DNP's failing the test????

Spacklehead, MSN, NP · Mar 5, 2009

Just to post exact numbers, here are the results of different med students (MD, DO, and non-US) from 2007. Also to clarify, the DNPs are taking a version of the Step 3, not Step 1 according to the first link you posted above. The pass rate that you listed is not indicative of ALL med students. Also, I would like to see these results again when more DNPs take the exam.

http://www.usmle.org/Scores_Transcripts/performance/2007.html

ETA: I am not a DNP advocate, but I do think the title of your post is a little misleading since even though 50% failed, 50% did pass.

silas2642 · Mar 5, 2009

Wow, so the DNP's are taking part of the USMLE exams. Likely a version of step 1.
"By this fall, the National Board of Medical Examiners (NBME) will begin offering part of the United States Medical Licensing Examination (USMLE) – the physicians’ medical board exam – as certification of DNPs’ advanced training. Passing that exam is "intended to provide further evidence to the public that DNP certificants are qualified to provide comprehensive patient care," according to the Council for the Advancement of Comprehensive Care (CACC), a consortium of academic and health policy leaders promoting the clinical doctoral degree for primary care nurses."
http://www.physiciansnews.com/cover/508.html
Well, the results are in......not so good. 45 DNP's tested have a pass rate of 50%........pretty horrible, especially when you consider the medical student pass rate is like 96-97%.
DNP advocates, how do you explain this? I'm curious to see the responses.
http://www.abcc.dnpcert.org/exam_performance.shtml
BTW, the NBME designed, or at least helped with the NCCPA exam for PA's. SO no, I am not trying to stir the pot, but the suggestion has been made in other threads that perhaps we should compare physicians to NP's, to see if physicians measure up. Apparently so.

Something tells me that exam was a little watered down from Step 3 USMLE. Regardless, this is not an exam that should be difficult to pass considering the vast clinical experience that NP's have over those green interns. The interns don't even really have much time to study for it-- as they say in med school, "Two months for Step 1, two weeks for Step 2, and a number 2 pencil for Step 3."

SpudID · Mar 6, 2009

What would be the purpose of taking this exam? Is it only for credibility in the medical community or does it assist in billing purposes? Just curious as to why a person with a DNP would be motivated to take this exam?

core0 · Mar 6, 2009

Something tells me that exam was a little watered down from Step 3 USMLE. Regardless, this is not an exam that should be difficult to pass considering the vast clinical experience that NP's have over those green interns. The interns don't even really have much time to study for it-- as they say in med school, "Two months for Step 1, two weeks for Step 2, and a number 2 pencil for Step 3."

The problem is you need more information than just the pass rate. I don't think that USMLE has ever published their exact scoring process, but I am guessing that its a dynamic scoring process similar to what is used on the PANCE where each question carries a certain weight. Depending on the question you can have a variable passing score. I am also guessing that the "experts" that developed this test off of what the USMLE provided did not have the experience to do this. This essentially makes the pass rate statistically questionable.

I would also like to see some demographics associated with this. There are a number of NP specialties represented here theoretically. It would be unusual for a Neonatal Nurse Practitioner whose patient population consists of those between 1 day and six months old to pass a test that is primarily based on adult inpatient medicine. Similarly given the number of pediatric questions on the example test, I would guess that someone doing adult outpatient medicine might have a hard time. Since they are testing NPs in areas that they are not trained in, essentially what they are measuring is the ability to pass the test. It calls into question the whole "certification" concept.

Finally from a public policy perspective, to be robust a certification organization should have independence from any promotional organizations that exist to promote the specialty. I would invite members to compare the ABCC board:

http://www.abcc.dnpcert.org/board.shtml

with the CACC board:

http://caccnet.org/members.shtml

Generally there should be a public representative also.

David Carpenter, PA-C

physasst · Mar 6, 2009

The problem is you need more information than just the pass rate. I don't think that USMLE has ever published their exact scoring process, but I am guessing that its a dynamic scoring process similar to what is used on the PANCE where each question carries a certain weight. Depending on the question you can have a variable passing score. I am also guessing that the "experts" that developed this test off of what the USMLE provided did not have the experience to do this. This essentially makes the pass rate statistically questionable.
I would also like to see some demographics associated with this. There are a number of NP specialties represented here theoretically. It would be unusual for a Neonatal Nurse Practitioner whose patient population consists of those between 1 day and six months old to pass a test that is primarily based on adult inpatient medicine. Similarly given the number of pediatric questions on the example test, I would guess that someone doing adult outpatient medicine might have a hard time. Since they are testing NPs in areas that they are not trained in, essentially what they are measuring is the ability to pass the test. It calls into question the whole "certification" concept.
Finally from a public policy perspective, to be robust a certification organization should have independence from any promotional organizations that exist to promote the specialty. I would invite members to compare the ABCC board:
http://www.abcc.dnpcert.org/board.shtml
with the CACC board:
http://caccnet.org/members.shtml
Generally there should be a public representative also.
David Carpenter, PA-C

Well put. My questioning of this has more to do with statements made comparing the DNP to a physician. I agree that statiscally, it is hard to know how a sample size of 45 can compare to thousands of medical students. Also, I would be interested in the weighting of the questions, as you noted. The demographics should be uniform however, as, at least to my knowledge, and someone PLEASE correct me if I am wrong, the DNP programs do not specialize in geriatrics, or pediatrics, etc. If they do, then the entire exam is worthless.

cruisin_woodward · Mar 6, 2009

wow! Confusing..just to clarify, I was not the one making the comparison... I do not want to be a physician. I am new to all of this and still consider myself wet behind the ears as a nurse...so, this is confusing. Not to mention, I think that a good quality of ANY provider in ANY capacity is to check the ego at the door, and know when to ask for help. Pts get hurt otherwise. I am curious, do PAs specialize, or is it all in one like med school? It is confusing bc there are all of these groups and initials etc. My head is spinning LOL!

physasst · Mar 6, 2009

wow! Confusing..just to clarify, I was not the one making the comparison... I do not want to be a physician. I am new to all of this and still consider myself wet behind the ears as a nurse...so, this is confusing. Not to mention, I think that a good quality of ANY provider in ANY capacity is to check the ego at the door, and know when to ask for help. Pts get hurt otherwise. I am curious, do PAs specialize, or is it all in one like med school? It is confusing bc there are all of these groups and initials etc. My head is spinning LOL!

It wasn't you...

PA's get a general medical education, in the medical model. Our initial board exam, the PANCE, which was designed with input from the NBME, and administered by the NCCPA is 360 questions, and is supposedly modeled on the Family Practice board exam. If a PA chooses to specialize, then they must either complete post graduate program (residency) which vary in length from 12-20 months. Otherwise, they must find a physician that will be willing to train them "on the job" in whichever specialty they choose.

The confounding part for us, is that currently, we have to take our board exams EVERY six years, ,the PANRE, and it is still a 300 question board exam modeled on a family practice board. When I practiced Ortho, and then had to take my first PANRE, I was sweating, like REALLY sweating. What did Ortho have to do with Family Practice? LOL. I studied my *** off and passed, but it was a bit intimidating. Now with EM, it's different.

sunray12 · Mar 6, 2009

I'm pro-DNP. The ones who passed know their stuff and now it's official. The ones who didn't pass will learn from the experience and work harder for next time. What more is there to say?

The DNP is new - taking this exam is new. MD's and DO's know what to prepare for - NP's don't ... yet. In a brand new DNP program in my state, NP students will learn alongside Med students. Results will even out in a few years as students and programs learn from early results and tweak their focus accordingly.

What is there to be anti-about vis a vis the DNP anyway?? (Other than the childish "but I wanted a 'real doctor' ....." bit). If APN's have evolved out of the nursing profession what in the world is rationally wrong with taking this level of specialization to the doctoral level??

cruisin_woodward · Mar 6, 2009

It wasn't you...
PA's get a general medical education, in the medical model. Our initial board exam, the PANCE, which was designed with input from the NBME, and administered by the NCCPA is 360 questions, and is supposedly modeled on the Family Practice board exam. If a PA chooses to specialize, then they must either complete post graduate program (residency) which vary in length from 12-20 months. Otherwise, they must find a physician that will be willing to train them "on the job" in whichever specialty they choose.
The confounding part for us, is that currently, we have to take our board exams EVERY six years, ,the PANRE, and it is still a 300 question board exam modeled on a family practice board. When I practiced Ortho, and then had to take my first PANRE, I was sweating, like REALLY sweating. What did Ortho have to do with Family Practice? LOL. I studied my *** off and passed, but it was a bit intimidating. Now with EM, it's different.

Thanks, I was wondering about that. I really am surprised that there seems to be different rules in different states etc. It's hard to know what is fact, what is only applicable in some states etc. One (of many) reasons I am getting my DNP, is bc I would like to get involved in nursing and NP policy reform etc. But now I feel I am over my head. I don't even know where to start learning all of this. I guess I need to become part of a professional organization. I am just AACN. I think that will help. I definately think there needs to be some continuity etc.

core0 · Mar 6, 2009

Well put. My questioning of this has more to do with statements made comparing the DNP to a physician. I agree that statiscally, it is hard to know how a sample size of 45 can compare to thousands of medical students. Also, I would be interested in the weighting of the questions, as you noted. The demographics should be uniform however, as, at least to my knowledge, and someone PLEASE correct me if I am wrong, the DNP programs do not specialize in geriatrics, or pediatrics, etc. If they do, then the entire exam is worthless.

DNPs do specialize. The DNP is supposed to be based off the original underlying ANP certification. Besides NPs, CRNAs and CNMs are eligible for the degree (at least according to the original paper). All NP and CNS programs are supposed to transition by 2015 and CRNAs are going to transition by 2025 (again according to their respective educational groups). On the other hand the CNMs are opposed to the DNP and have not agreed to transition (they were late to the MSN party also). I think that the CNMs especially understand what this will do to rural providers and programs. The theory is that the DNP is supposed to be a unifying degree for APNs but certification will remain in the specialty. Presumably at some time there will be independent practice associated with it as well as prescriptive privileges for all players. Of course that was before they started handing it out to anyone with an MSN (regardless of APN status).

David Carpenter, PA-C

core0 · Mar 6, 2009

I'm pro-DNP. The ones who passed know their stuff and now it's official. The ones who didn't pass will learn from the experience and work harder for next time. What more is there to say?
The DNP is new - taking this exam is new. MD's and DO's know what to prepare for - NP's don't ... yet. In a brand new DNP program in my state, NP students will learn alongside Med students. Results will even out in a few years as students and programs learn from early results and tweak their focus accordingly.
What is there to be anti-about vis a vis the DNP anyway?? (Other than the childish "but I wanted a 'real doctor' ....." bit). If APN's have evolved out of the nursing profession what in the world is rationally wrong with taking this level of specialization to the doctoral level??

Passing a test proves exactly that, that you can pass a test. What is the point of using a generalized medical test to show competency for specialty nursing practice. I could probably take any reasonably smart literate 20 year old and after a year or so at sylvan learning center taking their step III review course and memorizing crush the step III have them pass it. Its fairly common for FMGs to spend a year or so in private tutoring to pass the step III for residency here.

For comparison a physician must pass Steps I, II and III and the various shelf tests. Even then you cannot practice in the US without 1-3 years of residency. While the step III was originally touted as a licensing exam that shows that a medical student is ready for independent practice, it has evolved into a barrier to screen FMGs for US residencies. A modified version of that test means even less.

The DNP is not a generalist degree. Its is an extension of the underlying underlying APN certification. If you want to show the value of the DNP then develop a certification exam that shows that the DNP is practicing their NP specialty at a higher level than someone with basic certification. While you are at it try to keep the certifications per specialty to one group.

Anyone can make a specialty certification. For $35 I could organize the Federation of Academic Teaching Society Organizations. I could then develop my own DNP exam, get some friends to be on the board and pay the USMLE to help develop and exam and then administer it. Would that make it legitimate? If you are going to be pro-DNP you should critically examine the test and think about whether its best for your profession and the legitamacy of the profession.

David Carpenter, PA-C