Relationship of clinical skills performance in medical school with COMLEX-USA level 2-performance evaluation

Context: 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. Objective: 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. Methods: 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 per-formance: (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. Results: 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 sub-jective, 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. Conclusion: High-stakes OSCEs aligned with the level 2-PE blueprint are effective predic-tors 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.