Patient note fabrication and consequences of unprofessional behavior in a high-stakes clinical skills licensing examination

Acad Med. 2009 Oct;84(10 Suppl):S70-3. doi: 10.1097/ACM.0b013e3181b37e36.


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.

MeSH terms

  • Clinical Competence*
  • Educational Measurement*
  • Licensure, Medical / ethics*
  • Scientific Misconduct*
  • United States
  • Writing / standards*