Comprehensive Osteopathic Medical Licensing Examination-USA Level Research Articles

Six practical tips to prepare for the Comprehensive Osteopathic Medical Licensing Examination (COMLEX) USA level 1

Sophisticated high-stakes licensure and specialty certification maintenance examinations are educational requirements in osteopathic medicine. Passing the Comprehensive Osteopathic Medical Licensing Examination (COMLEX) USA Level 1 is one of the crucial milestones that osteopathic medical students (DO students) must achieve while starting clinical rotations and before applying to residency programs. While standardized examinations are often used for gatekeeping purposes, the broader goal of COMLEX USA Level 1 is to assess competent osteopathic physicians. This manuscript aims to assist DO students as well as osteopathic medical educators, learning specialists, medical advisors, and administrators in preparing a successful plan for the COMLEX USA Level 1. The tips within this manuscript align with the information taught in osteopathic medical school curricula, including osteopathic principles and practice (OPP), osteopathic manipulative treatment (OMT) and the content outline found within the National Board of Osteopathic Medical Examiners (NBOME) blueprint. The planning tip system is (1) Doctor of Osteopathic Medicine (DO) curriculum focus; (2) OPP/OMT content study; (3) Practice using clinical scenarios; (4) Review the NBOME blueprint; (5) Effective practice using question banks; and (6) Practice using full-length exams. Issues related to allocating DO students' time in preparation for the exam while providing useful resources to learn planning strategies and practice with board-style questions are discussed. Using the DO PREP tip system in this manuscript, DO students can develop more effective board preparation strategies to improve their success on COMLEX USA Level 1. This opinion-based article describes some but not all tips for osteopathic medical students to plan their COMLEX USA Level 1 board preparation.

Relationship of Clinical Skills Performance in Medical School With COMLEX-USA Level 2-Performance Evaluation.

Osteopathic medical students are required to pass the Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) Levels 1- and 2-Cognitive Evaluation and COMLEX-USA Level 2-Performance Evaluation (PE) to graduate. Predictors of COMLEX-USA cognitive exam performance are well established, but relatively few studies have explored factors associated with performance on the Level 2-PE. To evaluate the relationship between school-based clinical competency assessments (written, simulation, and workplace evaluations) and Level 2-PE performance to ensure that these assessment efforts are effective and grounded in evidence to support student readiness. School-based performance measures for 451 first-time takers of COMLEX-USA Level 2-PE were analyzed. A series of Mann-Whitney analyses were applied to compare 3 types of clinical performance assessments against COMLEX-USA Level 2-PE pass-fail performance: (1) internal objective structured clinical examinations (OSCE; average discipline-specific OSCE score and a comprehensive OSCE); (2) national examination performance (average clinical subject Comprehensive Osteopathic Medical Achievement Test, or COMAT, scores and Comprehensive Osteopathic Medical Self-Assessment Examination, or COMSAE, Phase 2 scores); and (3) a workplace-based clinical evaluation by preceptors. Students who passed the Level 2-PE had a significantly higher average discipline-specific OSCE score, COMSAE Phase 2 performance score, average COMAT score, and individual subject COMAT scores in all subjects except Psychiatry. Students who passed the Level 2-PE humanistic domain also had significantly higher scores in the communication skill component of the school's comprehensive OSCE. Similarly, students who passed the Level 2-PE biomedical domain had significantly higher scores in the data gathering and subjective, objective, assessment, and plan documentation scores on the internal OSCE. The size of these differences (η2) was relatively small. Student performance on the competency-based preceptor evaluation showed no significant relationship with pass-fail performance on the Level 2-PE. High-stakes OSCEs aligned with the level 2-PE blueprint are effective predictors of performance and are an important way to support student readiness for the Level 2-PE. Other assessments, such as subject-based COMATs and COMSAE Phase 2, add value to school-based assessments over workplace-based assessments.

Nelson-Denny Reading Test Scores as a Predictor of Student Success in Osteopathic Medical Education

Reading skills are crucial in medical school, where students are expected to absorb an onslaught of new and complex material. Studies on reading assessment in osteopathic medical education are lacking. To address gaps in the literature related to reading assessment and to investigate the correlation of the Nelson-Denny Reading Test with various performance indicators in osteopathic medical education. The West Virginia School of Osteopathic Medicine administered the Nelson-Denny Reading Test to first- and second-year students between 2015 and 2017. Raw scores were translated into the percentile rank, scale score, grade equivalent score, and stanine score based on guidelines supplied with the Nelson-Denny Reading Test. These translated scores were compared with Medical College Admission Test (MCAT) scores, first- and second-year performance on course examinations, Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) Level 1 scores, and scores provided in a 2002 study by Haught and Walls. A total of 623 students took the first-year Nelson-Denny Reading Test, and 408 took both the first- and second-year Nelson-Denny Reading Test. Findings showed a large correlation between the Nelson-Denny Reading Test and the verbal reasoning section (r=0.56 for the class of 2020 and 0.46 for the class of 2021) of the old MCAT (before 2015) and the reasoning skills section (r=0.42 for the class of 2020 and 0.49 for the class of 2021) of the new MCAT (released in 2015). There were no correlations with first- and second-year course examination scores or COMLEX-USA Level 1 scores. The Nelson-Denny Reading Test scores reported by Haught and Walls for medical students and health professional students were slightly higher than those found for osteopathic medical students in this study. The reasoning skills section of the new MCAT could serve as a good proxy for a reading test. There were no correlations between the Nelson-Denny Reading Test and performance in the first 2 years of medical school or COMLEX-USA Level 1 performance. Further research can strengthen the findings and determine whether correlations exist with clinical performance.

Association Between Undergraduate Performance Predictors and Academic and Clinical Performance of Osteopathic Medical Students.

Medical schools use a variety of preadmission indices to select potential students. These indices generally include undergraduate grade point average (GPA), Medical College Admission Test (MCAT) scores, and preadmission interviews. To investigate whether the admission indices used by Midwestern University Arizona College of Osteopathic Medicine are associated with the academic and clinical performance of their students. Associations between the prematriculation variables of undergraduate science GPA, undergraduate total GPA, MCAT component scores, and interview scores and the academic and clinical variables of the first- and second-year medical school GPA, Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) Level 1 and Level 2-Cognitive Evaluation (CE) total and discipline scores, scores in clinical rotations for osteopathic competencies, COMLEX-USA Level 2-Performance Evaluation passage, and match status were evaluated. Two-tailed Pearson product-moment correlations with a Bonferroni adjustment were used to examine these relationships. The traditional predictors of science and total undergraduate GPA as well as total and component MCAT scores had small to moderate associations with first- and second-year GPA, as well as COMLEX-USA Level 1 and Level 2-CE total scores. Of all predictors, only the MCAT biological sciences score had a statistically significant correlation with failure of the COMLEX-USA Level 2-Performance Evaluation examination (P=.009). Average interview scores were associated only with the osteopathic competency of medical knowledge (r=0.233; n=209; P=.001), as assessed by clerkship preceptors. No predictors were associated with scores in objective structured clinical encounters or with failing to match to a residency position. The data indicate that traditional predictors of academic performance (undergraduate GPA, undergraduate science GPA, and MCAT scores) have small to moderate association with medical school grades and performance on COMLEX-USA Level 1 and Level 2-CE. This finding requires additional research into the value of the interview in the medical school admissions process and the availability of alternatives that allow better prediction and assessment of applicant performance.

Evidence-Based Redesign of the COMLEX-USA Series.

To ensure that the Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) reflects the evolving practice of osteopathic medicine, the National Board of Osteopathic Medical Examiners has developed new content and format specifications for an enhanced, competency-based examination program to be implemented with COMLEX-USA Level 3 in 2018. This article summarizes the evidence-based design processes that served as the foundation for blueprint development and the evidence supporting its validity. An overview is provided of the blueprint's 2 dimensions: Competency Domains and Clinical Presentations. The authors focus on the evidence that supports interpretation of test scores for the primary and intended purpose of COMLEX-USA, which is osteopathic physician licensure. Important secondary uses and the educational and catalytic effect of assessments are also described. This article concludes with the National Board of Osteopathic Medical Examiners' plans to ensure that the COMLEX-USA series remains current and meets the needs of its stakeholders-the patients who seek care from osteopathic physicians.

Comprehensive Osteopathic Medical Licensing Examination-USA level 1 and level 2-cognitive evaluation preparation and outcomes.

The Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) assesses the competence of osteopathic physicians in training. It is designed to protect the public by setting minimum competence standards. All osteopathic medical students must pass COMLEX-USA Level 1, Level 2-Cognitive Evaluation, and Level 2-Performance Evaluation before being allowed to graduate from an osteopathic medical school. Residency training programs use COMLEX-USA scores as a major factor in deciding whom they will interview and admit into their programs. In addition, colleges of osteopathic medicine use student COMLEX-USA scores as an external assessment of their success in educating students. Because COMLEX-USA is a high-stakes examination series, it is important to understand predictive factors for performance. The authors review the literature on the relationship between COMLEX-USA scores and correlated student variables. Results from the Council on Osteopathic Student Government Presidents' survey on students' preparation methods and performance are also provided.

Relationship of admissions variables and college of osteopathic medicine variables to performance on COMLEX-USA level 3.

New accreditation standards require that all US colleges of osteopathic medicine (COMs) publically report the first-time pass rates of graduates on the Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) Level 3. Little is known about the extent to which admissions variables or COM performance measures relate to Level 3 performance. To examine the relationship of admissions variables and COM performance to scores on Level 3 and to assess whether a relationship existed between Level 3 scores and sex, curriculum track, year of graduation, and residency specialty in the first postgraduate year. Data were analyzed from 4 graduating classes (2008-2011) of the West Virginia School of Osteopathic Medicine in Lewisburg. Relationships were examined between first-attempt scores on COMLEX-USA Level 3 and Medical College Admission Test (MCAT) scores; undergraduate grade point averages (GPAs); GPAs in COM year 1, year 2, and clinical rotation years (years 3 and 4); and first-attempt scores on COMLEX-USA Level 1, Level 2-Cognitive Evaluation, and Level 2-Performance Evaluation. Of the 556 graduates during this 4-year period, COMLEX-USA Level 3 scores were available for 552 graduates (99.3%). No statistically significant differences were found in Level 3 scores based on sex, curriculum track, graduating class, or residency specialty. The strongest relationship between Level 3 scores and any admissions variable was with total MCAT score, which accounted for 4.2% of the variation in Level 3 scores. The strongest relationship between Level 3 scores and COM year performance measures was with year 2 GPA, which accounted for 35.4% of the variation in Level 3 scores. Level 1 scores accounted for 38.5% of the variation in Level 3 scores, and Level 2-Cognitive Evaluation scores accounted for the greatest percentage of variation (45.7%). The correlation of Level 3 scores with passing the Level 2-Performance Evaluation on the first attempt was not statistically significant. A weak relationship was found between admissions variables and performance on COMLEX-USA Level 3, suggesting that graduates with lower MCAT scores and undergraduate GPAs may have overcome their early disadvantage. Strong relationships were found between Level 3 scores and year 2 GPAs, as well as scores on COMLEX-USA Level 1 and Level 2-Cognitive Evaluation.

Predictive relationship of osteopathic manual medicine grades and COMLEX-USA Level 1 total scores and osteopathic principles and practice subscores.

Osteopathic manual medicine (OMM) encompasses hands-on diagnosis and treatment as part of patient care. The area of osteopathic principles and practice (OPP) is considered a core competency for students and practitioners of this medical tradition. The Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) is a useful tool for assessing candidates' competency. To examine the relationship of COMLEX-USA Level 1 total scores and OPP subscores with OMM course grades, and to determine if these grades are predictive of COMLEX-USA Level 1 OPP performance. The authors collected data-COMLEX-USA Level 1 total and OPP subscores, OMM grades (written, practical, and total for first and second academic years), sex, and age-for a cohort of osteopathic medical students at a single institution, and these data were then analyzed by means of correlation analysis. Records were obtained from a second-year class of osteopathic medical students (N=217). The authors' analysis of total scores and OPP subscores on COMLEX-USA Level 1 yielded a statistically significant correlation with all variables. Although the correlations were moderate, second-year written examination grades showed the strongest association with the COMLEX-USA Level 1 OPP subscores (r=0.530) and total scores (r=0.566). Performance in the second-year OMM written examination could identify students potentially at risk for poor performance on COMLEX-USA Level 1.

Relationship Between COMLEX-USA Scores and Performance on the American Osteopathic Board of Emergency Medicine Part I Certifying Examination

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. To determine how well COMLEX-USA predicts performance on the American Osteopathic Board of Emergency Medicine (AOBEM) Part I certification examination. 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. 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). 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.

Predictors of Scoring at Least 600 on COMLEX-USA Level 1: Successful Preparation Strategies

Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) Level 1 scores are an important criterion used by residency directors to make residency placement decisions. To explore the association between scoring at least 600 on COMLEX-USA Level 1 and grade point average (GPA), scores on the Medical College Admission Test (MCAT), and different test preparation strategies. Third-year osteopathic medical students at Nova Southeastern University were invited to complete a self-administered survey regarding their COMLEX-USA preparation strategies and to provide consent for the researchers to access their preclinical GPA and their MCAT and COMLEX-USA scores. Descriptive analyses were conducted to understand examination preparation procedures and resources used, and bivariate analyses were conducted to identify the statisically significant predictors of scoring 600 or higher. Two separate logistic regressions were also run. The first included all of the statisically significant factors that emerged from the bivariate analyses, and the second examined which candidate predictors remained statistically significant once the effects of GPA and MCAT scores were removed. One hundred twenty-two students completed the survey, and 113 (93%) provided informed consent to access their preclinical GPA and their MCAT and COMLEX-USA scores. In the first regression, scoring 600 or higher was associated with a higher GPA (P<.02), a higher MCAT score (P<.05), earlier preparation initiation (P<.05), and not ranking the Comprehensive Osteopathic Medical Self-Assessment Examination (COMSAE) as the most helpful practice examination (P<.04). In the second regression, scoring 600 or higher was associated with earlier initiation of examination preparation (P<.01) and not ranking COMBANK (question bank for COMLEX-USA) as the most helpful question bank (P<.03). Among the different examination preparation methods, the specific resources ranked as most helpful were First Aid for the USMLE (United States Medical Licensing Examination) (review book), the COMSAE (practice examination); COMBANK (question bank); and Kaplan USMLE (lecture videos). Preclinical GPA and MCAT scores continue to be important predictors of scoring at least 600 on COMLEX-USA Level 1. However, the findings underscore the importance of maintaining a high GPA during the first 2 years of medical school and initiating COMLEX-USA preparation early.

Student performance on levels 1 and 2-CE of COMLEX-USA: do elective upper-level undergraduate science courses matter?

The effect of a variety of preadmission variables, including the number of elective preadmission upper-level science courses, on academic achievement is not well established. To investigate the relationship between number of preadmission variables and overall student academic achievement in osteopathic medical school. Academic records of osteopathic medical students in the 2008 and 2009 graduating classes of Western University of Health Sciences College of Osteopathic Medicine of the Pacific in Pomona, California, were analyzed. Multivariate linear regression analyses were performed to identify predictors of academic achievement based on Medical College Admission Test (MCAT) subscores, undergraduate grade point average (GPA), GPA in medical school basic science (preclinical GPA) and clinical clerkship (clinical GPA), and scores on the Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) Level 1 and Level 2-Cognitive Evaluation (CE). Records of 358 osteopathic medical students were evaluated. Analysis of beta coefficients suggested that undergraduate science GPA was the most important predictor of overall student academic achievement (P<.01). Biological sciences MCAT subscore was a more modest but still statistically significant predictor of preclinical GPA and COMLEX-USA Level 1 score (P<.01). Physical sciences MCAT subscore was also a statistically significant predictor of preclinical GPA, and verbal reasoning MCAT subscore was a statistically significant predictor of COMLEX-USA Level 2-CE score (both P<.01). Women had statistically significantly higher preclinical GPA and COMLEX-USA Level 2-CE scores than men (P<.05). Differences in some outcome variables were also associated with racial-ethnic background and age. Number of preadmission elective upper-level science courses taken by students before matriculation was not significantly correlated with any academic achievement variable. Although undergraduate science GPA and MCAT biological sciences subscore were significant predictors of overall academic achievement for osteopathic medical students, the number of elective upper-level science courses taken preadmission had no predictive value.

Relationship between academic achievement and student performance on the Comprehensive Osteopathic Medical Licensing Examination-USA level 2.

The Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) is a three-part examination used for licensing osteopathic physicians. The relationship between performance on this examination and prior student academic performance has been unclear. This study explores the relationship between COMLEX-USA level 2 scores and student academic performance at Oklahoma State University College of Osteopathic Medicine (OSU-COM). All first-time examination candidates from OSU-COM had a formal, weeklong board review in March 2000, and all passed the examination. Predictions about COMLEX-USA scores generated by the academic dean's office at OSU-COM underestimated student examination performance; results suggest a significant correlation between level 2 performance with (1) level 1 performance (.751); (2) grade point average (GPA) in basic science (.659); (3) total GPA (.672); and (4) Medical College Admission Test (MCAT) scores (.406). The correlation of level 2 scores to clinical GPA (.269) was lower but still significant. Results of this study suggest that performance on COMLEX-USA level 2 is strongly correlated with prior student academic performance in this population.