Scoring Process

Candidate’s performance with respect to taking the patient’s history, conducting the physical examination, doctor-patient communication, interpersonal, and professionalism clinical skills are documented by the Standardized Patient (SP) immediately after the candidate exits the encounter. SOAP Notes and OMT skills are rated by NBOME trained and approved osteopathic physician examiners via a secured electronic recording process.

Because the COMLEX-USA Level 2-PE adheres to a conjunctive scoring standard the candidate must pass both the Humanistic domain and Biomedical/Biomechanical domain during the same exam administration. Performance within each domain; however, adheres to a compensatory standard, where low performance on one or more clinical skills (e.g., data-gathering) can be offset by high performance in another clinical skill (e.g., OMT). For candidates who pass the examination, COMLEX-USA Level 2-PE score reports include the candidate’s Pass overall and on both domains. For candidates’ who Fail the examination, COMLEX-USA Level 2-PE score reports include their overall fail and breakdown of pass or fail on each domain. Additional descriptive performance levels for each domain are provided only to those who receive an overall fail.

Humanistic Domain: Measures aspects of doctor-patient communication, interpersonal skills and professionalism. Measured skills within this domain include.

• Eliciting information
• Listening skills
• Giving information
• Respectfulness
• Empathy
• Professionalism

Biomedical/Biomechanical Domain: Measures aspects of data-gathering, osteopathic manipulative treatment (OMT) and documentation (e-SOAP Notes) skills.

1. The data-gathering component reviews clinical skill in taking a patient’s history and conducting the physical examination.
2. The OMT component reviews clinical skill in osteopathic assessment and manipulative treatment. The following OMT components are measured:
   • Osteopathic examination/evaluation
   • Patient/physician position for treatment
   • OMT modality selected
   • OMT technique
   • Treatment repetition/duration
   • Post-treatment assessment
3. The e-SOAP Note component reviews clinical skill in:
• Communication (synthesizing information gathered in the clinical encounter).
• Clinical problem-solving and integrated differential diagnosis.
• Formulation of a therapeutic plan.
• Osteopathic principles are incorporated into each of these three areas.

Candidates can request a score confirmation that reviews the accuracy of data collected and scoring procedure; however, NBOME policy does not engage in multiple review of video recorded encounters or e-SOAP notes.