Volume 114, Issue 4

Context: In 2007, the Lake Erie College of Osteopathic Medicine initiated its Primary Care Scholar Pathway (PCSP), a 3-year osteopathic predoctoral education curriculum. Objective: To assess preliminary outcomes of the PCSP curriculum. Methods: Scores for the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) Levels 1 and 2-Cognitive Evaluation (CE) and pass rates for Level 2-Performance Evaluation (PE) were obtained for individuals who graduated from the PCSP program in 2010, 2011, and 2012. Scores for Levels 1 and 2-CE were compared with national mean scores. Acceptance rates for residency programs were also recorded. Results: Nineteen PCSP graduates were included in the study: 3 graduated in 2010, 6 graduated in 2011, and 10 graduated in 2012. Scores for PCSP students were not significantly different than national average scores for COMLEX-USA Levels 1 and 2-CE ( P >.05). All 19 PCSP graduates passed the COMLEX-USA Level 2-PE on the first attempt, and all graduates were accepted into primary care residency programs. Conclusion: The COMLEX-USA scores of PCSP graduates were similar to national mean scores, suggesting that it is possible for osteopathic medical students to attain the same level of education as students of 4-year programs in less time. A 3-year osteopathic predoctoral education curriculum would allow students to complete their education at a reduced cost. This potential reduction in debt burden could encourage more students to pursue a primary care career and thus could help address the shortage of primary care physicians in the United States.

Context: The relevance of current standard medical school science prerequisites is being reexamined. Objectives: (1) To identify which science prerequisites are perceived to best prepare osteopathic medical students for their basic science and osteopathic manipulative medicine (OMM) coursework and (2) to determine whether science prerequisites for osteopathic medical school should be modified. Methods: Preclinical osteopathic medical students and their basic science and OMM faculty from 3 colleges of osteopathic medicine were surveyed about the importance of specific science concepts, laboratories, and research techniques to medical school coursework. Participants chose responses on a 5-point scale, with 1 indicating “strongly disagree” or “not important” and 5 indicating “strongly agree” or “extremely important.” Participants were also surveryed on possible prerequisite modifications. Results: Student responses (N=264) to the general statement regarding prerequisites were “neutral” for basic science coursework and “disagree” for OMM coursework, with mean (standard deviation [SD]) scores of 3.37 (1.1) and 2.68 (1.2), respectively. Faculty responses (N=49) were similar, with mean (SD) scores of 3.18 (1.1) for basic science coursework and 2.67 (1.2) for OMM coursework. Student mean (SD) scores were highest for general biology for basic science coursework (3.93 [1.1]) and physics for OMM coursework (2.5 [1.1]). Student mean (SD) scores were lowest for physics for basic science coursework (1.79 [1.2]) and organic chemistry for OMM coursework (1.2 [0.7]). Both basic science and OMM faculty rated general biology highest in importance (mean [SD] scores, 3.73 [0.9] and 4.22 [1.0], respectively). Students and faculty rated biochemistry high in importance for basic science coursework (mean [SD] scores of 3.66 [1.2] and 3.32 [1.2], respectively). For basic science coursework, students and faculty rated most laboratories as “important,” with the highest mean (SD) ratings for general anatomy (students, 3.66 [1.5]; faculty, 3.72 [1.1]) and physiology (students, 3.56 [1.7]; faculty, 3.61 [1.1]). For their OMM coursework, students rated only general anatomy and physiology laboratories as “important” (mean [SD] scores, 3.22 [1.8] and 2.61 [1.6], respectively), whereas OMM faculty rated all laboratories as “important” (mean scores, >3). Both student and faculty respondents rated research techniques higher in importance for basic science coursework than for OMM coursework. For prerequisite modifications, all respondents indicated “no change” for biology and “reduce content” for organic chemistry and physics. All respondents favored adding physiology and biochemistry as prerequisites. Conclusion: General biology and laboratory were the only standard prerequisites rated as “important.” Research techniques were rated as “important” for basic science coursework only. Physiology and biochemistry were identified as possible additions to prerequisites. It may be necessary for colleges of osteopathic medicine to modify science prerequisites to reflect information that is pertinent to their curricula.

Context: Assessment of osteopathic manipulative treatment (OMT) is included in the National Board of Osteopathic Medical Examiners' Comprehensive Osteopathic Medical Licensing Examination-USA Level 2-Performance Evaluation (COMLEX-USA Level 2-PE). The scores earned for OMT should be equivalent among all raters regardless of which technique is scored or which rater is scoring the performance. As a quality assurance measure, selected examination dates and the encounters within the administration of COMLEX-USA Level 2-PE are scored by 2 raters: first by a “live” rater and next by a quality assurance rater. Neither rater knows if he or she is the first or second rater. Objective: To compare candidate's scores recorded for OMT on COMLEX-USA Level 2-PE to determine whether differences exist among raters and techniques scored. Methods: The authors evaluated candidate performances that took place from July through November 2012. For each performance, 2 raters scored the same technique or different techniques using the OMT scoring rubric. Discrepancies between scores were compared using t tests. Statistical significance was set at P <.05 for most analyses. Results: Of the 708 performances, there was no statistically significant difference in scoring whether the OMT raters scored the same technique or different techniques when the students performed more than 1. There were no statistically significant differences between these results and instances when only a single technique was performed and scored. Conclusion: The present study provides reliability evidence for the use of the global OMT scoring tool in the evaluation of OMT in COMLEX-USA Level 2-PE.

Context: Few studies have investigated how well scores from the Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) series predict resident outcomes, such as performance on board certification examinations. Objectives: To determine how well COMLEX-USA predicts performance on the American Osteopathic Board of Emergency Medicine (AOBEM) Part I certification examination. Methods: The target study population was first-time examinees who took AOBEM Part I in 2011 and 2012 with matched performances on COMLEX-USA Level 1, Level 2-Cognitive Evaluation (CE), and Level 3. Pearson correlations were computed between AOBEM Part I first-attempt scores and COMLEX-USA performances to measure the association between these examinations. Stepwise linear regression analysis was conducted to predict AOBEM Part I scores by the 3 COMLEX-USA scores. An independent t test was conducted to compare mean COMLEX-USA performances between candidates who passed and who failed AOBEM Part I, and a stepwise logistic regression analysis was used to predict the log-odds of passing AOBEM Part I on the basis of COMLEX-USA scores. Results: Scores from AOBEM Part I had the highest correlation with COMLEX-USA Level 3 scores (.57) and slightly lower correlation with COMLEX-USA Level 2-CE scores (.53). The lowest correlation was between AOBEM Part I and COMLEX-USA Level 1 scores (.47). According to the stepwise regression model, COMLEX-USA Level 1 and Level 2-CE scores, which residency programs often use as selection criteria, together explained 30% of variance in AOBEM Part I scores. Adding Level 3 scores explained 37% of variance. The independent t test indicated that the 397 examinees passing AOBEM Part I performed significantly better than the 54 examinees failing AOBEM Part I in all 3 COMLEX-USA levels ( P <.001 for all 3 levels). The logistic regression model showed that COMLEX-USA Level 1 and Level 3 scores predicted the log-odds of passing AOBEM Part I ( P =.03 and P <.001, respectively). Conclusion: The present study empirically supported the predictive and discriminant validities of the COMLEX-USA series in relation to the AOBEM Part I certification examination. Although residency programs may use COMLEX-USA Level 1 and Level 2-CE scores as partial criteria in selecting residents, Level 3 scores, though typically not available at the time of application, are actually the most statistically related to performances on AOBEM Part I.

Context: Performance on the Osteopathic General Surgery In-Service Examination (ISE) has been shown to improve over time for osteopathic general surgery residents. The training level–specific concurrent validity of the ISE, however, has not been evaluated. Objective: To investigate whether residents' scores will improve as they move from level 1 through level 5 of the ISE. Methods: In this retrospective study, performance on the ISE was obtained from the American College of Osteopathic Surgeons for all of the osteopathic general surgery residency programs from 2008 through 2012. The weighted raw score and standardized score performance mean and standard deviation were determined across training levels. One-way t tests were performed between residency years and ISE scores. Parametric statistics were calculated with α set to .05. Results: The authors evaluated 1952 examinations during the study period. Of the 49 programs screened, 33 (67.3%) met inclusion criteria for the present study. Analysis of variance tests showed that there was significant variation in raw and standardized outcomes between residency levels (both P <.001). One-tailed t tests for both raw and standardized outcomes showed that all scores' differences between examinee levels were statistically significant ( P <.001), with the exception of raw scores between level 4 and level 5 examinees ( P =.20). Conclusion: There is near-uniform concurrent validity of the ISE by osteopathic general surgery training level. This psychometric characteristic supports the construct validity of this standardized test.

Context: Candidates taking the Comprehensive Osteopathic Medical Licensing Examination-USA Level 2-Performance Evaluation (COMLEX-USA Level 2-PE) are currently evaluated on their ability to document clinical findings using a handwritten postencounter note. However, keyboard data entry is increasingly used for medical documentation. Objective: To determine the use and perception of keyboard data entry among osteopathic medical students and residents in educational and clinical settings. Methods: A Web-based survey regarding frequency of and preference for keyboard data entry was distributed to 9801 osteopathic medical students, 17,268 osteopathic residents, and 34 clinical deans of colleges of osteopathic medicine (COMs). In addition, 31 COMs' clinical skills center directors were contacted to participate in a telephone survey about the use of keyboard data entry in their centers. Results: A total of 1711 students, 1198 residents, 14 clinical deans, and 17 clinical skills center directors responded to the surveys. The majority of students (872 [51%]) reported using electronic keyboard data entry at their COM's clinical skills center for postencounter notes. Among respondents, 379 students (23%), 77 residents (9%), and 1 clinical dean reported that electronic keyboard data entry is never or rarely used during clinical rotations. Most trainees (1592 students [93%], 864 residents [94%]) reported that they were either comfortable or very comfortable with typing. Given the option of recording methods for SOAP (subjective, objective, assessment, plan) note findings on the COMLEX-USA Level 2-PE, 7 clinical deans were unsure of their students' preferences, while the remaining favored keyboard data entry (5) over handwriting (2). The majority of student and resident respondents would choose keyboard data entry (1009 [60%] and 511 [55%], respectively). Conclusion: Osteopathic medical students and residents are comfortable with typing; they are exposed to and would prefer using an electronic form of entry for medical documentation. These results support a conversion from written postencounter notes to keyboard data entry of notes on the COMLEX-USA Level 2-PE.

The American Osteopathic Association Commission on Osteopathic College Accreditation (AOA COCA) is recognized by the US Secretary of Education as the only accrediting agency for osteopathic predoctoral education. To maintain its recognition with the US Secretary of Education, the AOA COCA is required to adhere to all federal laws and regulations associated with the recognition of accrediting agencies. The authors discuss changes in the policies and procedures applicable to review of substantive changes in existing colleges of osteopathic medicine. Also included is a review of AOA COCA–approved class sizes of the accredited colleges of osteopathic medicine.

Since 2008, the American Osteopathic Association has gathered data on osteopathic graduate medical education program compliance with the association's correction of deficiencies processes. The purpose of the current article is to look at those data to discover trends and identify patterns and areas for improvement for osteopathic graduate medical education. In addition to providing quantitative data, the author also uses qualitative data to explain why corrective action plans are recommended for denial.

The author provides an update on the current continuing medical education (CME) cycle, which began on January 1, 2013, and will end on December 31, 2015. The author also highlights changes to the CME process and the re-engineering of the CME program for the current cycle. Topic areas include recent changes in CME policies and the challenges associated with awarding and recording credits for the 2013-2015 CME cycle. In addition, the article provides information regarding online CME.