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

February 26, 2019

The vice president of clinical skills testing shared how first and second year osteopathic medicine students can prepare for the important exam.

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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.

The NBOME, founded in 1934, is an independent, nongovernmental, not-for-profit organization with the mission of protecting the public by assessing competencies for osteopathic medicine and related healthcare professions. The COMLEX-USA series is the primary pathway to licensure for physicians seeking to practice osteopathic medicine and surgery.

Dr. Gross explained that the performance evaluation is a standardized patient-based assessment of fundamental clinical skills essential for osteopathic patient care, while the COMLEX-USA Level 2 CE (cognitive evaluation) test is a computer-based application of osteopathic medical knowledge concepts related to clinical sciences, patient presentations and physician tasks.

To take the level 2 PE and CE tests, students must have completed their second year at an accredited college of osteopathic medicine, must have passed the COMLEX-USA Level 1 exam following their second year of medical school, and be in good academic and professional standing at their school.

According to Dr. Gross, the performance evaluation occurs at two NBOME testing centers—one in Conshohocken, Pennsylvania, a suburb of Philadelphia, and the other in Chicago, Illinois. The test takes place during a six hour period and includes 12 standardized patient-based cases allowing 14 minutes for each patient encounter plus nine minutes to document findings in an e-SOAP note also known as a Subjective Objective Assessment Plan format. In addition, she said, 15-minute breaks take place after every four patient encounters stretching the time at the testing center to seven hours.

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.

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