The 2019 Clinical Performance Exam

The 2019 CPX will take place Thursday, February 28th through Friday, March 8th.

 

IMPORTANT EXAM LOGISTICS

 Orientation will begin precisely at the time listed on your schedule. We recommend that you arrive a few minutes early.  If you arrive after the exam has begun, you will have to contact your Dean for permission to reschedule your exam.

 The exam will take approximately 5 hours to complete. 

 Wear your white coat and bring your student ID badge. The only piece of medical equipment you may bring is your stethoscope. All other necessary equipment is provided in the examination rooms; in each room, you will have access to a reflex hammer, a tuning fork, tongue depressors, cotton swabs, and an otoscope/opthalmoscope.

 You may not bring any outside materials or electronic devices into the testing area. This includes cell phones, watches, fitness trackers, any device with transmitting or receiving capabilities (e.g. Bluetooth), notes, papers, pens, or pencils. You must store these items during the examination and you will not be able to access them for the entirety of the exam, including during breaks.

 You will be provided with a clipboard, a pen, and blank paper for notetaking, all of which you may bring into the room. Do not write on the paper or log into your computer until you hear the announcement to begin each station.

 If you need assistance during the exam, raise your hand, and a proctor will assist you. You may not leave the testing area during the exam; if you need to use the restroom, a proctor will escort you.

 Light refreshments will be available during breaks. You may bring a snack to be consumed over your break time.


ON EXAM DAY

 The CPX cases represent common and important diagnoses encountered in the curriculum at UVA.  There will be 10 stations in the CPX. You will have a 20-minute break after you finish 4 stations and a 15-minute break after the 7th station.

 Each station will include a 15-minute patient encounter.  You will hear an announcement when there are 5 minutes remaining. If you are in the exam room when you hear the announcement that time has expired, you must leave the room immediately. Once you leave the room, you may not re-enter the room.

 At each station, you will interact with a standardized patient, either face-to-face or over the phone. You will be asked to communicate in a patient-centered manner to elicit a relevant history for the patient’s chief complaint. 

 You will also perform a relevant physical exam; the history you elicit should guide you in determining which physical exam maneuvers to perform.  All physical exam findings, including the vital signs on the door instructions, should be treated as accurate and incorporated into your diagnostic reasoning process. Intimate portions of the physical exam (e.g. the pelvic exam) should not be done; please refer to the door instructions for a list of exams you may not perform.  If one of these parts of the exam should be done to evaluate your patient, include it in your initial diagnostic plan.

 You should introduce yourself as a 3rd-year medical student who has the responsibility to provide care to the patient you are seeing.  At or near the end of the encounter, you are expected to let the patient know what your impressions are and what next steps they should expect, in terms of your plans for initial diagnostic studies to evaluate the diagnoses you are considering. Do not defer decision-making to others. 

 After you exit each room, you will have 10 minutes in which to write a patient note about the encounter on a computer. If you finish the patient encounter early, you may begin your note at that time.

 The notes will be similar to the USMLE Step 2CS patient note format. (Note that there will not be a countdown clock on the CPX patient note screen, but there will be an announcement when there are 2 minutes remaining.) If you were instructed not to perform a physical exam for a case, you should leave that part of the note blank. Your notes can be written in either narrative or bulleted form; please see the Step 2CS website for more information.

 Please refer to the following for more information and sample notes:

http://www.usmle.org/pdfs/step-2-cs/cs-info-manual.pdf (pp 8-9)

http://www.usmle.org/practice-materials/step-2-cs/patient-note.html

 You will use your findings from history taking and your physical exam to create and prioritize a differential diagnosis and to determine the initial diagnostic plan for the patient. Your note should a differential including up to 3 likely diagnoses, listed in order of likelihood.  You must support the inclusion of each diagnosis using the relevant positive and negative findings from the history and physical exam.

 You will then list the diagnostic studies, including any intimate physical exam maneuvers that are indicated but that were not performed, that you would perform/order for the patient.

 

SCORING THE EXAM

 Scores will be released on Monday, March 18th. If you did not pass the exam, you will be notified by ASAC whether you will be allowed to take a retake exam. The retake is scheduled for Friday, March 22nd.

 Passing the CPX is a requirement for graduation. In order to receive a Pass for the CPX, you must pass both domains that are being assessed on the exam:  Patient Encounter Skills and Communication Skills.  These skills will be assessed during your encounter with the standardized patient and through your patient note.

 Patient encounter skills include your abilities to obtain a history relevant to the patient’s problem, to perform a relevant physical examination, to develop a list of likely differential diagnoses, to prioritize and support these diagnoses using your findings from the history and physical exam, and to identify the initial diagnostic studies you would order to evaluate these diagnoses. 

 Communication skills include your abilities to build a relationship with the patient, to open the discussion, to gather and share information, to understand the patient’s perspective, to reach agreement in discussing plans, and to provide closure to the encounter.

 Your performance on the CPX will also provide you with feedback that will be helpful to you as you prepare for the USMLE Step 2CS exam.

 Please refer to the website below for more information about the Step 2CS exam.

http://www.usmle.org/step-2-cs/

 

If you were not able to attend the faculty information session, you can find a link to the podcast below:

https://vmed.hosted.panopto.com/Panopto/Pages/Viewer.aspx?id=061e8c4b-ea14-4263-9d4b-a9ed0150dd73