Patient note fabrication and consequences of unprofessional behavior in a high-stakes clinical skills licensing
Jeanne M Sandella1, William L Roberts, Laurie A Gallagher
1National Board of Osteopathic Medical Examiners, Center for Clinical Skills Testing, 101 W. Elm St, Suite 150, Conshohocken, PA 19428, USA. jsandella@nbome.org
Background:
The National Board of Osteopathic Medical Examiners (NBOME) administers the Comprehensive Osteopathic Medical Licensing Examination USA Level 2-PE (COMLEX-USA Level 2-PE) and has developed a process that links the competencies of written communication and professionalism by tracking fabrication in the postencounter SOAP (Subjective, Objective, Assessment, Plan) note exercise.
Method:
A process used to identify potential SOAP note fabrication was implemented in the 2007-2008 test cycle for the COMLEX-USA Level 2-PE.
Results:
A total of 3,753 candidates took the COMLEX-USA Level 2-PE in the 2007-2008 test cycle. Forty-eight candidates were screened, and the NBOME's Subcommittee on SOAP Note Fabrication made failure decisions on eight, leading to a failure rate of 0.2% based on fabrication review.
Conclusions:
The NBOME has adopted the stance that postencounter note fabrication represents unprofessional behavior. Screening for and failing candidates who exhibit unprofessional behavior enhances the validity of the examination.
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