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Standardized Patients and Osteopathic Manipulative Treatment During COMLEX-USA Level 2-PE

Journal: The Journal of the American Osteopathic Association Date: 2010/08, 110(8):Pages: 479-480. doi: Subito , type of study: retrospective study

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2010.110.8.445/html)

Keywords:

exams [33]
OMT [3779]
osteopathic manipulative treatment [3799]
osteopathic medicine [2055]
retrospective study [325]
USA [1707]

Abstract:

Objective: This study reports the use of a safety phrase (the “stop” phrase) by standardized patients (SPs) during the performance of osteopathic manipulation treatment (OMT) in the Comprehensive Osteopathic Medical Licensing Examination-USA Level 2-Performance Evaluation (COMLEX-USA Level 2-PE). Methods: The performance of OMT on SPs is unique to this examination. The “stop” phrase is used for SPs to employ when they feel discomfort during the physical examination or OMT on the COMLEX-USA Level 2-PE. Standardized patients are told to use the phrase, “That's a bit rough, Doctor” in this situation. Candidates are reminded of the stop phrase during orientation. High-velocity, low-amplitude or articulatory-type thrust techniques are not permitted because of the repetitive nature and potential exposure to multiple treatments in one examination session. These encounters were viewed by physicians to document and verify circumstance of use. Results: In the 2007-2008 and 2008-2009 test cycles, 8452 candidates were tested (101,416 encounters, as 1 candidate left after the fourth encounter). The stop phrase was used 69 times (0.07%). The most common use of the stop phrase was during the head, eyes, ears, nose and throat examination (n=24, 34.8%) OMT accounted for only 17.4% of all indicated uses (n=12), or 0.01% of all encounters. The pass rate for all candidates during the 2008-2009 testing cycle was 94.7%. The pass rate for candidates who heard the stop phrase was 91.3%. No candidate failed after the stop phrase was employed during the performance of OMT. The pass rate for the candidates who received the stop phrase was slightly lower than all candidates tested during the 2008-2009 cycle, but there were no significant differences between the 2 groups (assuming equal variances and correcting for unequal sample sizes) for mean scores of GPA (t[4191]=1.051, α=.05); Data Gathering (t[4191]=-0.157, α=.05); SOAP Note (t[4191]=0.171, α=.05); and OMT (t[4191]=0.336, α=.05). Conclusions: The performance of OMT did not significantly increase the use of the stop phrase. Standardized patients were twice as likely to use the stop phrase for HEENT examination. The pass rate was slightly lower with candidates in this cohort than with all candidates, though not statistically significant. Perhaps candidates who are aggressive in their physical examination skills leading to the SP using the stop phrase have other deficiencies in overall clinical skills. This serves as evidence OMT can be performed and evaluated safely during a standardized patient examination without adversely affecting SPs or candidates.


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