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Clinical Performance

Examination
NAMA : CHAYRUNISA
NILOVAR AMIR
NIM: N10118090
N10118065
NAME
Goals

•Assess the clinical skills performance of medical students after


the completion of their third year of medical school.

•Serve as a competence benchmark for clinical performance


(history taking, physical exam, communication, clinical reasoning)
at this stage of training.
Competence
“The habitual and judicious use of
communication, knowledge, technical skills,
clinical reasoning, emotions, values, and
reflection in daily practice for the benefit of the
individual and community being served.”

-Epstein and Hundert. JAMA. 2002;287:226


Objectives
Based on BCM standards, the students will:
• Perform a focused history in a SP environment.
• Perform an appropriate physical exam given the SP case.
• Communicate effectively in a SP encounter.
• Demonstrate fundamental patient-centered skills that
constitute the basis of safe and effective patient care
• Synthesize and construct a differential diagnosis,
diagnostic plan & treatment plan based on the SP
scenario provided.
Framework
Basic Clinical
Skills
Physical
Examination 5 Clinical
Communication
Cases
Context in Healing
Problem Solving
Framework
5 Clinical Cases
15 minutes each
Outpatient, time-limited cases
Checklists to assess clinical skills
10 minutes for interstation
exercises to evaluate clinical
reasoning
New This Year
Pilot stations (you won’t know which ones)
No invasive exams (breast, rectal, pelvic,
GU). If you need to do one, notify the
patient as part of your plan
New communication scale (details to
follow)
Interpretation of labs and studies
Post-encounter note in the USMLE Step 2
CS Format
Basic Clinical Skills
Draw upon experiences from core
clerkships, LACE, and special sessions

• History based on complaint and patient


setting
• Physical exam items evaluated according
to BCM standards (available on CPX
website)
Communication
Opening the Interview
• Addresses the patient by name
• Introduces self by name AND title
• Involves patient when discussing the reason
for the visit
• Maintains appropriate eye contact
• Uses effective body language
Communication
Responding to the Patient
• Legitimizes patient’s emotions
• Reinforces positive behaviors
Communication
Conducting the Interview
• Encourages questions or concerns
• Elicits patient perspective
• Avoids interrupting
• Avoids leading questions
• Avoids multiple questions
• Conducts the interactions in an organized manner
• Uses open- and close-ended questions effectively
• Checks for accuracy during the interview
Communication
Educating, Negotiating,
Collaborating
• Summarizes the interview (history and exam,
if applicable)
• Avoids inappropriate language
• Reviews next steps
• Verifies patient’s understanding
Cases
Problem solving tasks
related to type of visit

• New problem
• Chronic illness
• Psychosocial
New Problem Visit
Assess Presenting Complaint
• Information gathering and differential
diagnosis
• HPI questions
• Associated symptoms
• Relevant review of systems
• Thoroughness associated with accuracy
• Major error is “premature closure”
Chronic Visit
History
• Assess severity and control of
condition
• Signs and symptoms of condition
• Home monitoring
• Target organ damage from condition
• Evaluate adherence and treatment
side effects
• Review status of other risk factors
Psychosocial Visit
History
• Assess emotional needs of patient
• Background, Affect, Trouble,
Handling, Empathy (BATHE)
• Evaluate for diagnosable mental
illness
• Evaluate for suicide risk
Areas of Weakness
HPI
• Open-ended questions
• OLD CARTS/OPQRST
• Alleviating/aggravating factors
• Associated symptoms
• Pertinent review of systems
Areas of Weakness
Differential diagnosis
• Vascular
• Vascular • Inflammatory/Infectious
• Infectious • Neoplastic
• Traumatic • Degenerative/Deficiency/Drugs
• Autoimmune • Idiopathic/iatrogenic/intoxication
• Metabolic • Congential
• Idiopathic/iatrogenic • Autoimmune/Allergic/Anatomic
• Neoplastic • Traumatic
• Congential • Endocrine/Environmental
• Metabolic
Areas of Weakness

Chronic illness
• Level of control
• Adherence to treatment plan
• Signs/symptoms of end-organ damage
• Other related risk factors
Areas of Weakness

Psychosocial
• Effect on functioning
• Emotional reaction
• Social support
Areas of Weakness
Physical Exam
Thoroughness Technique
• Lymph nodes • Lung
• Thyroid • Cardiovascular
• Abdomen • Neurologic
• Neurologic
Thoroughly test any organ system Drape patients appropriately. Don’t
associated with the chief complaint. listen over gown/sports bra. Don’t
Don’t forget to look for abbreviate the heart/lung exam
complications of the disease. PE (e.g., don’t just listen to one valve).
should be focused but thorough Don’t be overly aggressive with
(should take longer than 30 sec). palpation.
The Neurologic Exam
Clarification of wording
• Focused - specific components of neurologic
exam relating to the patient’s complaints
• Screening - the 36 item checklist taught in PPS
and the neurology clerkship
• Full - a complete, head-to-toe neurologic
examination with adjunct testing tools included

Any patient with a primary neurologic complaint


should get a screening examination!
The Neurologic Exam
Pitfalls and Tips
• Memorize the components – be sure to address all
of them (CN, motor, sensation, reflexes,
coordination, mental status)
• Full MMSE is not required, but you should ask ALL
orientation questions
• Pay attention to details specified in BCM Physical
Exam Standards document (available on website)
• Time management is crucial on this station
• Practice the screening neuro exam. Time yourself!
Performance Information

Available online after review and


release of grades

Passing the BCM CPX is a


graduation requirement
Professionalism

It is our expectation that you will


show up ON TIME* and
PREPARED for the exam

*Please refer to the tardiness/late policy


Professionalism

Professional dress + white coat


enhances the standardized
patient’s perception of your
competence
Professionalism

DO NOT share exam content


with your colleagues
Website
Website
Further Information
Contact Email
Ms. Michelle Higgs Michelle.higgs@bcm.edu
Program Manager
Simulation & Standardized
Patient Programs

Dr. Anita Kusnoor avk1@bcm.edu


CPX Director

Dr. Tyson Pillow pillow@bcm.edu


Medical Director
Simulation & Standardized
Patient Programs

https://www.bcm.edu/education/schools/medical-
school/programs/standardized-patient-program