Volume 111, Issue 7

Context: In 2007, The National Board of Osteopathic Medical Examiners (NBOME) instituted a policy to address the accuracy and integrity of postencounter written documentation recorded during the Comprehensive Osteopathic Medical Licensing Examination Level 2-Performance Evaluation (COMLEX-USA Level 2-PE). This policy was instituted not only to protect the integrity of the examination, but also to highlight that overdocumentation of clinical findings not obtained during patient encounters may jeopardize patient safety. Objective: To investigate overall and domain pass/fail patterns of candidates who misrepresented clinical findings with regard to past and subsequent performance on COMLEX-USA Level 2-PE. Specifically, to investigate what percentage of candidates failed because of misrepresentation on first attempts and how they performed on subsequent administrations, as well as the previous performance patterns of candidates who failed because of misrepresentation on examination retakes. Methods: Historical records from NBOME's COMLEX-USA Level 2-PE database (testing cycles 2007-2008, 2008-2009, and 2009-2010) were used to analyze overall and domain pass/fail patterns of candidates who failed at least once because of misrepresentation of clinical findings. Results: Of the 24 candidates who failed because of misrepresentation of postencounter (SOAP) notes, 20 candidates (83%) were first-time examinees. Four candidates (17%) were repeating the examination, 2 of whom were making a third attempt to pass. Among these 20 candidates who failed because of misrepresentation of clinical findings on their first attempt, 19 passed on their next attempt. At the time of study analysis, all but 2 candidates eventually passed the examination in subsequent attempts. Conclusion: Among candidates found to have misrepresented clinical findings on postencounter written documentation on COMLEX-USA Level 2-PE, no pattern existed between their past or subsequent performance with regard to overall or domain pass/fail results. The vast majority of these candidates passed the examination on subsequent administrations, and none failed twice because of misrepresentation. Consequences of misrepresentation of clinical findings on COMLEX-USA Level 2-PE are severe and may serve to both raise awareness and prevent these types of errors in the future.

Bevacizumab has shown efficacy in many different malignancies and is approved by the US Food and Drug Administration for advanced colon and lung cancers. As bevacizumab use is expanding, the number of reports of serious adverse effects from the drug are growing. Bowel perforation is a rare but often fatal event that leads the list of dangerous adverse effects. It has been frequently reported in ovarian cancer trials, with early closure of some trials because of the high incidence of bowel perforation. Physicians should be familiar with not only the presentation of bowel perforation, but also with the risk factors, considerations for surgery, and management of perforation in selected patient populations. The authors review the current knowledge on bevacizumab-induced bowel perforation.

During her year as president of the American Osteopathic Association, Karen J. Nichols, DO, visited all 26 colleges of osteopathic medicine. She reflects on those visits and shares her perceptions of the future of the osteopathic medical profession.

Living organ donors are growing in number and account for a substantial proportion of organs transplanted. Types of living organ donors include family members, anonymous donors, and friends. Although familial donation is the most common form of living organ donation, anonymous donation and donation among friends are gaining popularity. Society has placed living organ donors at the top of the altruistic ladder. However, one's altruistic motives for living organ donation may be affected by the type of relationship he or she has with the organ recipient. Although family relationships are close, pressure and coercion from family members may make informed consent difficult. Anonymous donors do not have the pressure associated with a familial donation, but psychological and self-worth issues may influence their choice to donate. Friendship incorporates the close relationships associated with familial donation and the freedom associated with anonymous donation. Using Aristotle's definition of true friendship, the author argues that best friends are the only true altruistic living organ donors and therefore may be preferable to family donors or anonymous donors.

In this inaugural installment of “Clinical Images,” the authors describe a patient with extraparenchymal neurocysticercosis.