title: Pass/fail patterns of candidates who failed COMLEX-USA level 2-PE because of misrepresentation of clinical findings on postencounter notes.
abstract: BACKGROUND
  In 2007, The National Board of Osteopathic Medical Examiners (NBOME) instituted a policy to address the accuracy and integrity of postencounter written documentation recorded during the Comprehensive Osteopathic Medical Licensing Examination Level 2-Performance Evaluation (COMLEX-USA Level 2-PE). This policy was instituted not only to protect the integrity of the examination, but also to highlight that overdocumentation of clinical findings not obtained during patient encounters may jeopardize patient safety.
  
  
  OBJECTIVE
  To investigate overall and domain pass/fail patterns of candidates who misrepresented clinical findings with regard to past and subsequent performance on COMLEX-USA Level 2-PE. Specifically, to investigate what percentage of candidates failed because of misrepresentation on first attempts and how they performed on subsequent administrations, as well as the previous performance patterns of candidates who failed because of misrepresentation on examination retakes.
  
  
  METHODS
  Historical records from NBOME's COMLEX-USA Level 2-PE database (testing cycles 2007-2008, 2008-2009, and 2009-2010) were used to analyze overall and domain pass/fail patterns of candidates who failed at least once because of misrepresentation of clinical findings.
  
  
  RESULTS
  Of the 24 candidates who failed because of misrepresentation of postencounter (SOAP) notes, 20 candidates (83%) were first-time examinees. Four candidates (17%) were repeating the examination, 2 of whom were making a third attempt to pass. Among these 20 candidates who failed because of misrepresentation of clinical findings on their first attempt, 19 passed on their next attempt. At the time of study analysis, all but 2 candidates eventually passed the examination in subsequent attempts.
  
  
  CONCLUSIONS
  Among candidates found to have misrepresented clinical findings on postencounter written documentation on COMLEX-USA Level 2-PE, no pattern existed between their past or subsequent performance with regard to overall or domain pass/fail results. The vast majority of these candidates passed the examination on subsequent administrations, and none failed twice because of misrepresentation. Consequences of misrepresentation of clinical findings on COMLEX-USA Level 2-PE are severe and may serve to both raise awareness and prevent these types of errors in the future.
authors.affiliation: National Board of Osteopathic Medical Examiners (NBOME) National Center for Clinical Skills Testing in Conshohocken, Pennsylvania, USA. elangenau@nbome.org
authors.forename: Erik E
authors.initials: EE
authors.lastname: Langenau
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Sandella
mesh_terms: D000328:Adult; D002983:Clinical Competence; D016208:Databases, Factual; D004521:Educational Measurement / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008007:Licensure, Medical / Q000592:standards*; D008297:Male; D019300:Medical Errors; D010021:Osteopathic Medicine / Q000193:education*; D055360:Osteopathic Physicians / Q000193:education* / Q000706:statistics & numerical data; D018570:Risk Assessment; D014481:United States