between different clinical skills assessments, such as COMLEX-USA Level 2-PE and program director competency ratings, is inherently difficult because of the heterogeneity of tools used. Future work in utilizing comparable assessment tools would help to elucidate some of the findings of this study.

 

[mathnerd88]

The CS exam was quite literally built to screen foreigners.

If that's the case, why make US MD students take the CS then? Some US MD's still fail the CS at about the same rate that DO's fail the PE. They should make only foreigners take the CS. I understand that perhaps the NBME/NBOME wants to make more money, but I believe there's more reasons for the CS than just literally built to screen foreigners. My view is that the CS was done to make sure all those entering residency has some basic humanistic/SOAP note taking/history taking skills.

 

[V5RED]

There is relevance in the exam for PD's. There's a positive correlation between PD competency ratings and the PE. Argue what you want, but there is still relevance here for the PE, however big or small. It is difficult to be quantifiable. Saying that the PE has absolutely no relevance into becoming a competent physician is short-sighted. It's not about medical school; it's about training to become a competent physician.

Relationships between high-stakes clinical skills exam scores and program director global competency ratings of first-year pediatric residents

Responding to mandates from the Accreditation Council for Graduate Medical Education (ACGME) and American Osteopathic Association (AOA), residency programs have developed competency-based assessment tools. One such tool is the American College of Osteopathic ...

www.ncbi.nlm.nih.gov

Conclusions
Results of this study support the view that program director global assessments, like those used by most AOA and ACGME-accredited residency training programs, correlate with high-stakes clinical skills examination performance. Results specifically supported three major outcomes. First, biomedical/biomechanical domain and SOAP note component scores correlated positively with overall program director competency ratings. Second, humanistic domain scores correlated with program director competency ratings for interpersonal and communication skills. Third, three competency assessment factors were identified using principal component analysis, rather than the six ACGME or seven AOA general competencies. Exploring relationships between different clinical skills assessments, such as COMLEX-USA Level 2-PE and program director competency ratings, is inherently difficult because of the heterogeneity of tools used. Future work in utilizing comparable assessment tools would help to elucidate some of the findings of this study.

This was a study of 94 residents in total. Not particularly compelling for a test taken by thousands every year. At best this would give motivation to conduct an actual robust study.

"The sample included all 94 pediatric first-year residents who took COMLEX-USA Level 2-PE"

Also:
"Although significant correlations were found between biomedical/biomechanical domain scores and program director competency ratings, few significant correlations between component scores within the humanistic domain and competency ratings were identified"

"First, although correlations found in the study were statistically significant, many were weak and may lack practical significance"

 

[qwertythrowaway]

posting on a throwaway account - I recently failed the PE. I used the Kauffman videos, practiced multiple cases with classmates and wrote a bunch of timed notes. Wound up with a fail due to data gathering. Board scores, clerkship grades, OSCE/SP encounters were all pretty solid. I actually thought the exam went fairly well. I thought most of the cases were straightforward and there were only one or two I didn't think went well. If I had to guess, I think some of my physical exam skills were rusty and awkward (ophthalmoscope) and I didn't do a great job with asking/documenting ROS. Never in a million years did I think these mistakes would add up to a fail. It sucks.

In regard to the lack of open test dates, the NBOME specifically holds a few dates for repeat test takers. I was able to nab an August spot. There are quite a few June/Sept/Oct dates. I imagine these will open up to you all soon, so keep checking. Also feel free to post here or DM me if you have any advice on a retake. To anyone else going through this - hang in there. We'll get through this.

 

[Spectreman]

posting on a throwaway account - I recently failed the PE. I used the Kauffman videos, practiced multiple cases with classmates and wrote a bunch of timed notes. Wound up with a fail due to data gathering. Board scores, clerkship grades, OSCE/SP encounters were all pretty solid. I actually thought the exam went fairly well. I thought most of the cases were straightforward and there were only one or two I didn't think went well. If I had to guess, I think some of my physical exam skills were rusty and awkward (ophthalmoscope) and I didn't do a great job with asking/documenting ROS. Never in a million years did I think these mistakes would add up to a fail. It sucks.

In regard to the lack of open test dates, the NBOME specifically holds a few dates for repeat test takers. I was able to nab an August spot. There are quite a few June/Sept/Oct dates. I imagine these will open up to you all soon, so keep checking. Also feel free to post here or DM me if you have any advice on a retake. To anyone else going through this - hang in there. We'll get through this.

My IM preceptor matched at a VERY good program with a PE fail and “meh” Comlex in 2016, not that long ago. Point is you can still do great things my friend, hang in there. Work on your explanation for when it comes up in interviews and you’ll be good.

 

[bananafish94]

posting on a throwaway account - I recently failed the PE. I used the Kauffman videos, practiced multiple cases with classmates and wrote a bunch of timed notes. Wound up with a fail due to data gathering. Board scores, clerkship grades, OSCE/SP encounters were all pretty solid. I actually thought the exam went fairly well. I thought most of the cases were straightforward and there were only one or two I didn't think went well. If I had to guess, I think some of my physical exam skills were rusty and awkward (ophthalmoscope) and I didn't do a great job with asking/documenting ROS. Never in a million years did I think these mistakes would add up to a fail. It sucks.

In regard to the lack of open test dates, the NBOME specifically holds a few dates for repeat test takers. I was able to nab an August spot. There are quite a few June/Sept/Oct dates. I imagine these will open up to you all soon, so keep checking. Also feel free to post here or DM me if you have any advice on a retake. To anyone else going through this - hang in there. We'll get through this.

I’m really sorry that happened to you. Like we’ve said in this thread, it has nothing to do with your capabilities as a student and a doctor. I can tell you that in my experience on the trail this year, CS was openly derided and laughed at by multiple PDs - they’re pretty open about knowing that it’s a sham and the only reason they care at all about it is that you need it to get licensed. I forgot to submit my CS until very late in the game and nobody even emailed me.

Edit tried to type some tips and it got formatted strangely

 

[Ttriple-SEc]

Comlex pe cancelled. CS cancelled super impotent after all