NBOME for Osteopathic Physicians

The National Board of Osteopathic Medical Examiners

The National Board of Osteopathic Medical Examiners is a private independent nonprofit organization. Its mission is to protect the public against incompetent osteopathic physician practice by designing and administering competency assessments. The National Board is, in other words, a professional testing organization focusing on osteopathic medicine. While the National Board does not license osteopathic physicians, state licensing boards rely on the National Board's testing. Specifically, the National Board of Osteopathic Medical Examiners administers the COMLEX-USA series of licensing examinations for osteopathic physicians, otherwise known as the NBOME. The National Board's terms and conditions for the NBOME exam create challenges for students in osteopathic medical programs and graduates in osteopathic residency programs, sitting for and passing the NBOME. Retain LLF Law Firm to help you meet and overcome those challenges.

What Is the NBOME?

While the acronym NBOME technically stands for “National Board of Osteopathic Medical Examiners,” and some use the acronym to refer to that organization, NBOME more commonly stands for the series of licensing examinations that the organization designs and administers. The National Board gives a different name, COMLEX-USA, to that series of licensing examinations, although again, many will simply use the organization's acronym NBOME to refer to that series of exams. The NBOME or COMLEX-USA series of licensing exams, taken both during the osteopathic medical education as step exams and during or after residency, includes:

• the COMLEX-USA Level 1 400-question, mostly multiple-choice exam taken during the student's osteopathic medical education;
• the COMLEX-USA Level 2 CE 400-question, mostly multiple-choice exam is also taken during the student's osteopathic medical education; and
• the COMLEX-USA Level 3 two-day exam involving 420 multiple-choice questions, clinical decision-making cases, and other novel test item formats.

Who Must Take the NBOME?

The NBOME is the series of exams osteopathic physicians must pass to gain state licensure for osteopathic medical practice. Osteopaths must pass the NBOME to get a state license to practice medicine. All U.S. states and jurisdictions accept the NBOME for licensing osteopathic physicians. Osteopaths who do not qualify to sit for the NBOME or cannot pass the exam once qualified will not get a license and can not practice medicine. However, they may find alternative careers in public health and medical administration, using their osteopathic medical education. The National Board permits examinees to make only four attempts at each level of the NBOME exam, meaning that each time counts. If you find yourself unable to sit for any part of the NBOME exam or otherwise at risk of failing the exam due to an accusation of cheating or other irregularity, retain LLF Law Firm to help you meet and overcome that challenge. Preserve your laudable ambition and enormous investment to practice osteopathic medicine.

Qualifying to Take the NBOME

The National Board does not permit a candidate to take any Level 1, 2, or 3 NBOME exam unless the candidate can prove the candidate's good academic and professional standing. For NBOME Level 1 and 2 exams, the student must supply an attestation of good academic and professional standing from the student's college of osteopathic medicine. For NBOME Level 3 exams, the resident must supply an attestation of good academic and professional standing from the residency program director. These requirements mean that to even sit for the NBOME, you must avoid the things that can derail a professional education. Your college of osteopathic medicine will have some form of student code of conduct, like the one included in the Student Handbook for Michigan State University's College of Osteopathic Medicine. Violating one or more of those student code provisions can lead to discipline for academic or professional misconduct. School discipline can prevent you from sitting for the NBOME. Student codes of conduct for osteopathic medicine programs routinely include prohibitions against:

• Title IX and non-Title IX sexual misconduct;
• cheating, plagiarism, and other forms of academic misconduct;
• alcohol or drug abuse interfering with school activities;
• disruptive or disorderly conduct interfering with the classroom or campus;
• unprofessional conduct toward peers, support staff, and supervisors;
• violence or threats of violence, including domestic violence;
• trespass, misuse of school computers, and vandalism; and
• other criminal conduct such as drunk driving or drug crimes.

Fighting School Discipline to Qualify for the NBOME

Just because your osteopathic medicine program charges you with behavioral misconduct doesn't mean that those charges will end up in your school record and keep you from sitting for the NBOME. Charges are simply a way of initiating disciplinary proceedings. With skilled and effective attorney advisor representation, you may be able to defend and defeat those disciplinary charges. Colleges of osteopathic medicine have protective procedures to ensure that students accused of misconduct can prove those charges false or exaggerated or that other circumstances should mitigate any potential penalty. The Policies and Procedures for Alleged Code of Conduct Violations at Nova Southeastern University's College of Osteopathic Medicine are an example, requiring that college disciplinary officials provide fair notice to the accused student and an opportunity for a hearing. The procedures typically provide some opportunity not only to testify on one's behalf but also to call other witnesses and offer documentary evidence. These protective procedures, though, are not self-executing. Your success will likely depend on retaining skilled and experienced academic administrative defense representation. If you face disciplinary charges in your osteopathic medicine program, retain LLF Law Firm to defend and defeat those charges so that they do not prevent you from sitting for the NBOME.

NBOME Disqualification for Unsatisfactory Academic Progress

You must also maintain satisfactory academic progress to get the requisite letter of good academic standing from your college of osteopathic medicine or residency director to sit for the NBOME exam. Your college of osteopathic medicine will have satisfactory academic progress (SAP) standards like those at the Philadelphia College of Osteopathic Medicine. Federal student loan regulations require that schools receiving federal funding enforce those SAP standards. Osteopathic colleges cannot just give students a free pass when their grades, course failures, incompletes, or withdrawals show that they cannot meet the college's academic standards. SAP standards typically require a minimum cumulative grade-point average, that the student complete a certain percentage of credits attempted, and that the student graduate within a reasonable time frame. The college's registrar or financial aid office will notify you if your academic record no longer meets the college's SAP requirements. Retain LLF Law Firm to challenge your SAP probation or suspension so that you can continue your osteopathic medical education and qualify for the NBOME.

SAP Appeal for NBOME Qualification

The same federal SAP regulations permit osteopathic colleges and other schools to waive their SAP requirements if the student can show extenuating circumstances for failing to progress academically. You may qualify for the NBOME, even if you have fallen out of good standing if you can win an appeal for reinstatement. The Philadelphia College of Osteopathic Medicine, for instance, has a representative SAP appeal procedure. SAP appeals, though, are not as simple as they sound. You must usually advocate and document your special grounds for relief, like a death in the family, a disabling or distracting illness or injury, or a similar circumstance. Your SAP appeal must also articulate an achievable plan to get back into good academic standing. If you have received your osteopathic college's notice of SAP probation or suspension, retain LLF Law Firm to prepare, submit, and win your SAP appeal. Don't lose your osteopathic medicine education or your opportunity to sit for the NBOME exam. Let our Student Defense Team help you get back on track and in good academic standing.

Other Conditions for Taking the NBOME

The National Board of Osteopathic Medical Examiners requires that any candidate taking any part of the three-level COMLEX-USA or NBOME licensing exam agree to its terms and conditions outlined in its Bulletin of Information. Those terms and conditions, addressing things like test security, test confidentiality, and test cheating, are where osteopathic students and residents often get tripped up in sitting for, taking, and passing the NBOME exam. Violating these terms and conditions may result in the testing personnel refusing to admit the student for the exam, revoking exam admission, removing the student from the testing center, rejecting completed exams, or revoking exam scores in favor of a failing score. The NBOME's terms and conditions include the following specific requirements:

• that the candidate “shall not in any manner whatsoever discuss, disclose, paraphrase, publish, or otherwise make known to anyone any test item” or other NBOME exam information not publicly available on the NBOME website;
• that the candidate “shall not in any manner whatsoever contribute to or participate in the development or administration of any test preparation service” for the NBOME for at least eighteen months after taking the exam;
• that the candidate will promptly report any examinee who offers test preparation help within that eighteen-month period;
• that the candidate “shall fully cooperate with any NBOME investigation of actual or alleged irregularities in test administration, candidate behavior, or breach of test security or confidentiality,” where failing to do so may result in failure of the exam;
• that the candidate must avoid “any irregular conduct in connection with the application, registration or taking of an examination,” including behavior that “violates the integrity or security of the examination,” “is disruptive to the administration of the examination,” or the NBOME deems “inappropriate in connection with the application, registration, taking, administration, integrity, and security of any NBOME examination”;
• that the candidate must avoid other unprofessional conduct such as loud, lewd, or culturally insensitive comments toward test personnel or other examinees; and
• that the candidate must avoid discussing or disclosing any aspect of the test items or the clinical cases or standardized patients during or after the exam.

Irregular Conduct During an NBOME Exam

Irregular conduct during an NBOME exam is one of the more significant risks that NBOME candidates face. You may have aced all of your osteopathic medicine courses and clinics, and have full confidence in your ability to pass each step of the NBOME exam. But unpredictable testing circumstances and conditions may raise suspicions that you violated one or more of the exam's testing conditions. The National Board's Bulletin of Information gives these examples of “irregular conduct” that its terms and conditions expressly warn can result in failure of the exam:

• copying, fraud, deceit, or other dishonest conduct;
• refusal to provide proper identification for verification at any time;
• disrupting another candidate or candidates;
• verbally or physically harming or threatening to harm test center staff, other examinees, or NBOME personnel during telephone and in-person encounters regarding schedules, scores, or score reporting, before, during, or after an exam;
• communicating or attempting to communicate with others during the exam other than authorized test center professional staff;
• removing or attempting to remove any test material, scrap paper, or whiteboard from the assigned test area;
• damage to test center property;
• non-compliance with test center rules and security requirements;
• operating test center equipment without reasonable care;
• providing or receiving unauthorized information about exam content;
• communicating or attempting to communicate about the content, format, or specific test items with another candidate or with any outside source or party (including use of cell phones, personal computers, internet access, test review companies, or any other means) before, during, or after an exam;
• using or having available any unauthorized device, text, notes, or other material that could assist the candidate in taking the exam;
• providing false admittance information or altering or misrepresenting information in applications, score reports, transcripts, or certificates;
• providing false or forged identification upon presentation for testing;
• violation of the NBOME's non-disclosure or confidentiality policies;
• any other violation of the terms and conditions, policies, rules, procedures, or obligations set out in the Bulletin of Information;
• bringing personal property into the test area; and
• any other behavior the NBOME deems unethical or unprofessional.

NBOME Irregular Conduct Consequences

The National Board's Bulletin of Information, stating the NBOME's terms and conditions, tells you what the National Board can do if its test center personnel suspect that you engaged in irregular conduct before, during, or after an NBOME exam. The consequences can be severe, effectively ending the candidate's opportunity to sit for and pass the exam and share the score with the state licensing board. In short, if not effectively addressed, irregular conduct on the NBOME can end your opportunity to practice osteopathic medicine. And the Bulletin of Information reserves that decision to the National Board's sole discretion. The National Board's options for disciplinary action for irregular conduct include:

• voiding the candidate's examination score or not scoring the examination;
• deem the candidate to have failed the examination and enter a “fail” score on the candidate's examination record and NBOME transcript;
• for less severe violations, annotating the candidate's examination record and NBOME transcript as “Irregular Conduct”;
• suspend or revoke a score report, or refuse to provide any score report or NBOME transcript to a candidate or third party;
• deny the candidate's application to take or retake any NBOME examination;
• report the incident to the candidate's school, graduate medical education program, or licensure board, and
• take any other action the NBOME, in its sole discretion, deems appropriate.

NBOME Irregular Conduct Proceedings

Fortunately, the National Board provides a mechanism for challenging its allegations that you engaged in irregular conduct on its NBOME exam. According to its Bulletin of Information, an irregular conduct proceeding begins when a test center staff member reports suspected misconduct to the National Board. Other candidates who observe irregular conduct may initiate that report to center staff members. The National Board's disciplinary officials then investigate. The Board's NBOME terms and conditions require that the candidate under suspicion cooperate with the investigation. Failing to do so can result in sanctions “including examination failure, notation of irregular conduct, suspension of eligibility, or permanent loss of eligibility to take a future COMLEX-USA examination.” If disciplinary officials continue to suspect irregular conduct, they must notify the candidate, who then has ten days to submit a signed personal statement of their position on the allegations. That submission may include “any and all information known or available to the candidate that they believe is relevant to the matter.” The NBOME then determines whether the candidate has engaged in irregular conduct and, if so, what action the NBOME will take. The National Board's Bulletin of Information concludes, “Decisions regarding irregular conduct are determined solely at the discretion of the NBOME, and all such decisions of the NBOME are final.”

The Attorney Advisor's Role in NBOME Disputes

School Program Issues

If your NBOME issue involves a school record, such as SAP probation or suspension, or a finding of academic or professional misconduct, that keeps you from qualifying to sit for the NBOME, then your retained attorney advisor may be able to intervene with your school to obtain the necessary relief. You may still have SAP appeals, disciplinary hearings, or other appeals and procedures available to you within your college of osteopathic medicine to clear your school record. Even if you don't have formal procedures remaining and have instead exhausted all procedures, retain LLF Law Firm to negotiate with school oversight officials for alternative special relief. A clear school record should allow you to sit again for your next NBOME step exam.

Residency Program Issues

If, instead, your NBOME issue involves a residency problem where your residency program director refuses to issue you the NBOME's required letter of good standing, then your retained attorney advisor may be able to intervene with your residency program's officials to obtain the necessary relief. Your residency program may have grievance or discipline procedures available to you through which your retained attorney advisor can clear your residency program record of allegations of unprofessional conduct, academic or performance deficiencies, or other disqualifying misconduct. And once again, even if you have exhausted all apparent avenues for residency program relief, LLF Law Firm may be able to negotiate with hospital or other program officials for alternative special relief. Don't let a residency program issue keep you from taking your Level 3 NBOME exam and qualifying for state licensure.

NBOME Irregular Conduct Issues

If, on the other hand, your issue is with the National Board, involving alleged irregular conduct on the NBOME, then retain a skilled and experienced attorney advisor to help you prepare and submit the personal statement contesting the allegations. You may have abundant exonerating or mitigating evidence available in the form of documentation, electronic records, and witness observations. When you retain LLF Law Firm, the student defense team can gather that evidence, summarize it in a compelling personal statement, and document it in exhibits to submit with your personal statement. Your submission may need to be much more than a simple letter expressing your own observations, assertions, and conclusions. A winning presentation may require substantial other information and documentation. The student defense team at LLF Law Firm knows the customs and practices of disciplinary officials and the materials that winning presentations need.

Retain Premier Attorney Advisor Representation

You have invested enormous time, tuition, and effort in your osteopathic medical education, far too much to treat a risk to its substantial rewards with anything other than the greatest seriousness. Your osteopathic medical education is worth skilled and effective defense attorney advisor services. Don't retain an unqualified local criminal defense attorney. Instead, retain LLF Law Firm. Our Student Defense Team has successfully represented hundreds of students nationwide against all kinds of charges in programs of all kinds and at all levels. Call 888.535.3686 or go online now to retain LLF Law Firm's student defense team.