Book Review  |   September 2010
In the Public Trust: The National Board of Osteopathic Medical Examiners 1934-2009
Author Affiliations
  • Konrad C. Miskowicz-Retz, PhD, CAE
    Director, Department of Accreditation; Secretary, Commission on Osteopathic College Accreditation; American Osteopathic Association, Chicago, Illinois
Article Information
Book Review   |   September 2010
In the Public Trust: The National Board of Osteopathic Medical Examiners 1934-2009
The Journal of the American Osteopathic Association, September 2010, Vol. 110, 556-557. doi:
The Journal of the American Osteopathic Association, September 2010, Vol. 110, 556-557. doi:
In the Public Trust: The National Board of Osteopathic Medical Examiners 1934-2009, by Betty Burnett, PhD, provides a history of the first 75 years of the National Board of Osteopathic Medical Examiners (NBOME). In providing this history, Dr Burnett—a St Louis, Missouri–based author of numerous books, mostly involving social history—also offers a contextual explanation for the development of independent examination and licensure ability in the osteopathic medical profession. For example, on page 8 of the book, Dr Burnett quotes Asa Willard, DO, the American Osteopathic Association's president in 1925 and a founder of the National Board of Examiners for Osteopathic Physicians and Surgeons (NBEOPS, the original name of the NBOME), as saying the following at the 1932 American Osteopathic Association Annual Convention: 

With independent regulation and the natural numerical expansion it allows, we will ultimately get every right for ourselves and those to come. If we lose the vision we have shown in the past, yield to expediency, and accept unlimited privileges at the expense of independence, we will take care of the present, but there will be no future.

One of the most defining attributes of any profession—in addition to defining the scope of its practice—is the ability to determine who is appropriately prepared by education, experience, and demonstration of knowledge to enter into that profession. Independent examination and licensure gave that ability to the osteopathic medical profession. 
In the Public Trust is organized into three thematic sections—history, examinations, and people—and an appendix. The first section, “History,” accounts for slightly more than half of the text. This section covers the early history of the then NEBOPS through its restructuring into the present NBOME. It also details the context in which this progression took place. For example, key events in the growth of the osteopathic medical profession and in the development of medical licensure of both osteopathic and allopathic physicians are included. Paragraph-length text boxes describing interesting attributes of United States society (eg, the costs of cars and houses, the names of popular musicians) from the 1930s through the 2000s are also incorporated. 
The early examination philosophy of the osteopathic medical profession is discussed in the history section, as is the evolution of this philosophy into the Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA). The development of the COMLEX-USA began in the early 1990s. 
Other material in the history section recounts the concerted efforts that took place throughout the 20th century to hinder, if not to destroy, the osteopathic medical profession by attacking its licensure process. The author notes that these efforts ranged from basic science legislation for medical licensure in the 1920s and 1930s to the questioning of the psychometric validity of the COMLEX-USA in the late 1990s. Readers who enjoy reviewing history through charts will be pleased to find two timelines in the appendix: “NBOME Timeline” and “Brief Summary of Osteopathic Medical History in Canada.” 
The second section, “The Examinations,” is more tightly focused on the present COMLEX-USA and its construction. Included is a reprint of text from a medical education article in the February 2000 issue of JAOA—The Journal of the American Osteopathic Association1 that explains the development of Level 3, the first part of the COMLEX-USA to be offered. This section of the book also contains a COMLEX-USA timeline that lists key events in the development, acceptance, and administration of the examination from 1989 to 2006. 
The third section, “NBOME: The People,” focuses on the NBOME's organization, including its board of directors, as of 2008. Charts on facing pages compare the organizational structure of the NBEOPS in 1935 with that of the much larger NBOME in 2008. A list of 12 NBOME committees, their areas of responsibilities, and their chairs is also provided. Photographs and vignettes are presented for each of the board members and some of the longer-serving staff members. The section ends with a list of staff names from the Chicago office of the NBOME and the Conshohocken, Pennsylvania, office of the NBOME National Center for Clinical Skills Testing. 
The appendix of the book includes—in addition to the previously mentioned timelines—a list of NBOME presidents, images of NBOME seals from 1951 to 2009, and a glossary of commonly used organizational terms. The book closes with a 6-page index. 
There are many reasons to recommend reading In the Public Trust. This is a book that tells the story of the NBOME in a way that focuses on people. For example, the text throughout the book is richly accompanied by photos and sidebar biographical sketches of contributors to the osteopathic examination process—from founders such as Dr Willard and Charles Hazzard, DO, to modern-day leaders such as Thomas Cavalieri, DO, and Sheryl A. Bushman, DO. The book also weaves together multiple threads of osteopathic medical history as part of its history theme. In addition, In the Public Trust is printed and bound in an archival style that is not often seen in the mass trade press these days. The style reminds me of the high production standards of clinical medical books published in the 1960s. 
Some “purists” might fault the book's format for not including footnotes in each chapter. Instead, the source material is listed in a selected bibliography in the appendix. However, any losses in scholarly value resulting from this format are balanced by the rich presentation of photos and sidebars depicting NBOME leaders. 
Some critics might question whether such a new history of the osteopathic medical profession's development is necessary given the excellent existing work on this subject by Norman Gevitz, PhD.2,3 However, the story that Dr Gevitz tells comes from the perspective of a medical sociologist, rather than from one who is specifically interested in the history of licensure examination. I believe In the Public Trust can serve as a lasting record of the history of securing recognition for independent osteopathic medical licensing examinations and the role that these examinations played in defining the osteopathic medical profession in the United States. 
This book will be of greatest value to those readers who are interested in the history of the osteopathic medical profession in the United States and how its independent licensure process affected that history. For casual readers, the book will delight even those who simply thumb through its extensive photographs. For more mature readers, these photos will likely bring back memories of leaders in osteopathic medical education whom they have known over the years. Finally, for professional historians, In the Public Trust serves as a good companion to the history of osteopathic medical research edited by George W. Northup, DO.4 
 By Betty Burnett, PhD. 118 pp. Chicago, IL: National Board of Osteopathic Medical Examiners; 2010.
 Editor's Note: In the Public Trust: The National Board of Osteopathic Medical Examiners 1934-2009 can be obtained free of charge by contacting the National Board of Osteopathic Medical Examiners at (610) 825-6551.
Osborn GG, Meoli FG, Buser BR, Clearfield MB, Bruno JP, Sumner-Truax L. The Comprehensive Osteopathic Medical Licensing Examination, COMLEX-USA: a new paradigm in testing and evaluation. J Am Osteopath Assoc. 2000;100(3):105-111. Accessed July 28, 2010.
Gevitz N. The DOs: Osteopathic Medicine in America. Baltimore, MD: The Johns Hopkins University Press;1982 .
Gevitz N. The DOs: Osteopathic Medicine in America. 2nd ed. Baltimore, MD: The Johns Hopkins University Press; 2004.
Northup GW, ed. Osteopathic Research: Growth and Development. Chicago, IL: American Osteopathic Association;1987 .