The 2018 Clinical Performance Exam

Orientation will begin precisely at the time listed on your schedule. We recommend that you try to arrive a few minutes early.   The exam will take approximately 3 hours to complete. 

Please wear your white coat and bring your stethoscope. In each encounter 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 exam room. You will be provided with a folder, containing the station instructions and blank paper for notetaking, which you may bring into the room.



The CPX cases represent common and important diagnoses encountered in the curriculum at UVA and also reflect common presenting signs and symptoms seen on the USMLE Step 2CS exam. There will be 6 stations in the CPX. You will have a 10-minute break after you finish 3 stations. 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 pertinent history of the patient’s chief complaint. 

You will also perform a pertinent 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 but should interact with the standardized patients as though you were an intern with primary responsibility for the care of each patient. Do not defer decision-making to others.  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 initial plans for diagnostic studies to evaluate the diagnoses you are considering.  

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 in the USMLE Step 2CS format. (Note that there will not be a countdown clock on the CPX patient note screen; there will be a warning when there are 2 minutes remaining.) You will use your findings to create and prioritize a differential diagnosis and to determine the initial diagnostic plan for the patient. Your note should include the pertinent findings from the history and physical exam, a differential including up to 3 diagnoses listed in order of likelihood, and the pertinent positive and negative findings from the history and physical that support each of the diagnoses listed. You will then list the diagnostic studies, including physical exam maneuvers indicated but not performed, that you would order for the patient.  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: (pp 8-9)



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 pertinent 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.