2014-2015 Orientation Guide

COMLEX-USA Level 2-PE

IMPORTANT FACTS

It is recommended that candidates arrive 30 minutes prior to the scheduled examination, allowing for travel
delays common to the Greater Philadelphia area.


Candidates are required to bring one source of government-issued legal photo identification (drivers license
preferred) and confirmation of their scheduled examination from the website or their confirmation email.

Candidates should view the Instructional Program available online via www.nbome.org. Candidates should
note that a tutorial and practice module for the eSOAP are also available on our website.

Candidates should dress professionally, wear a white lab coat and bring a standard stethoscope.

Due to extensive psychometric equating, calibration, and quality assurance processes, Level 2-PE scores are
generally released within 8-10 weeks of the examination date. Score release schedules are posted on the
NBOME website for examination cohorts. Candidates should schedule their Level 2-PE as soon as possible,
but no later than the Fall of their 4
th
year, in order to meet any graduation requirements.

Any irregular conduct will be thoroughly investigated and dealt with according to NBOMEs policies and
procedures (See Bulletin of Information).




Overview

This Orientation Guide is designed to be one of several sources of reference for osteopathic candidates who
have registered for the COMLEX-USA Level 2-PE. In addition to reviewing this guide, it is strongly advised
that prior to taking the examination, all candidates view the Instructional Program and eSOAP tutorial for
COMLEX-USA Level 2-PE available online. On the day of a candidates scheduled examination, a detailed
orientation session will also be provided on-site at the NBOME National Center for Clinical Skills Testing.
Students will not have the opportunity on-site to practice writing an eSOAP note.

Candidates are encouraged to consult the NBOME website regularly, as any new information regarding
COMLEX-USA Level 2-PE will be posted. Candidates are also required to review the information provided in
the NBOME Bulletin of Information. This bulletin, as well as other helpful information regarding the
examination, is posted on the website at www.nbome.org.


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Statement of Purpose

COMLEX-USA Level 2-PE is the clinical skills component of the Comprehensive Osteopathic Medical
Licensing Examination (COMLEX-USA). Consistent with NBOMEs mission to protect the public,
COMLEX-USA Level 2-PE fulfills the public and licensing authority mandate for enhanced patient safety
through the documentation of the clinical skills proficiency of graduates from osteopathic medical schools. The
Performance Evaluation augments the written COMLEX-USA Level 2-Cognitive Evaluation (CE) of
osteopathic medical knowledge by providing an assessment of fundamental clinical skills. These clinical skills
are: doctor-patient communication, interpersonal skills and professionalism, medical history-taking and physical
examination skills, osteopathic principles and osteopathic manipulative treatment, and documentation skills
(including synthesis of clinical findings, integrated differential diagnosis and formulation of a diagnostic and
treatment plan). These patient-centered skills are evaluated in the context of clinical encounters with
standardized patients, and are required to be personally performed as appropriate in a timely, efficient, safe, and
effective manner. The ability to communicate in the English language is required in each clinical encounter. A
passing score for COMLEX-USA Level 2-PE means that the candidate has demonstrated minimal competency
in clinical skills for entry into graduate medical education.


Scheduling and Rescheduling

Candidates should visit the NBOME website to register for the examination as soon as they are eligible to take
the clinical skills examination. Registered candidates will be able to view exam dates and schedule the
examination by an automated online scheduling system (using a secure identification number and password) via
the website. Examination dates are opened for scheduling and can be scheduled up to 1 year in advance. Dates
on different weekdays as well as many weekend dates will be made available on a continuous basis throughout
the testing year, and will be scheduled on a first-come, first-served basis. Note that both morning sessions
(8 AM-3:30 PM) and evening sessions (2 PM-9:30 PM) are available throughout the year. The
confirmation page or email of the examination date should be brought to the National Center for Clinical Skills
Testing as proof of your appointment time. Candidates will want to schedule their PE examination as soon
as possible, and no later than the Fall of their 4th year, in order to meet any graduation requirements.
Candidates who have failed the examination and need a retake date should call NBOMEs National
Center for Clinical Skills Testing if they are encountering any difficulties with scheduling through the
registration system. Further information regarding retesting is available on NBOMEs website.

If candidates must cancel and reschedule any testing date for the COMLEX-USA Level 2-PE examination,
significant rescheduling charges may apply. Candidates can cancel a scheduled examination online, unless
it is on the same day as the examination. Candidates are advised to contact the NBOME National Center for
Clinical Skills Testing (610-825-6551) immediately if encountering travel delays or the need to cancel an
exam session on the day of a scheduled examination; failure to notify NBOME prior to the start of the
examination session will result in a cancellation fee of $650 as noted in NBOMEs Bulletin of Information.







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101 W. Elm Street
Conshohocken, PA
NBOME National Center for
Clinical Skills Testing
Overview of the Examination

NBOME National Center for Clinical Skills Testing

The COMLEX-USA Level 2-PE/Clinical Skills Examination is administered
at the NBOME National Center for Clinical Skills Testing in Conshohocken,
Pennsylvania (near Philadelphia). The Center has the look and feel of an
outpatient clinic, with examination rooms that are equipped with
examination/treatment tables, diagnostic equipment (diagnostic otoscopes
and direct ophthalmoscopes, blood pressure cuffs, tongue blades, cotton
swabs, reflex hammers, tuning forks), sinks, and instant hand sanitizer. The
center has been in operation since 2004 and is a state-of-the-art, technologically advanced clinical skills testing
facility designed to ensure the necessary safety, security, and standardization required for fairness in high-stakes
testing.

Candidates should dress professionally, wear a white lab coat and bring a standard stethoscope to the
examination. Amplified stethoscopes, or any similar device that may mimic a recording or communicating
device, or any attachments to a standard stethoscope (e.g., light source) are prohibited. Candidates with
disabilities including hearing impairment should refer to NBOMEs website for an application for testing
accommodations. All other diagnostic equipment will be provided. While wrist watches and other personal
timing devices are prohibited in the examination, there are clocks in each examination room and throughout the
testing center. Regular audio timing prompts will also guide you through your timing.


Arriving at the Test Center

Candidates are advised to arrive at the center, well rested and well fed, at least thirty minutes prior to the
examination start time. Candidates should anticipate heavy traffic delays, which are common to the Greater
Philadelphia area, and plan accordingly. The high stakes nature and complexity of this examination allows little
leniency with regard to unforeseen traffic or other such delays. Candidates who arrive late for the
examination may not be able to take the examination and risk forfeiture of a significant portion of the
registration fee. Candidates are advised to contact the NBOME National Center for Clinical Skills
Testing (610-825-6551) immediately if encountering travel delays or the need to cancel an exam session;
failure to notify the NBOME prior to the start of the examination session will result in a rescheduling fee
of $650 as noted in NBOMEs Bulletin of Information.

Candidates are required to bring one source of government-issued legal photo identification (drivers license
preferred) and confirmation of their scheduled examination, either the email or printed from the website. All
candidates will be digitally photographed and biometrically scanned (fingerprint) as part of the registration
process. Pagers, cell phones, wrist watches, and other electronic devices are prohibited and must be stored in
lockers during the examination. Individual full-sized (large enough to accommodate carry-on sized luggage)
lockers are available for storing all personal belongings; however the stored items will not be accessible during
the examination. The use of Smartphones, pocket PCs, iPods, MP3 players, other electronic devices, manuals or
other clinical resources is not permitted during the examination. Other valuables such as laptop computers,
expensive jewelry, etc., should not be brought to the test center as the NBOME cannot be held responsible for
these during the examination. Candidates will not be permitted to leave the test center or have contact with
others outside of the center by phone or otherwise until the conclusion of the examination.

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Information regarding travel to the center and accommodations is available on the website (www.nbome.org).
Student discounts have been negotiated with local hotels for candidates traveling to the area for the exam.


Examination Design

Prior to beginning the examination, candidates will receive a 50-minute orientation. During the 6-hour
examination, candidates will rotate through a series of 12 standardized patient encounters. In each encounter,
candidates will have 14 minutes to evaluate and treat the patient as they see fit given the time allowed, including
the patient interview and history-taking, performing indicated physical examination maneuvers, communicating
with and counseling the patient, and performing osteopathic manipulative treatment as indicated. Following
each encounter candidates will have an additional 9 minutes to type a SOAP Note detailing their clinical
findings and assessment of the case at a computer terminal outside of the clinical encounter room.

Patients presenting complaints and reasons for their visit are those common to osteopathic medical practice in
the outpatient, primary care, or emergency room settings. Symptoms and problems are classified as relating to
the following systems: respiratory, cardiovascular, neuromusculoskeletal, gastrointestinal, and other (e.g.
genito-urinary, behavioral, etc.). All cases are developed by a committee of osteopathic physicians and faculty
members representing the osteopathic medical profession, including the osteopathic medical colleges. The set
of psychometrically equivalent cases administered on any given test date will match a predefined blueprint
which balances cases across the criteria mentioned above. COMLEX-USA Level 2-PE assesses the ability to
interact with patients who vary in age, gender, and ethnic and cultural background, and will present with clinical
presentations that could be acute, chronic, or opportunities for health promotion and disease prevention. This is
essential to the construct of the COMLEX-USA Level 2-PE examination. Therefore, requests to alter the types
of patients encountered in the examination will not be considered, as this would fundamentally alter what is
being assessed.


The Standardized Patient Encounter

Standardized patients are professionals who are trained to portray clinical scenarios in a standardized fashion in
clinical skills testing situations. Candidates are advised to interview and evaluate standardized patients as they
would with real patients presenting with the same symptoms or problems. Candidates are reminded to respect
the standardized patients as with real patients, remembering to wash their hands (with soap & water or instant
hand sanitizer) in each station, to use appropriate draping of the patient for physical examination as necessary,
and to treat the patients gently.

When taking a medical history and performing a physical examination or treatment, given the 14-minute time
limit, it may not be feasible to perform a comprehensive evaluation in every case. Candidates are advised to
choose the history questions, physical examination maneuvers, and treatment techniques that are most important
to making the diagnosis, based on clinical judgment and training, and to rule out red flags for the significant
other possibilities existent for the clinical presentation. In addition, candidates should demonstrate effective
doctor-patient communication skills, interpersonal skills, and professionalism throughout the examination.

Candidates should accept their physical examination findings as real even though the finding may be simulated.
Physical examination maneuvers should be performed as they would in any real clinical situation. Candidates
should avoid sloppiness and short cuts. However, the following physical examination maneuvers are prohibited
on the standardized patients in the examination: genital exams, rectal exams, internal pelvic examinations,
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female breast exams, and corneal reflex exams. A candidate may mention these exams to the standardized
patient if they would be important to the case, and then document the intention to do so in the eSOAP note. If
indicated, cardiac, respiratory and abdominal examinations, for example, should be performed on male and
female patients as with real patients. There is no need to bring in an additional person to the room as an exam
chaperone, as all encounters are being viewed live and digitally recorded by surveillance cameras. Standardized
patients will not use any cue cards or finding cards in this examination and will stay in their character at all
times during the exam. Candidates are not to use or refer to imaginary people, equipment, paperwork,
interventions, medications, etc. which are not provided for use in the examination rooms. Standardized patients
will not respond to these artificial items or maneuvers. For instance, a candidate may not instruct a patient to
take this pill during the encounter. If asked how do you feel after taking the pill?, the standardized patient
will not acknowledge that anything has been given. Parental consent to evaluate standardized patients who are
minors (i.e., younger than 18) will be noted on the doorway information sheet in the patient chart.

Standardized patients are involved in repeated physical examinations throughout the course of the day. J ust
with any patient, candidates should treat standardized patients with appropriate force and obtain
information from the physical examination and utilize OMT in a manner that is not excessively forceful for the
patients. If the standardized patient states, Thats a bit rough, Doctor the candidate should either modify or
discontinue the maneuver or treatment to be more gentle. While candidates are likely to encounter potentially
life threatening patient conditions that require prompt diagnosis and intervention, COMLEX-USA Level 2-PE
does not currently test advanced cardiac life support or invasive procedures.

Candidates should not turn off the overhead lights in the examination rooms, for example, to perform
ophthalmological/fundoscopic examination, as this will affect the video digital recording.


Doorway Information Sheet/Patient Chart

For each exam room, a doorway information sheet will be contained inside the patient chart. The doorway
information sheet will contain a brief statement of the patients reason for visit (similar to a nurses note), as
well as the patients vital signs, and instructions to evaluate and treat the patient in 14 minutes as you see fit.
This chart and its contents can be taken into the room and to the SOAP Note completion desk after the
encounter. Scrap paper is also provided in the chart for additional note taking and will not be scored, but
shredded after the exam.

Information such as the patients vital signs should be accepted as accurate for the patient. Candidates may
desire to recheck the patients vital signs if the case warrants the physician confirming them, but are advised to
always consider the numerical values listed on the doorway information sheet as accurate for the purposes of
formulating the differential diagnosis/problem list or evaluation and treatment plan. Any additional information
provided in some cases such as relevant x-ray reports, lab results, or EKGs will be found in the chart as well.


An example of the Doorway Information sheet is found on the next page:






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DOORWAY INFORMATION

Patient Name J oe Sample

Clinical Setting Family Medicine Office

Case Information This 52 year old male complains of neck pain.

Vital Signs

Height 69 inches

Weight 170 lbs

BMI 25.1 kg/m
2


BP 130/80 mmHg

Temp 98.5 F

HR 72 bpm

RR 14 bpm



Candidate Instructions

You have 14 minutes to evaluate and treat the patient as you see fit.

Following the examination you will have 9 minutes to complete a post-encounter SOAP
note.



Please do not write on this page.






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Examination Day Schedule

The examination day at the center lasts approximately seven hours. This includes an orientation presentation by
NBOME staff, as well as a video program and time for candidates to familiarize themselves with the diagnostic
equipment and the examination/treatment tables. Fourteen minutes are allowed for each standardized patient
encounter, which includes the time before a candidate enters the room in which the patients presenting
information (doorway information) is reviewed. In the event that a candidate finishes evaluating and treating
the patient in fewer than 14 minutes, he/she may leave the room and finish completing the SOAP Note,
however, the candidate will not be permitted to re-enter the room. After the 14 minute encounter time,
candidates will have nine additional minutes to complete the SOAP Note, which will be completed at the
computer terminal immediately outside of the exam room.

After a set of four encounters, there will be a 30-minute break where a light meal will be provided. Candidates
may bring their own food if desired. If a candidate has strict dietary needs, it is recommended that they bring
their own food. Refrigeration of personal food is possible; however the ability to cook or reheat food is not. An
additional 15-minute break will follow the next four encounters. Timing bells followed by clear audio prompts
will announce the start of each encounter and guide candidates along the way. For example:

You may begin your clinical encounter.
Two minutes remaining in the encounter.
Time is up in the encounter, please leave the room and report to your SOAP Note desk.
Two minutes remaining for the SOAP Note.
Time is up, please stop writing.
Please rotate to your next station (or) Follow the proctors to the break area.

Candidates will have the opportunity to complete a brief survey at the end of the examination day.


Use of Osteopathic Principles and OMT

Candidates are expected to incorporate osteopathic principles and practices into encounters with standardized
patients in COMLEX-USA Level 2-PE where indicated and appropriate. This includes palpatory diagnosis,
osteopathically-oriented history taking, documentation of osteopathic findings and treatment, and osteopathic
manipulative treatment (OMT). When indicated, a candidate may choose to perform OMT on any patient in the
examination, with their consent, provided that the candidate follows the following guidelines:

Standardized patients may be treated with any indicated OMT technique with the exception of High
Velocity Low Amplitude (HVLA) or other articulatory mobilization techniques (where a barrier of an
articulation is engaged and a thrust is utilized to normalize joint mobility). Similar to physical
examination maneuvers, OMT techniques should be performed with appropriate force on
standardized patients, and the total duration of the treatment should not be longer than three to
five minutes for any given patient, or until a trained physician observer could note effectiveness and
quality of technique. Commonly employed techniques include muscle energy, counterstrain, functional
technique, soft tissue/myofascial, facilitated positional release, Still technique, Spencer technique,
lymphatic pump, Cranial Osteopathy, fascial release, Galbreath technique and sinus drainage. While
HVLA and other articulatory techniques are safe, proven, and effective for treating real patients with
somatic dysfunction, they can create hypermobility if the body is not allowed the opportunity to recover.
The standardized patient may not be able to tolerate the multiple candidates treating them with these
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techniques during the typical exam day. Similar to certain physical exam maneuvers in the exam, (e.g.,
rectal exams, etc.), candidates would be advised to document their plan to perform this type of OMT, if
indicated, in their SOAP Note. As with physical examination maneuvers, candidates should either
modify or discontinue the maneuver or treatment to be more gentle if a standardized patient states,
Thats a bit rough, Doctor.


SOAP Notes

The SOAP Note represents an opportunity to demonstrate documentation skills (in English), document clinical
findings, exercise clinical problem-solving skills, formulate a differential diagnosis and a diagnostic and
treatment plan. It is acceptable to use either a narrative or a more bullet or laundry list style for the notes,
provided they are documented in English. The S is for the subjective components, the O for objective
findings, the A for the assessment/differential diagnosis, and the P for the plan.

Candidates are instructed to document significant findings from the patients history in the Subjective portion,
and physical examination findings and any other key objective findings in the Objective portion. Candidates
should try to be as specific as possible when documenting physical findings, avoiding the word normal. With
the exception of vital signs provided, under no other circumstances should a candidate document results of
physical examination maneuvers or techniques that were not performed, or medical history that was not
elicited. Documenting results of physical examination maneuvers that were not performed, or medical history
that was not elicited will be considered irregular conduct and will be thoroughly investigated and dealt with
according to NBOMEs policies and procedures (see Professionalism section below).

For the Assessment section, candidates will be evaluated on the ability to make an accurate or plausible
diagnosis, as well as to list at least two other diagnostic possibilities for the patients presenting problem. This
should be listed in a Differential Diagnoses format, with the most likely diagnosis for the presenting
concern/symptom/issue listed first. Even if the diagnosis is fairly certain or the presenting problem is more for
health promotion and disease prevention, candidates should consider and document at least three potential
diagnoses or etiologies in this section. For health promotion / disease prevention visit types of encounters,
if providing a differential diagnosis would not be relevant, candidates may list the patients problems in a
problem list format, or list relevant risk factors for the area of concern.

For the Plan component, candidates should note any workup or treatment that he/she would propose for the
patient, including questions or physical exam maneuvers that you inadvertently did not ask or perform, but
would plan to if time allowed. In most cases, specific drugs or drug dosages are not required, but candidates
should try to be as specific as possible when referring to diagnostic tests (e.g., serum electrolytes, BUN,
creatinine, and glucose as opposed to blood tests, SMA7, or Chemistry Panel). All SOAP Notes should
be completed to stand alone as the only documentation for that encounter, as information on the scrap paper
or doorway information sheet will not be considered as part of the required documentation.

Candidates should be careful to adhere to the nine minute time limitation on completing their SOAP Notes. The
eSOAP note keyboard will be disabled at the conclusion of the 9 minute completion period.

It is generally advisable to avoid or limit abbreviations in medical documentation due to the lack of
standardization and the potential for medical error. If a candidate desires to do so, it is advisable to use only
those abbreviations that are considered standardized and would be easily recognized by the osteopathic
physician examiners scoring the SOAP Notes. Common English language or medical abbreviations are
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included in the Common Abbreviation List, which will be available at each SOAP Note writing desk throughout
the examination. The use of uncommon, obscure, confusing and idiosyncratic abbreviations runs the risk of
misinterpretation by the physician examiner, which could negatively impact the score on the note.

SOAP Note Directions (similar to the posting at each desk)
Complete a note documenting your findings in the text boxes provided.

Note that overall synthesis and linkage, organization and accuracy is important as notes are scored by physician
examiners.

Limit abbreviations to avoid confusion for the examiners; a Common Abbreviations List is provided for your
reference.

With the exception of vital signs provided, under no other circumstances should you document results of
physical examination maneuvers or techniques that were not performed or medical history that was not elicited.

S = Subjective findings
List patient input regarding the problem(s), medical history, etc.

O = Objective findings
List data from your physical examination, lab or imaging studies, etc.

A = Assessment
This is your impression as to the diagnosis, listing at least three possible etiologies for the patient
problem/symptom or concern. Rank in order of likelihood for the given case. For well visits, list at least
three problems or risk factors.

P = Plan
This is your plan for preliminary work-up and treatment (indicated diagnostic investigations, other history
and physical exam data you would gather & therapeutic interventions). Specific drug dosages are
generally not required, but be as specific as possible when referring to diagnostic tests.

















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A completed SOAP Note example (not necessary exemplary) is provided below:




There is an eSOAP Note practice module available on the NBOME website: Click here to access the site

By visiting the site, you will learn how to get the most out of the SOAP Note online practice resources
available. The brief tutorial will guide you through the features and navigation of the electronic SOAP Note
used at the NCCST. There is also a sample encounter video that can be used as a base for the content of your
practice note, as well as the Doorway Information sheet and an example of a completed SOAP Note.







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SOAP NOTE Common Abbreviations

It is recommended that you spell out names and terms rather than abbreviate when creating your SOAP notes.
However, if you desire, you may use common abbreviations when creating your notes, similar to those listed
below. Avoid abbreviations that might lead to medical errors.


Abd abdomen LMP last menstrual period
AIDS acquired immune deficiency syndrome LP lumbar puncture
ETOH alcohol Lspine lumbar spine
b black MRI magnetic resonance imaging
BMI body mass index m male
BUN blood urea nitrogen Meds medications
CCU cardiac care unit MVA motor vehicle accident
CPR cardiopulmonary resuscitation MI myocardial infarction
CVA cerebrovascular accident - negative
Cspine cervical spine Neuro neurologic
CXR chest x-ray NKA no known allergies
cc: chief complaint NKDA no known drug allergies
COPD chronic obstructive pulmonary disease NIDDM non insulin-dependent diabetes mellitus
CTA clear to auscultation NSR normal sinus rhythm
c/o complaining of Po orally
CBC complete blood count OMT osteopathic manipulative treatment
CT computed tomography Ppd packs per day
CHF congestive heart failure PTT partial thromboplastin time
CABG coronary artery bypass grafting PMH past medical history
DTR deep tendon reflexes PSH past surgical history
DM diabetes mellitus PE physical examination
ENT ears, nose and throat + positive
ECG or
EKG electrocardiogram PT prothrombin time
ED emergency department PERLA pupils equal, react to light and accommodation
EMT emergency medical technician ROM range of motion
E extended RBC red blood cells
EOM extraocular muscles RRR regular rate and rhythm
Ext extremities ROS review of systems
FH family history R right
f female ROT rotated
F flexed RO rule out
GI gastrointestinal SB side bent
GU genitourinary SH social history
HEENT head, eyes, ears, nose and throat Tspine thoracic spine
HVLA high velocity, low amplitude TIA transient ischemic attack
hx history US ultrasound
h/o history of URI upper respiratory tract infection
HIV human immunodeficiency virus U/A urinalysis
HTN hypertension W white
JVD J ugular venous distention WBC white blood cells
KUB kidney, ureter, and bladder WNL within normal limits
L left Yo year-old
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Humanistic Domain: Doctor-Patient Communication, Interpersonal Skills & Professionalism

Doctor-patient communication, interpersonal skills and professionalism are complex and multidimensional, and
are best defined in the assessment context as specific observable behaviors and conduct throughout the entire
examination.
1. One dimension assesses the candidates ability to elicit information, including the ability to ask
questions in an articulate, understandable, straightforward manner, the appropriate use of open-ended
questions and facilitative prompts, and a good command of spoken English.
2. A second dimension is that of listening skills, assessing the ability to both listen to and respond
appropriately to the patients statements and questions.
3. The next dimension is giving information, described as the ability to effectively communicate clear
explanations and counseling with regard to the patients concerns and to facilitate appropriate closure.
4. Next is respectfulness, differentiated as the ability to treat the patient in a polite, sensitive and
collaborative manner; honoring others choices and rights, demonstrating appropriate cultural
competence, and holding the patient in high regard or esteem.
5. The fifth dimension is empathy, defined in this context as the ability to demonstrate and communicate
(verbally/non-verbally) understanding, concern and interest in the patients medical problem and life
situation.
6. The last dimension is professionalism, which in this context assesses the ability to show an altruistic
interest in the patients welfare, the ability to appear both appropriately confident and therapeutic, and to
ensure patient confidentiality and ethical principles.
Humanistic domain attributes are evaluated by trained professionals using holistic rating tools and extensive
quality assurance processes, and standards are set as informed by input from communication experts and
osteopathic physicians who are representative of osteopathic medical practice from around the country.


Additional Attributes of Professionalism

The assessment of professionalism in COMLEX-USA Level 2-PE extends beyond behaviors that are
documented in the examination rooms with standardized patients. Any irregular conduct that would constitute
unprofessional conduct, as outlined in NBOMEs Bulletin of Information, with regard to the application or
registration for, the taking of, or the conduct after taking any COMLEX-USA examinations subject to
NBOMEs policies, could result in invalidation of an examination or disqualification. This includes copying,
fraud, or sharing of any examination content or material, use of prohibited reference materials during the
examination, and verbally or physically harassing any NBOME staff at any time, including when contacting
NBOME for information about failing scores. In addition, misrepresentation of clinical findings on the
medical record (eSOAP Notes) in COMLEX-USA Level 2-PE by documenting medical history that was
not elicited, or physical examination maneuvers or techniques that were not performed, is considered
irregular conduct and will be thoroughly investigated and dealt with as specified in NBOMEs Bulletin of
Information.


Scoring and Score Reporting

Candidates history-taking and physical examination skills will be documented by the standardized patient
portraying the case immediately following the encounter. Doctor-patient communication, interpersonal skills,
and professionalism will be evaluated by the standardized patient at that time. Completed eSOAP Notes and
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OMT skills (by digital recording) will be rated by NBOME trained and approved osteopathic physician
examiners.

Pass or Fail scores will be reported as the overall examination score, and for each of two examination
domains which are shown below.

Humanistic Domain: Measures skills in doctor-patient communication, interpersonal skills,
professionalism. Assessed skills within this domain include the ability to elicit information,
listening skills, giving information, respectfulness, empathy and professionalism.

Biomedical/Biomechanical Domain: Measures skills in Data-Gathering, osteopathic
manipulative treatment, and documentation skills (eSOAP Notes).
1. The Data-Gathering component reflects skills in history-taking and physical examination.
2. The OMT portion represents performance in osteopathic assessment and manipulative
treatment in select cases.
3. The completed eSOAP Note measures communication (synthesizing information gathered in
the clinical encounter), clinical problem-solving, integrated differential diagnosis and
formulation of a therapeutic plan. Osteopathic principles are incorporated into each of the
three areas.

In order to receive a passing score for the overall examination, a candidate must pass both of the domains.
A passing score for COMLEX-USA Level 2-PE means that the candidate has demonstrated minimal
competency in clinical skills for entry into graduate medical education. Candidates may compensate for poor
performance in one case with stronger performance in another. Similarly, candidates may compensate for
substandard performance in some areas of the Biomedical/Biomechanical domain with stronger performance in
others. All candidates who receive a failing score for either domain will be provided relative performance
feedback (e.g. poor, proficient) for each domain, as well as for each score component for the
Biomedical/Biomechanical domain, designed to assist with remediation at their osteopathic medical school or
program. This performance feedback provided on the score report represents the only feedback that can be
reported to candidates who fail the examination. The NBOME will not rescore encounters or components by
videotape, or review case specific or general deficiencies with candidates. Information about Candidate Score
Confirmation can be found in the Bulletin of Information. Further information regarding failing scores is
available on the COMLEX-USA Level 2-PE Score Reporting FAQ Document, which is available on the
website. Failing candidates should consult with their school for recommended remediation programs.

Scores will generally be available within 8-10 weeks of the examination date. Please see the NBOME
website for more detailed information on expected score release dates for your particular examination session.
There are occasionally short delays in score reporting due to circumstances that are out of NBOMEs control.
Score reports will be available via secure access through the website. A personal email is sent to each candidate
tested informing them when scores have been posted. A score release calendar is also available on the website
which shows the date range within which you can expect your scores based on when you tested. Candidates
should consult with NBOMEs Bulletin of Information posted on the website for detailed information
regarding score reporting.





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Testing Regulations

Candidates are restricted from discussion of the clinical cases or the examination at any time during the
examination, including breaks, or at any time after the examination. Any attempt to gain prior information
regarding specific clinical cases is strictly prohibited. Any violations or other disclosure of such material will
be taken very seriously by the NBOME and may lead to disqualification and thus jeopardize a candidates
eligibility for licensure. These violations are further detailed in the NBOMEs Bulletin of Information,
which is available at www.nbome.org.

All common areas as well as examination and break rooms in the center are monitored with video surveillance.
Any irregular conduct that is judged as undermining the security of the examination process will be
thoroughly investigated and dealt with according to NBOMEs policies and procedures. These behaviors
may include, but are not limited to: disruptive or inappropriate behavior at the center; giving or receiving
unauthorized assistance during the examination; possessing unauthorized devices, equipment, or materials
during the examination (recording or photographic devices, cellular phones, reference materials or other
communications devices); sharing of examination content before, during or after the examination;
communicating with other candidates in any language other than English at any time at the center; failure to
follow proctors instructions, including continuing to evaluate the patient or complete the SOAP Note after the
time limit; note-taking of any kind, except on the SOAP Note forms and scrap sheets provided for that purpose;
falsifying a candidates own identity or eligibility to take the examination; failure to adhere to any NBOME
examination policy and failure to follow instructions of NBOME staff at the center.