title: An evaluation of cost and appropriateness of care as recommended by candidates on a national clinical skills examination.
abstract: BACKGROUND
  The National Board of Osteopathic Medical Examiners administers the COMLEX-USA Level 2-PE, an assessment of clinical skills of osteopathic medical students. This evaluation includes developing a patient care plan.
  
  
  OBJECTIVE
  Based on one simulated case, we investigated the appropriateness and cost of care and quantified their relationship to performance.
  
  
  METHODS
  Four hundred sixty-seven postencounter notes were coded for appropriateness using expert physician judgments and for cost of care using Centers for Medicare and Medicaid Services data. Various outcome measures were correlated with physician scores.
  
  
  RESULTS
  In this case, candidates recommended an average of 5.6 interventions with an average cost of $227 and appropriateness rating of 2.4 on a 1 (indicated) to 4 (potentially dangerous) scale. Total cost and inappropriateness of actions were negatively correlated with candidate scores (r = -.208, p < .0001 and r = -.318, p < .0001, respectively).
  
  
  CONCLUSIONS
  Results from this investigation provide some evidence to support the validity of physician note ratings of patient care plans and demonstrate the need to include these principles in medical education.
authors.affiliation: Clinical Skills Testing, National Board of Osteopathic Medical Examiners, Conshohocken, PA, USA. jsandella@nbome.org
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Sandella
authors.forename: John R
authors.initials: JR
authors.lastname: Boulet
authors.forename: Erik E
authors.initials: EE
authors.lastname: Langenau
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D055360:Osteopathic Physicians / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D005791:Patient Care / Q000191:economics* / Q000592:standards / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data; D014481:United States; D055815:Young Adult