Episode 28: John Gimpel D.O. President and CEO of the NBOME

In today's episode, we welcome Dr. John Gimpel. Dr. Gimpel is the president and CEO of the National Board of Osteopathic Medical Examiners. The NBOME is the organization that administers the Comprehensive Osteopathic Medical Licensing Examination or COMLEX- USA for short, which ensures that osteopathic physicians have competency for licensure and practice.

In today’s conversation, Dr. Gimpel will speak with us about the history of the Board and the examination and the importance of the COMLEX for licensure. Furthermore, Dr. Gimpel will share his opinion on topics including the importance of the ACGME merger for osteopathic postgraduate education, whether DOs need to take the USMLE,  specifically if considering competitive fellowship, and the challenges that faced the board specifically with the Level 2-PE during the pandemic.

Transcript

My name is Dr. Ian Storch. I'm a board-certified gastroenterologist and osteopathic physician,

and you are listening to DO or DO NOT. If you are interested in joining our team or

have suggestions or comments, please contact us at DoOrDoNotPodcast.com. Share our link

with your friends and like us on Apple Podcasts, Facebook, Twitter, and Instagram. We hope

you enjoy this episode. On today's episode, we welcome Dr. John Gimple. Dr. Gimple is

the president and CEO of the National Board of Osteopathic Medical Examiners. The NBOME

is the organization which administers the Comprehensive Osteopathic Medical Licensing

Exam, or COMLEX USA for short, which ensures that osteopathic physicians have competency

and licensure for practice. In today's conversation, Dr. Gimple will speak with us about the history

of the board and the examination and the importance of the COMLEX for licensure.

Further, Dr. Gimple will share his opinion on topics including the importance of the

ACGME merger for osteopathic postgraduate education, whether DOs need to take the USMLE

specifically if concerning competitive fellowship, and the challenges which face the board

specifically with the level 2 PE during the pandemic. We hope you enjoy this episode.

Dr. Gimple, thank you so much for being with us tonight. We really appreciate your time in

being on the podcast with us. Thank you, Dr. Storch. Do you mind if I call you John and

all for the time of the interview? Sounds fine. Thank you. All right, John. Thank you. John,

you are the president of the NBOME, which is the reason that we invited you on to hear about the

NBOME and to hear the story of your osteopathic physician journey. But can you start by telling

us what NBOME stands for and a little bit about the organization and what its role is?

Absolutely. The NBOME is the National Board of Osteopathic Medical Examiners, and it's a

nonprofit organization that was founded in 1934 at a time when osteopathic medicine was still

really in its first kind of chapter within the United States and of development. And it was a

profession that was continuing to evolve at the time, but a profession that felt it had an

important niche within the overall healthcare spectrum and the overall house of medicine,

but that needed to have self-regulation and needed to have the self-regulation processes

put in place to assure the public that when osteopathic physicians sought licenses to practice,

that they had demonstrated their competencies appropriately by the standards set by the

profession. One element of self-regulation is individual assessment, licensure assessment,

to get a license to then practice. And for DOs, back starting in and around the 30s and moving

on from there, the exam which became known as Comlex USA was the licensure exam put together

for DOs. Now at that time, many states had their own assessments, their own tests, and many states

would administer basic science, examinations, and other tests that any physician needed for licensure.

But of course, osteopathic physicians were often excluded from unrestricted licensure in a number

of states. And it was by the development of the NBOME that actually came through a number of

leaders from the American Osteopathic Association putting together this independent organization.

It was from the development of that that osteopathic assessment began and that

osteopathic licensure began to really spread throughout the United States, providing an

opportunity for DOs to practice, get licensed, and help to serve the public. So the NBOME has

grown since that time to about 200 full-time equivalent staff and a volunteer national faculty

of over 700 credentialed individuals. And all of that group is governed by a board of directors

of about 22 osteopathic physicians and other leaders. And essentially the mission is to

protect the public through assessment by assessing competencies for osteopathic medical practice and

for related health care professions. So that's great, John. I think the history is so interesting.

It sounds like, and correct me if I'm wrong, but the COMLEX was actually developed to allow DOs to

have full licensure in the United States. So it was actually allow us to be complete physicians

anywhere in the United States. Is that right? In a sense. It was also, of course, developed to make

sure to protect the public. And putting the patients first and protecting the public by

making sure that every osteopathic physician has demonstrated minimal competency before they even

are allowed to be granted a license by any state was another critical element. We refer to that

collectively as self-regulation, a profession kind of setting the standards for who is able to enter

the profession. A definition of a profession is that a profession self-regulates. And NBOME is one

of the organizations that participates in the self-regulation for the profession.

So the MDs have the USMLE as their licensure exam and as DOs, we have the COMLEX. Do both exams cover

the same course material? Good question. The COMLEX exam is designed expressly for osteopathic

medical practice. So what our national faculty does is it researches and studies what osteopathic

physicians do and see in practice, what patient presentations present to osteopathic physicians,

and what competencies osteopathic physicians need to use. And then they develop a test that samples

from that blueprint domain. The USMLE was developed by the National Board of Medical Examiners,

and it arose from its precursors back in the early 1990s as a medical licensing test essentially for

MD practice. International medical graduates as well as students from MD granting schools would

take that examination both for licensure as an MD to practice medicine, but also for various

requirements that MD granting schools had or that the international medical graduates needed to

demonstrate for certification in order to apply for residency programs in the United States.

So in terms of content, I think it's safe to say that in our study of osteopathic medical practice,

there's a lot of overlap in some of the content, like some of the foundational biomedical sciences

and some of the other content, certainly some of the clinical presentations that we've studied and

that we would sample from. So there certainly is an overlap, but there is an evidence-based design

for the complex blueprint that completely aligns with the practice of osteopathic medicine, not an

exam, for example, where we tack on some OMT questions or we assess a couple of stations

with osteopathic principles, but that we build the entire blueprint around an evidence-based design

for the practice of osteopathic medicine. So John, would you think that it was safe to say,

again, I'm a gastroenterologist, so of course I bring everything back to GI.

So if I sat for both exams, the GI questions, the basic GI course material would be similar

for both exams. There's certainly some truth to that statement, but I remember the entire design

of Comlex is different than the design of USMLE. So in Comlex, it's a very patient care-oriented

and patient presentation-based exam, as well as being competency-based. So that is to say that

each test question is designed around a patient presentation, and that patient presentation is one

that we've studied that would come from osteopathic medical practice. So in your specialty,

you're an osteopathic gastroenterologist, correct? Correct. So you see a patient who comes in and,

you know, is complaining of, let's say, epigastric pain. I believe you're probably thinking as a DO

already that this is a person. This isn't biochemistry, this isn't anatomy, this isn't

physiology, but it's a person who has a symptom. And the foundational biochemical underpinnings,

the foundational anatomical underpinnings, the foundational clinical underpinnings, are all

going through your mind from the time you see that person walking in the door or that you walk into

the exam room or the emergency room to see the patient. So those are some of the concepts and

the way we might approach testing that. Likewise, some of the concepts you might be looking at with

that patient might involve palpatory physical diagnosis in addition to observation. Any good

physician would do that. But obviously, as you know from your training, and the osteopathic

physician is very likely to use palpatory touch in helping to make a diagnosis and sometimes even

to help in certain conditions with treatment. So those principles and those competencies are likely

to be a little bit more assessed in an exam called COMLEX as opposed to an exam designed for MD

medical practice. I'll also point out that COMLEX USA is a primary care oriented general type of an

assessment. It's designed for undifferentiated practice of osteopathic medicine, such to say

that content level that's at the subspecialty or specialty level like gastroenterology would be

kind of brought down to the primary care presentation base of somebody presenting to a general

internist's office or a pediatrician's office or a family physician's office or the emergency room

with acute abdominal pain that all might fall under broadly under your specialty.

I don't know, John, I'm getting a little older and maybe a little silly, but I like to take tests

and that sounds like a test I would like to take. That sounds like a fun test. Now a question

specifically going into the palpatory skills and the osteopathic portion of the exam. I know

different schools maybe teach things differently and maybe there are some schools that have a

stricter osteopathic focus. My question on that is do you think there are certain COMs that have an

advantage on OMM sections of the exam over other COMs and are there variations in techniques that

maybe make the questions a little more challenging for students that went to different osteopathic

schools? Well, Ian, I think it's probably safe to say that for lots of different areas, including

specialties and including basic science disciplines, there are probably approaches at different

schools and also faculty at different schools that are stronger than at others. I would imagine most

schools have strengths in some things and relative weaknesses in other areas. The area of OMM and OPP

often brings this type of question and I believe that probably stems from a time

even perhaps when we were trained or before that where there probably was a wider variation

in the various COMs. Now with the accreditation standards from the AOA COCA it's called that

accredits the schools and with advances in osteopathic medical education around the nation,

a group called the ECOP, the Educational Council for Osteopathic Principles, this group aligns

the chairs or the OMM department leaders or course directors from all of the different schools together

where they talk about core curricular issues and they talk about standard approaches to different

things. I believe there's a lot more homogeneity in the way the educational program is designed,

both with from the lecture standpoint, lecture discussion, but also with the lab, the OMM

lab standpoint. But certainly some of them spend more time and have probably stronger and deeper

faculty and more time integrating osteopathic concepts and OMM into the curriculum and others

probably don't. But I can assure you and I do assure students because we get this question quite

a bit that there's no advantage because all of the test questions are written by an OPP specialist

at one school for example. Our national faculty for example in our department of OPP for the

NVOME we have a national faculty department. We have I believe 85 individuals from across the

country and across the comms and GME and private practice who comprise that department alone

contribute a lot of the test content. Also review of test content before it even becomes an item

that gets pre-tested in COMLEX is reviewed by individuals from different geographies, different

comms and even different specialties to make sure that it isn't just for example the OMM department

at at NYIT COM the way they say it is and it's different on the other coast. If it's different

on the other coast and there's that much wide variation that test item is going to fall off.

It's not going to pass our levels of scrutiny and review and ultimately would never count for a

student score. It won't survive kind of the pre-testing. So that national faculty and the

processes we have in place don't make a perfect test. There's no such thing as a perfect test,

but I think they create a sampling which is the test which is fair and I think it's fair

no matter where you go. But certainly I would think there are probably schools with the strongest

anatomy departments and there are probably schools with the strongest physiology departments and

there's probably schools with the strongest OMM departments for sure. I'm going to change

gears John a little bit and talk about the ACGME merger and how the COMLEX is affected or how

students are affected with. My first question is do all residency programs in the ACGME

accept the COMLEX? In the the most recent national residency matching program director survey which

was just released this August demonstrated the highest number of program directors reporting

that they require and accept COMLEX for DOs and it was 86 percent. That's the highest number ever

in history across the more than 10 000 residency programs in the ACGME. That is additional evidence

that there has never been more availability and more accessibility to residency programs for DO

applicants ever in history. There has never been a better time to be a DO applying to ACGME programs

because ACGME is now accrediting all the residency programs. There's never been more access

and that was further evidenced by the success rate of the graduating class of 2020 that had

a placement rate into ACGME residency programs of 99.29 percent the graduating class of this spring.

Unbelievable results. There was similar very positive results in the specialty fellowship match

program that the NRMP runs in March. 22 percent increase and about 1300 DOs matched

into those programs and just recently the internal medicine subspecialty fellowships

including in your specialty had record numbers of DOs matching in these ACGME internal medicine

subspecialty fellowships. So there's never been a better time for DO students albeit understanding

that the single accreditation system for GME did create a lot of anxiety on the part of students

who might have felt that would this new system put them in a disadvantage when they no longer had

the somewhat so-called safety net of programs that were AOA accredited that only DOs could apply to

and thus far this could not have worked out any better I think for DO students. It's a great time

to be a DO applying to residencies and again the success of the class of 2020 just this past year

helps to demonstrate that. John I'm going to go back to my other comment now I want to take the

test I want to reapply for my residency because that sounds great. We recently interviewed a

program director from an internal medicine residency out of the Northwell system his name

is Kyle Katona and he mentioned that he is able to use a computer program to compare the USMLE

and COMLEX scores. Can you talk to me a little bit about how that works is that difficult for

program directors to find and use? Let me describe a little bit right now that the USMLE step one

provides numerical scores as well as a pass fail it's a three-digit numerical score COMLEX likewise

provides a three-digit numerical score and pass fail they are both standard scores and they're

on a different score scale and so therefore comparability for those who are unfamiliar with

either exam can be somewhat difficult. However both exams provide percentile conversion tools

so if you're interested in what a 600 was in on level one last May you can use the website very

simple two steps you have the percentile score and you can see oh that was a 75th percentile

for the 8000 DOs that took that exam that particular year probably a pretty strong score

right whereas if you're using that to compare an MD student who took a USMLE and you see that their

exam score was also let's say in the 70th percentile when you use their percentile conversion tool

then you know you have two applicants who are pretty similar in terms of demonstrating

their foundational biomedical science and clinically related knowledge which is similar

to what is tested in level one and and step one. The formulas that convert one score to another

that I have seen and some of them have been in the literature for example converting a level one of

COMLEX to a step one of USMLE have all demonstrated pretty significant flaws. We are actually working

on a research paper right now with score concordance data that actually we believe might

demonstrate a formula that has less law that's closer and more valid but I can tell you that

we have published a number of times including in the ACGME's journal the Journal of Graduate

Medical Education score concordance work that shows about a 0.84 0.85 statistical correlation

between a level one of COMLEX and a step one of USMLE so there's a strong association between

performance on one or the other even though they're different tests and they say they sample in

somewhat different ways and they're constructed in somewhat different ways if all you're really

interested is it does this student this applicant have a decent fund of foundational biomedical

science and applied clinical knowledge let's say the level on step one comparing those percentiles

from each score is probably a pretty valid way of going about that. That's super helpful John

thank you. My next question is as far as licensure with the COMLEX in the United States are there

states that don't accept the COMLEX for licensure? Oh no Ian for 20 years now or so COMLEX has been

accepted in all states for licensure and in fact it's required in a number of states for DOs to

get a license you won't you won't get a license with taking any other licensing exam so that has

been a real success story again back to the 1930s and 40s and even closer to our time period you

know in the 80s and 90s there were states that didn't accept national licensing exams including

what became known as USMLE and for MDs and including what became known as COMLEX for DOs

but since 2004 Louisiana was the last state to accept COMLEX for DOs for licensure and so now

not only does COMLEX open up every door of every licensing board in every state and some territories

and other the District of Columbia of course but there's other jurisdictions that recognize

COMLEX just recently in the Australia Australian Medical Board it's called the Medical Board of

Australia just granted COMLEX competent authority pathway for comprehensive medical licensure they

call it registration in Australia such that an American DO who trains with two years of

GME training accredited by the ACGME or the AOA who passes all of the COMLEX exams including

the level 2 PE and including the level 3 of COMLEX the entire series can now go to Australia

and be recognized for registration for licensure for unrestricted medical practice in Australia

the first such competent medical authority granted in over 15 years by the Medical Board

of Australia and that's your MVOMI your COMLEX so very very exciting news. That's really cool so

if I want to do colonoscopies in Australia now I would be able to do that. The last time I talked

with a couple of my friends in Australia on an international board that I'm on where they had

not had a COVID-19 case in over 25 days straight of course they're on an island and they can protect

who comes in and who goes out but it was looking pretty attractive right on those dark days of

COVID. It's a good pitch. John you know we're talking a little bit about the USMLE and we

recently had president of the of the FSMB on our podcast Hank Chowdhury who's also DO just interesting

what is the relationship between the MVOMI and the FSMB? Well the FSMB is the Federation of

State Medical Boards so that's kind of the group that aligns or unites all of the different

licensing authorities and we have an excellent relationship with the Federation. They have

official policy that the evidence for the validity of COMLEX USA for osteopathic physician licensure

is exemplary. At their annual meeting each year we're often invited to give an overall

update for all of the state medical and osteopathic medical licensing board about COMLEX

oftentimes on a panel with the USMLE program for example. We co-published with the Federation of

State Medical Boards researchers in academic medicine a journal that a lot of deans read it's

kind of a very prestigious journal in medical education that's the journal of the American

Association of Medical Colleges and we published a predictive validity article about COMLEX together

with the Federation of State Medical Boards just this June. It was a really a landmark article

in it actually demonstrated that COMLEX performance was highly associated with eventual performance

in practice such that the higher your COMLEX score the lower your likelihood of having a state

disciplinary board action like losing your license or having your license revoked due to

some type of a you know a practice issue. This was a very strong article published in a very

prestigious journal and we co-published it with the Federation of State Medical Boards so a great

relationship with the FSMB Dr. Hank Chaudhary is their president and chief executive their board

of directors also works very closely with members of our governance our board of directors and we

share many things in common including very similar missions protecting the public through assessment

and of course the Federation aligning all of the licensing boards around the country to make sure

that patients feel protected and are protected by these boards granting licenses to doctors who have

demonstrated their minimal competency for the the practice that they're entering. That's amazing so

John I'm going to again switch gears a little bit and ask you a few controversial questions some

things that we've spoken to a lot of our DO students that are helping us with the podcast

and working on it with us and there are some burning questions about the complex that I think

that you are certainly the best person to ask and the first one is many students feel that in order

to be a strong candidate for a competitive residency specialty such as orthopedics or

dermatology that they really need to take the USMLE to be competitive with allopathic students.

What do you think of that idea or statement? Well obviously the more competitive a residency program

to me that means there's a higher number of applicants in a smaller number of spots

so there's more people who are trying to distinguish themselves for that smaller numbers

of spots. In order to distinguish yourself there are a number of ways to do so some people will

publish papers join professional organizations get mentors and do a lot of networking have good

grades if your school gives those or a good high class rank if your school reports that

and demonstrate lots of other things including interest in that particular field as it as it

gets competitive. As of now the USMLE exam gives numerical scores for its step one

but they are moving away from that come January of 2022 so just a little over a year from now.

There will be no way to distinguish yourself with a high USMLE step one score after January of next

year 2022 because they won't be providing those scores. The complex interestingly enough has been

looking at this for about 10 years recognizing that this use by residency program directors of

determining that we're only going to interview people with the super highest scores was probably

an overuse of what those score scales and what those scores were created for their licensure

exams they're really minimal competency and the score scales aren't really designed to discriminate

that level and was probably keeping out or excluding a number of people you mentioned

orthopedic surgery who might be great orthopedic surgeons but maybe they just weren't getting

uh certain high scores in their level one or in their step one if they're if they're an MD student.

So the MBOMI has been studying this issue of numerical scores and we're actually on the

verge of making an announcement on where we're going. I'm not at liberty to share that quite

quite yet but that announcement is coming very very soon. So when you ask well would I advise

a DO student who's applying to a super competitive situation to try to distinguish themselves in any

way possible they might need to in certain types of circumstances there's a large number of

applicants for a small number of spots maybe they need to do really well in their school maybe they

need to be involved with publishing papers or joining professional networks in that in that

specialty maybe they need to take COMLEX and make sure you do well maybe they do need to take one

step of USMLE at least in this interim period as the single accreditation system continues to roll

out and provided that their scores available to help distinguish themselves but for the vast

majority of DOs applying into residencies I mentioned earlier the 86% of ACGME program

directors accepting requiring and using COMLEX for DO applicants it is not a necessary step

and we believe as the single accreditation system you called it the merger but technically we call

it the single GME accreditation system as that continues to roll out more and more DOs will

recognize that taking additional exams for purposes other than which they were created

is not necessary to establish credibility. Most program directors in ACGME programs know about

DO applicants and most residency program directors know about COMLEX USA and know how to actually

use it and is there a subset of them that do not sure there are there's also a subset of

program directors that only interview DOs as well as part of that single system so that answers my

question perfectly I think there's no answer on a case by case basis it's just a general opinion

and I think your opinion is pretty and we always advise students to work with an advisor and work

with evidence-based resources and this and not go with sometimes the paranoia that comes from

resources such as studentdoctor.net and these other avenues that clearly disseminate lots of

misinformation for whatever reason and that's why I'm so thrilled to hear about your podcast and

that the student kind of directed program which is a real in earnest effort to share accurate

information and to share career paths and other types of things with DO students it's very very

exciting because I think it helps in professional identity formation for us to have accurate

information and not self-deprecate as we sometimes do as a profession because we sometimes feel like

we're in a minority position or a position of disadvantage when kind of like David and Goliath

sometimes that position is actually a strength and we just have to kind of realize that that's a

wonderful way in my mind of thinking about it. I'm a huge Malcolm Gladwell fan John and his book

David and Goliath definitely talks about looking at things differently that David might not be the

little guy he may just be the guy that takes a different approach so I agree with you 100 percent.

My follow-up question as you mentioned is sort of on the same lines but I think the question is a

little bit different with the ACGME merger many DO students that we've spoken to are concerned

that residencies that were previously quote unquote allopathic or ND residencies looked very

strongly at the actual percentile on boards and if a DO student did very well on one of those exams

they felt that it allowed them an increased competitiveness in some of those programs.

So I guess the question is as and again you haven't commented on what the complex is going to do

but as some of these exams do move towards a pass-fail and away from a numerical grade

many students feel that this may put them at a disadvantage for those competitive programs

assuming they would have gotten a very high score how do you feel about that concern?

I certainly understand the anxieties of change but even the language that we use sometimes Ian

frames things in in one way or another kind of along the lines of Malcolm Gladwell and David

and Goliath for example we refer to certain programs sometimes as MD residencies well

there really are no such thing as MD residencies now in the single accreditation system all

residencies are ACGME accredited and program directors are advised to accept kind of the

best candidates whether they be from DO granting schools MD granting schools international

medical schools with various degrees MD or MBBS or there's various medical degrees kind of related

there. If this elimination of numerical scores in the US MLE world and potentially in other

situations helps to increase the holistic view that residency program directors use in looking

at all applicants and trying to find those who are likely to be most successful in their program

and also most happy in their program which probably contributes to being successful in the program

then tremendous and kudos and that will be that would be a wonderful scenario because what has

happened in the last five to ten years in particular with the increasing number of DO and MD graduates

and international graduates applying to residencies is that there has been a tremendous overuse or

misuse of one single day numerical score whether that be Comlex or US MLE and this move back to

a pass fail should hopefully broaden the holistic view and I believe what do residency program

directors want in an applicant well I've shared this with student groups for years and I've shared

it with program director groups and I said please challenge me on this if you disagree

and I still do spend one half day a week in at a residency program so I'm still connected with

seeing patients and working with residency faculty and such and I ask them what are you most looking

for in a resident and almost always what they say is somebody who is competent but somebody who is

caring somebody who is a team player somebody who is professional somebody you know who has a strong

work ethic somebody who has good communication skills many things that aren't necessarily

predicted by step one of Comlex or a step one of US MLE and using particularly that score as the

be-all and end-all of who to interview into a residency program is probably not not the best

tool once you get into that interview again most program directors and their faculty are looking

holistically at who do I see as really being successful and happy in in the program and it

would make up a real hopefully kind of diverse and wonderful group of residents that we would

bring on in and be successful I think a lot of program directors use those licensing exam scores

as a screening because they don't want to bring somebody into a program who's going to be

unsuccessful basically because they can't pass tests like board certification tests which are

often used as outcome measures of a success of a residency program now the ACGME has downplayed

the importance of that particular marker in accreditation used to be you know higher

percentages needed to pass board certification on the first time in order to maintain accreditation

and they've they've really paid some attention to that impact but ultimately I think the move

to pass fail for USMLE and should COMLEX decide and announce to kind of move similarly will shift

away the emphasis of that one day numerical score to more of a okay if they pass what are the other

markers and other indicators of both their academic ability their other competencies their

professionalism and the other things that communication skills that we care about and

they may have to work a little harder to screen who are the best people to interview for their

program who are the people who they think would would really be successful and happy in the

program but I do think they'll figure it out and I think DO students who are strong and MD students

who are strong and international graduates who are strong will find ways to continue to differentiate

themselves as being folks who are worth interviewing and then once you get into the interview hopefully

worth putting on the rank list and once you get on the rank list and you rank them high and you

play your cards right you're probably going to match like the 99.29 percent of DO students in

last year's class did so I envision an even better world with some of these changes moving forward

okay John that's a that's a great answer again much appreciated I have two more questions one

I'm going to start with my question you know I always hide behind this is the student's question

and I have one last student question so my question as far as that goes I have never reviewed the full

ACGME policy but I'm sure that there are policies from the ACGME saying that there can't be

discrimination against people if they're purple if they're green if they're old if they're young

but my question for you is is there an ACGME policy that says that DOs can't be discriminated

against for only taking the COMLEX for residency and if there is not such a policy should there be

thank you for that question the ACGME has taken a strong stance in equity inclusion diversity and of

course non-discrimination and that's admirable they do not have requirements for that are specific

to licensure exams however other than in the transitional year you have to under non-COVID

circumstances you have to take the level three or step three by the end of your first year of

residency that's been modified or temporarily taken away during the COVID time because it's

been harder to get access to certain tests and such but other than that ACGME has always said

that DOs and COMLEX are part of the osteopathic medical education and licensure pathway and it

is recognized USMLE is part of the licensure pathway for MDs and is recognized but they have

been reticent to set a requirement specifically about that however following organizations all do

have official policy that support equivalent use of these exams COMLEX for DOs USMLE for MDs

and they include the Federation of State Medical Boards who had official policy about the validity

and have written letters to residency program directors over the years supporting COMLEX equivalent

COMLEX use the AMA the American Medical Association has official policy from its House of Delegates

about two years ago the COMLEX and USMLE should be used equivalently by program directors and

to not do so would be discriminatory against DO applicants a remarkable effort in solidarity

for D with MD students and DO students standing up together in support of that initiative and of

course the AOA the ACOM and a number of other organizations that have these official policies

supporting that equivalent use so I think your idea is a great one and I do think we have we

have certainly talked with ACGME officials to help program directors to understand and we've

certainly done a lot of networking the MBMA with program directors and program directors

associations over the years to help them to understand and in fact we've been very very

well received by program directors in the quote ACGME world with you know medical specialties

and such who have been very interested in learning more about DO candidates as well as

learning more about COMLEX and and how to use it including the level two PE exam and such so

we're on a really good trajectory as the single accreditation system just really hit its fifth

maturation year this past year and it will be interesting to see how things go over the next

five years especially with the USMLE change eliminating numerical scores I would think no

DO candidate would ever feel the need to take a USMLE step one since they will no longer you know

be able to distinguish themselves with a numerical score in any way in the very near future I think

that's a very interesting point as the scores go away that that question sort of goes away John my

last question on test and then I'd like to spend some time speaking about you from the students I

understand that there has been a lot of anxiety over the past year as far as medical education

and the setting of the pandemic one of the issues that a lot of students have have brought up is

the inability to access places to take the level two PE exam and and what that means for them both

this year and getting licensed and going out into residency and potentially needing to take it during

residency can you talk a little bit about the MBOMI's position and how they came to that position

when it comes to that issue absolutely certainly it's important for you to hear that the MBOMI

has tremendous connections with student leaders and student individuals both on we have a board

committee called liaison committee that has student members we have multiple outreach initiatives with

the sum of the student osteopathic medical association and the cosgp the council of osteopathic

student government presidents we get regular input from those organizations and of course

we live in the same world that you do with you know twitter and social media and lots of ways

to get information we also meet with deans very regularly and have many deans on our board of

directors as well as on our national faculty so we have our finger on the pulse pretty good at

the students and let me tell you we were dying a thousand deaths along with our students back in

april and may when prometric test centers were closed and we couldn't deliver any licensing exams

for a period of time due the pandemic but then again you know you live in new york i mean you

know you know what it was like and for those of us who also on the front line of patient care and

whatever we all recognize it was a pandemic but it happened to be very bad timing for the students

both do and md because it was right around the time may and june and july when most of them take

their computer-based licensure exams and they had delays and they had scheduling snafus by

prometric test centers and it was it was a nightmare and we really we felt for them we

understood how anxiety provoking that was and it was regrettable the way many of them were

rescheduled multiple times and it created chaos and we we walked with them together we worked with

them together we worked with the schools together to find them places to test and i'm here to tell

you we've actually tested about 23 000 complex candidates since may since we restarted and with

all that testing in about 300 per metric test centers including two satellites we put up at

two university-based comms we had zero cases of covet 19 transmission we made the changes

to make the test safe to make the testing experience safe and that was a real success

in the in the end the trickier one though is this level 2pe that you mentioned that's the

the performance evaluation it's a standardized patient-based clinical skills exam so it's a

hands-on exam where students travel to either one of our national centers for clinical skills

testing in philadelphia a suburb called concha hawken or in chicago near o'hare airport and that

was much trickier because it involves bringing individuals in and while we had protocols set up

with our consultants from johns hopkins and others to make sure that the exam was as safe as possible

there was the traveling to the center that was creating a lot of angst on the part of students

now of course we had just as many students anxious to say we want to take the test and we want to

get to the exam center and we want to get this requirement done with so we can graduate and we

can move on so the accreditor of do schools is called the coca and coca made a decision back

in june june 5th in fact of this summer to say since the complex usa level 2pe exam is suspended

because of covid and we're not likely to be restarting in the very near future we're going

to temporarily suspend or modify the graduation requirement so that students do not need to take

this exam in order to get the do degree or graduate like they normally would in last

year's class and other classes have had to do this was a big decision for coca but it was one that

the nbome enthusiastically supported because we knew that even if we were getting the testing up

in november there would be some students who would struggle to get a test site or a date and

be able to take it that fit into their schedule and we didn't want the students to have this

additional anxiety that well if they don't take the exam and pass it they wouldn't graduate they

might only get one attempt etc that was needless anxiety that we thought we should enthusiastically

support and we did so unfortunately ian there was a rampant amount of misinformation and

disinformation some of it put out there on social media by people who should have known that they

were putting out bad information and it created such an amount of anxiety on the part of do

students that it was it was extremely unfortunate our most recent announcement in october suspending

the exam all the way until april certainly made it clear that even though 25 of the graduating

class of 2021 has already taken and passed the level 2 pe exam this year that means 75 percent

of them have not about 5 000 or so students and for those students if we are able to bring the

exam up and help to ensure that it's safe and a safe testing experience that it will not be able

to test likely all 5 000 of them before graduation which means some and quite a number of them might

either choose to or be required to take it in their first year of residency we've had many older do's

approach us and say oh you mean they're going to have to leave their hospital and take a licensing

exam well even though the the word resident was named because you used to actually live in the

hospital these days there have been some some changes some work rules and other things that

mean you actually do get to leave the hospital on occasion when you're a first year resident and

while it certainly might be an inconvenience for a first year resident to take the level 2pe exam at

some point in their first year let's say or early in their second year of residency in order to stay

right on time with things if that's when they feel safe to test and that's when they can access the

exam and that's when they can demonstrate their competencies and then go on and get a license

anywhere it's the sacrifice certainly that again thanks to covid that they're likely to need to

have to do should they do that and even if they take this exam as an intern let's say a first year

resident and then take their level three within six to twelve months of that and pass that exam

by the end of their second year of residency they'll still be able to go for an unrestricted

license in any state of course unless the state requires more than two years of gme in order to

increase the capacity so that more students or recent graduates could take the exam even sooner

than under normal circumstances not only are we doing everything we can to increase the number of

test spots opening in our philadelphia and our chicago site but we're actually likely to be

opening a satellite test center for level 2pe out on the west coast near fresno california

and that would be open from approximately may till october of next year and would provide

considerable number of additional test spots and those a little bit closer for some on the west

coast would help reduce some of the quote backlog of the 5000 or so dio students in the class of

2021 and then the following class that will also be then interested in taking their tests but

prioritization will continue to be for the class of 2021 until we can make up that backlog and then

offer that exam is it an inconvenience yes is it anxiety provoking yes but at least dio students

should know it's not going to prevent them from graduating it's not going to prevent them from

moving along on their pathway we certainly empathize with that condition we didn't cause

covid you didn't cause covid they didn't cause covid covid has created all kinds of chaos for

all of us but we the nvme has worked very hard with the program director the residency program

director community to let them know that students should not be held back or they should have no

concern about interviewing students who've not taken the level 2pe exam because of the pandemic

remember that dio students many have not taken the level 2pe and they're applying to residencies

many md students have not taken the clinical skills exam that usmle has in its series the step 2cs

which has also been suspended since march so there's a pretty level playing field there

with the vast majority of applicants in this year's residency pool not having a national

standardized clinical skills testing at the time that they're applying and interviewing for

residency so john i think my interpretation of everything that you just said is and i just want

you to correct me if i'm wrong that the nvme's job is to make sure that osteopathic physicians

have competency before they go out into practice that the situation of the pandemic is unfortunate

and certainly has delayed the test but it doesn't mean that the test is not needed to prove

competence and that the nvme needs to continue to use that test to make sure the doctors are going

to treat patients and that the osteopathic profession is producing excellent doctors that

are competent as it always has and they will do their best in the future to make sure that all

osteopathic students have access to the exam in the best way that they can in this well said two

additional points i might just make one is it's also our responsibility to make sure that the

testing is safe as it can be just like the computer-based testing that i mentioned no

covet cases and we're doing everything we can to make sure when that examination does relaunch

that it is in fact a safe testing experience to do so there was a lot of misinformation about that

and quarantines and trial and other stuff that nvme didn't care or wasn't concerned about the

safety of our students and of course that couldn't be the the furthest thing from the truth but also

the licensure community the state licensing community is still in the osteopathic world very

very dependent upon national clinical skills testing it's a really important exam for licensing

boards to give do a license and in fact in some similar to what you said ian the testing has to

test what you value and it has to test the competencies that are critical to providing

safe and effective osteopathic medical care this test the level 2 pe tests doctor patient

communication skills palpatory physical diagnosis omt and omm which are what the profession values

and what the patients look for when they seek care from an osteopathic physician so demonstrating

those fundamental competencies as you said so well is a critical professional responsibility

that you have as a rising osteopathic medical student and an applicant to get a license

it's back to what we talked about in the very beginning which is self-regulation meaning that

the profession self-regulates and sets the standards and that you as a professional who take

various oaths along these lines say i'll demonstrate i'll i'll do what i need to to

demonstrate that i have those competencies so that i can earn the trust of patients and the trust is

in that piece of paper that's called the license to practice john thank you so much for answering

all of my questions i am very educated now in complex usa and mb o me so i think everything

that i wanted answered and that our group wanted answered you've done an amazing job answering for

me i want to hear a little bit about how the president of the mb o me got to where he is

and our podcast is mainly to document the osteopathic physician journey so can you start

by telling me where you grew up where you went to college and when you decided you wanted to be a

doctor absolutely i grew up in the pennsylvania not too far from philadelphia and i grew up the

oldest of eight children interestingly enough two of them also became osteopathic physicians and

two of them married osteopathic physicians so we've got in-laws outlaws we've got dos all over the

place on a normal year with thanksgiving or christmas of course in this year we'll be doing

a little bit more zoom connection but kind of a big family and being the oldest of a big family

if anybody can relate to that you're always taking care of individuals and providing care

certainly had i had dreams of being a physician from very early years age 10 12 14 thinking of

being interested in some of the sciences and anatomy and being enamored by you know the health

care providers that i interacted with but it was really in high school when in a leader in the

future physicians club of our high school we had a biology teacher who was there for two years

who was the son of an osteopathic physician who was himself going on to osteopathic medical school

that next year and he also worked at a hospital so he took those interested like myself on round

like around the hospital he was a phlebotomist so he would take us and show us some of the things

in the lab and other things and then he'd say oh by the way uh you know lay down on the table let

me show you what what i can do and i was enamored and he would talk to me as he was treating me

about you know body mind and spirit and about you know treating each patient as a person but not a

constellation of biochemical particles and interactions there but really body mind and

spirit the social determinants of health and what what does that i was sold and so much so that when

i went to lasalle university in philadelphia which was a real pre-med mecca at the time and had a

wonderful biology pre-med training there and it became time to to apply philadelphia college of

osteopathic medicine was nearby i applied to about five do schools and two md granting schools got

interviews at i think all but one of the of the seven schools or so i applied but pcom philadelphia

college of osteopathic medicine was my first choice having visited it with my mentor and friend there

and was lucky enough to have been accepted relatively early on and it interviewed at a

few of the other schools but wound up choosing my path and boy was it a wonderful path to go through

interestingly enough that then took me of course into residency training and i was one of those

medical students who loved every clinical rotation i did so i was going to be an obstetrician for six

weeks then i was going to be a pediatrician for six weeks and i was going to be an internist for

six weeks you know as as you did each clinical rotation and that ultimately led me to choosing

family medicine and kind of a primary care training path and when it came time to do my residency

after doing a rotating internship we still had the ability to do a one-year rotating internship

at that time i then applied to residencies and was accepted or matched into the family medicine

residency at the very hospital in that i was born in chestnut hill hospital just outside in the

outskirts of of philadelphia so i felt for the the whole several years that i was there like i had

been there before and sure enough i had been there before i was born in in that hospital

and my dream was to throw a shingle in that community and be a family doc and

practice for 30 or 40 years and and retire and i lived that dream i right out of residency i

threw a shingle my father helped me to put it up literally one of the old things i started my own

independent practice back at the time early early 1990s took care of little babies including in the

nursery hospital care icu and all the way up back in the good old days where primary care docs went

into the hospital each day and made house calls and became you know really a part of that community

just on the outskirts of philadelphia but i was only in practice about three to three to six months

when one of my mentors and a dean then at the osteopathic medical school that i graduated with

dr dan wisely called me up and said you know you really ought to you know get back in in medical

education you ought to you come back and be a teacher you're a born teacher you ought to

you know be involved with that and so i did spend some time part-time in the practice and part-time

doing some teaching which was not too far away and during that time actually went back at night

and got a master's in in education and adult education back at lasalle university my original

alma mater and learned a lot about assessment and about teaching and learning and about pedagogy

and that kind of skyrocketed me towards moving a little bit more into the academic part of the

career but continuing all the while at least 50 percent of the time in active clinical practice

and despite having gone into some different roles like being a dean up at the university of new

england college of osteopathic medicine and being a pre-doc director at georgetown university school

of medicine and a number of different roles all the while i've always had a good amount of my

time in direct patient care seeing patients and teaching at the bedside if you will and even now

as president of nba which i've been in now for starting my 12th year i still am involved in

patient care still involved in the clinical delivery and graduate medical education side

of the house and that kind of keeps me grounded into it's all about the patients it's all about

the public and you got to always remember that this is about somebody who puts their trust in you

to take care of their family member to take care of themselves and earning that trust and also

continuing to earn that trust is a really important element of what we do john i think it's amazing

that you run this organization that you're president of the mvome and that you don't give up

your ties to patient care i just i think that's very difficult to do but i think that if i could

choose a leader of an organization who's a physician the fact that that physician is still

practicing just makes would make me proud to have that physician as the leader so i kudos to you

for still practicing that has to be hard though well it's not it's not all selfless as you know

ian as a practicing gastroenterologist the rewards that you get the intrinsic rewards that you get

from being able to help a person at a time of need and being able to just be a good human being and

just listen to them and just recognize them recognize the emotions or the concerns or the

anxieties and reassure them and or deliver the news empathically and is a tremendous reward and

it's a real intrinsic reward what we do so i can tell you i leave on wednesdays after doing that

feeling fulfilled and feeling rewarded and feeling rejuvenated to go back into the next day which

might be 10 12 14 hours of in this case zoom meetings in a normal situation traveling and

airplanes to meetings to professional meetings and those types of things so certainly for the

students who are listening to the podcast don't ever lose sight on the fact that it's all about

the patient and it's in serving patients in a servant leadership type of a role as their

physician and their partner and serving those patients that you're going to receive many times

over vast rewards so do always keep that in mind john i know your time is valuable you're obviously

very busy you're running this organization you're taking care of patients and you gave us over an

hour of your time to explain some of the questions that students have about the mbom e again thank

you very much for for giving us your time tonight thank you very much ian and best to you and to all

the students listening for a very healthy safe holiday season and start to hopefully a very

healthy and successful and happy new year this concludes our episode of do or do not send all

inquiries comments suggestions and even let us know if there's someone you want us to interview

to do or do not podcast at gmail.com don't forget to like us on facebook at do or do not podcast

for updates if you enjoyed our podcast please share it with your classmates and administration

we have plenty of more interviews lined up and we're excited to share them with you

this is tian you shea thank you guys so much for listening to do or do not