M2 Clinical Comprehensive Assessment (CCA)

October 7, 2009

Exam Composition
Practical Exam Physical Exam History Taking History Presentation

Written Exam

Exam Composition
Physical Exam (6) Abdominal Cardiac Musculoskeletal A or B Neurology A Neurology B Pulmonary History Taking (3) History Taking A History Taking B History Presentation Communication Skills

Physical Exam

General Principles
Each station 15 minutes in length Patients are volunteers Faculty proctor present during exam Targeted, but complete physical exam Expectation is NOT to elicit abnormalities No checklists, notes, or aides allowed Required equipment posted on CCA website

Safety tip: Practice talking through your exam aloud

Neurology
Split into two stations (Neurology A & B) Neurology A Mini-mental state*** (new for 2010- students will be able to use MMSE card during exam) Cranial nerve exam Ophthalmologic exam*** (new addition for 2010) Neurology B Motor Reflexes Sensory Coordination/gait Paper, safety pins will be provided. You must have a tuning fork (see required equipment list)

Musculoskeletal
Split into two stations (A & B) During the exam you will perform only either A or B, but are responsible for content of both Musculoskeletal A Hands Wrists Elbows Shoulders Spine

Musculoskeletal B Hips Knees Ankle/Foot Spine

Resources and Helpful Hints

Clinical Foundations of Medicine (CFM) checklists are your friends
Refer to course syllabus, M2 CCA website

Practice the exam in sections

e.g. Neurology, Musculoskeletal Become familiar with equipment (e.g. safety pins for sensory testing)

Practice talking aloud while you are performing the exam New resources under development to assist in your preparation
Modified CFM checklists to guide preparation Exam FAQs drawn from prior exams/student questions to be posted on M2 CCA website

M2 CCA Website

Example Teaching (CFM) Checklist

History Taking

History Taking
Each station is 15 minutes in length Patients are standardized patients Goal is to elicit a focused, but complete history based on patients chief complaint Communication skills will be assessed as a component of the history taking sessions Content of interview drawn from CFM curriculum and CEP experiences

Standard templates and ROS sheets will be provided at each station; no other notes may be used

Preparation and Resources

Review CFM teaching videos, interviews (portal) Practical history taking Patient interview Review prior interview topics covered during the M1/M2 year Review and practice ROS in a targeted manner Recognize that every clinical history is a story- not everything is PQRST Practice, practice, practice

History Presentation

History Presentation
Station 15 minutes in length History taken from prior station (History A) will be presented Gather thoughts; generate differential diagnosis (10 min) Present your observations to a faculty physician (5 min) List differential diagnosis (top 2-3 possibilities)

Notes may be taken during history taking station and you may use these notes to present to faculty

Preparation and Resources

Review CFM outlines on history presentation Review feedback from presentations to faculty Practice, practice, practice

Written Exam

Exam Composition
Written examination Closed-book, web-based exam Approximately 90-100 questions covering principles of physical exam and basic pathophysiology Topic areas include: abdominal, cardiac, musculoskeletal, neurologic, pulmonary, ENT, ophthalmology Content from exam covered in CFM lectures, course syllabus, exam checklists Administered during CCA exam weekend Note: You may take the written examination either before or after the clinical portion of the CCA

Example Question #1
Which of the following is the ideal order in which to perform the abdominal exam? a. b. c. d. Auscultation, inspection, percussion, palpation Inspection, auscultation, percussion, palpation Inspection, palpation, auscultation, percussion Inspection, palpation, percussion, auscultation

Example Question #2
A 17-year-old football player is seen in clinic for his sports physical. Initial blood pressure is 140/85 with pulse of 98 and repeat blood pressure measurement in the exam room is 126/84. Previous blood pressure measurements have been normal and he is otherwise healthy. Initially, he is fidgety and anxious during the visit. The most likely explanation for this finding is: a. Development of essential hypertension b. He ate a Super size meal at McDonalds just prior to the visit c. He is nervous he may be withdrawn from practice d. Use of a cuff that is too small for the patient

Preparation and Resources

Review content specifications (M2 CCA website) CFM written exam Review physical exam outlines Review physical exam checklists Swartz: Textbook of Physical Diagnosis

Example: Content Specifications Outline

Knowledge (Written Exam): Abdominal
Know the anatomic location of intra-abdominal organs Know the physical exam findings in patients with ascites Know how to assess liver span Know the physical exam findings in patients with abdominal aortic aneurysms Know the physical exam findings in patients with diverticulitis Know the technique for examination of the spleen Know the physical exam findings in patients with peritonitis Know the correct sequence of performing the abdominal exam Know the physical exam findings in patients with pyelonephritis Know the technique for auscultation of abdominal and renal bruits Know the physical exam findings in patients with appendicitis Know the terminology for associated physical exam findings in patients with cirrhosis Know the anatomic location for referred pain from intra-abdominal organs

Exam Logistics

Exam Dates
Clinical Exam Friday, January 29, 2010 Saturday, January 30, 2010 Monday, February 1, 2010 Tuesday, February 2, 2010

Make-Up Exam
Wednesday, March 17, 2010 Written Exam The M2 CCA Written Exam opens on Thursday, January 28, 2009 at 8:00 a.m. through Tuesday, February 2, 2009 at 12:00 a.m. (24h, midnight). Sign up for the exam will open following the holiday break

Make-Up Exam
Make Up Exam Wednesday, March 17, 2010 Remediation Tentatively scheduled between March 1 through March 12, 2010

Note: Students who are unable to take the exam during February must obtain approval to take the exam on March 17 from the M2 CCA Committee and Director

Myths and Misconceptions About the CCA

Myth: Each year, many students fail the exam and do not begin their M3 year on time. Fact: Although there are a handful of individual station failures each year, the majority of the students pass each section on the first attempt. We have NOT had an overall clinical exam failure since 2006. We have NEVER had a student receive a failing grade for the CCA recorded on his/her transcript. We have NEVER had a students matriculation to the M3 year delayed because of his/her performance on the M2 CCA. Myth: Students are graded on/expected to perform tasks that are not on the teaching checklists. Fact: The exam is not designed to trip up students. The tasks to be completed at a given physical exam station is based on what is taught during the CFM course using the teaching checklists. Myth: There is no way that I will be able to complete an exam/history in less than 15 minutes. Fact: The overwhelming majority of students complete the exam/history taking stations within 15 minutes and often have time to spare. Many times, students who run into time pressure have not followed the door instructions and spend time completing tasks not required/expected at the station. Practice, practice, practice. Myth: Drs. Lukela and DiPonio enjoy inflicting physical and emotional pain on the medical students by making them take the M2 CCA. Fact: Drs. Lukela and DiPonio REALLY enjoy inflicting physical and emotional pain on the medical students by making them take the M2 CCA.

Contact Information
Michael Lukela, MD Director, M2 CCA E-mail: mlukela@umich.edu Lisa DiPonio, MD Assistant Director, M2 CCA E-mail: gooby@umich.edu Kelly Poszywak Manager, Standardized Patient Program E-mail: kellypos@umich.edu