J Am Osteopath Assoc. 2020 Apr 1;120(4):245-252. doi: 10.7556/jaoa.2020.041.
Osteopathic medical students are required to pass the Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) Levels 1- and 2-Cognitive Evaluation and COMLEX-USA Level 2-Performance Evaluation (PE) to graduate. Predictors of COMLEX-USA cognitive exam performance are well established, but relatively few studies have explored factors associated with performance on the Level 2-PE.
To evaluate the relationship between school-based clinical competency assessments (written, simulation, and workplace evaluations) and Level 2-PE performance to ensure that these assessment efforts are effective and grounded in evidence to support student readiness.
School-based performance measures for 451 first-time takers of COMLEX-USA Level 2-PE were analyzed. A series of Mann-Whitney analyses were applied to compare 3 types of clinical performance assessments against COMLEX-USA Level 2-PE pass-fail performance: (1) internal objective structured clinical examinations (OSCE; average discipline-specific OSCE score and a comprehensive OSCE); (2) national examination performance (average clinical subject Comprehensive Osteopathic Medical Achievement Test, or COMAT, scores and Comprehensive Osteopathic Medical Self-Assessment Examination, or COMSAE, Phase 2 scores); and (3) a workplace-based clinical evaluation by preceptors.
Students who passed the Level 2-PE had a significantly higher average discipline-specific OSCE score, COMSAE Phase 2 performance score, average COMAT score, and individual subject COMAT scores in all subjects except Psychiatry. Students who passed the Level 2-PE humanistic domain also had significantly higher scores in the communication skill component of the school's comprehensive OSCE. Similarly, students who passed the Level 2-PE biomedical domain had significantly higher scores in the data gathering and subjective, objective, assessment, and plan documentation scores on the internal OSCE. The size of these differences (η2) was relatively small. Student performance on the competency-based preceptor evaluation showed no significant relationship with pass-fail performance on the Level 2-PE.
High-stakes OSCEs aligned with the level 2-PE blueprint are effective predictors of performance and are an important way to support student readiness for the Level 2-PE. Other assessments, such as subject-based COMATs and COMSAE Phase 2, add value to school-based assessments over workplace-based assessments.
骨科医学专业的学生必须通过美国骨科医师考试综合水平 1-和 2-认知评估以及美国骨科医师考试综合水平 2-表现评估（PE）才能毕业。美国骨科医师考试认知考试成绩的预测因素已经得到很好的确定，但相对较少的研究探讨了与第 2 级 PE 表现相关的因素。
评估学校临床能力评估（书面、模拟和工作场所评估）与第 2 级 PE 表现之间的关系，以确保这些评估工作是有效的，并基于证据支持学生的准备情况。
分析了 451 名首次参加美国骨科医师考试第 2 级 PE 的学生的学校表现数据。应用一系列曼-惠特尼分析比较了 3 种临床表现评估与美国骨科医师考试第 2 级 PE 通过-失败表现的关系：（1）内部客观结构化临床考试（OSCE；平均学科特定 OSCE 分数和综合 OSCE）；（2）国家考试表现（平均临床科目综合骨科医师成就测试，或 COMAT，分数和综合骨科医师自我评估考试，或 COMSAE，第 2 阶段分数）；（3）导师的工作场所临床评估。
通过第 2 级 PE 的学生在平均学科特定 OSCE 分数、COMSAE 第 2 阶段表现分数、平均 COMAT 分数以及除精神病学以外的所有学科的个别学科 COMAT 分数方面显著更高。通过第 2 级 PE 人文领域的学生在学校综合 OSCE 的沟通技巧部分的得分也显著更高。同样，通过第 2 级 PE 生物医学领域的学生在内部 OSCE 的数据收集和主观、客观、评估和计划文档记录分数方面的得分也显著更高。这些差异的大小（η2）相对较小。基于能力的导师评估学生的表现与第 2 级 PE 的通过-失败表现之间没有显著关系。
与第 2 级 PE 蓝图一致的高风险 OSCE 是表现的有效预测因素，是支持学生为第 2 级 PE 做好准备的重要途径。其他评估，如基于科目的 COMAT 和 COMSAE 第 2 阶段，在基于工作场所的评估之上为学校评估增加了价值。
