Friday, October 21, 2005
As threatened, I took the physical examination portion of my medical board exams today - the COMLEX PE (Comprehensive Osteopathic Medical Licensing EXam) Physical Exam. Ever since I first heard we were going to be required to take this exam nearly 3 years ago, I have been (usually quite vehemently) opposed to it. When the president of the AOA (American Osteopathic Association) came to our school to "answer questions" (read: tell us what he wants us to know and avoid answering any questions we might ask), I was there asking what was the need for this exam when the schools test us on the exact same things that were to be tested on this exam.

The reasons we were given is that there was a "public outcry"to the schools of medicine to prove that their graduates are adequately trained to talk to patients and take medical histories and perform physical exams. This test has been around for years - it was previously administered only to foreign medical graduates who wished to enter residency training in this country, and it was called the Clinical Skills Assessment (CSA). Everyone knew the exam basically tested proficiency in spoken English language and had very little to do with actual clinical skills. This is one reason I opposed the exam - everyone graduating from a US medical school already has demonstrated English proficiency and does not need to be tested on their English language skills.

So, the arms on the clock have turned enough times that I have now taken this exam. Still, I claim it is a waste of time and a very large amount of money. The exam charge is $995.00, which is outrageous enough until one considers the exam is administered in only one place in the US - Conshohocken, Pennsylvania. This means that all 4th year students from all Osteopathic medical schools must travel to this one site and take the exam. Travel and lodging is not included in the exam fee, nor was it included in my loan disbursement. I was told that I would need to "budget carefully" to allow extra money to travel to the site and stay in a hotel (for an average of $150 per night) while there. All this to take a test that has not been proven to be necessary by any study or even common sense.

Needless to say, I'm a bit pissed. I'm even more angry after having taken the exam. It was poorly designed, poorly run, and I assume will be poorly scored. From what I understand, something on the order of 96% of exam-takers pass the test, if not more. This means that basically, I could have gone up there, given the NBOME my $1000 and (statistically) walked back out without having to waste a whole day taking this ridiculous exam.

Why is it poorly designed? Let me explain: The exam uses Standardized Patients (SPs) as their subjects. They are "extensively trained" to perfectly emulate whatever condition they are supposed to "have." They use a series of tricks to try to emulate physical exam findings - none of which are particularly successful or accurate. For instance, if one is trying to elicit reflexes and they want to show them to be decreased, they will contract their muscle as you strike the tendon, thereby diminishing the visible reflex. On the other hand, if they want to show hyperactive reflexes, they will exaggeratedly flex the muscle after the tendon is struck. These two are the most believable methods they use to fake physical exam findings. Others they use is saying "Hush, Hush" while you listen to their heart to fake a murmur, moving their chest wall and not actually breathing to emulate decreased breath sounds, whistling to emulate wheezes, and more.

The problem with these maneuvers is that they are not realistic, and they are frequently inaccurate. For instance, on several patients, I thought they were trying to emulate "crackles" in their lungs, but I could not tell what it was they were trying to do, since I had no idea what their "trick" for making crackles is. Maybe they were trying to emulate "crackles," but maybe they are just coarse breathers. I couldn't tell. All I know is that it didn't sound like any crackles I'd ever heard before.

I suppose we'll see how it all turns out in the end. I'm expecting my Pass/Fail score sometime in January 2006. I expect to have passed, but I really think it's a toss-up. I could have flipped a coin at the front desk and had just as good a feeling about the outcome of the exam as I do now. Funny for someone who always as people remark to him how good his clinical skills are, eh?
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Ahhhhh.. 4th year. If the rumours are true, this will be a cake walk. Herein is my online account of my 4th year of medical school - follow with me to see if the hype is true or lie.

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