Clinical Practice Examination (CPX)
The purpose of the CPX session is to document, observe, and measure your clinical and interpersonal skills, as well as to construct a SOAP note. The SOAP (Subjective, Objective, Assessment & Plan) note is used to document your clinical thinking and reasoning skills.
Educational Objectives
At the end of this examination, the student should be able to complete two Standardized Patient (SP) interactions that will:
- objectively measure the integration of clinical data (developed from a focused history and phyiscal examination) into a plausible differential diagnosis and diagnostic plan as evaluated by the faculty
- document the students' interpersonal skills as reflected by the SP evaluation
- measure the student's ability to develop a complete SOAP note as evaluated by the faculty
Teaching Strategies
- A SP-student interaction documenting a common abulatory case history into SOAP format that will stress the importqnce of a complete focused history and physical examination culminating into a plausible assessment (differential diagnosis) and plan.
- A SP-student interaction using the CCX computerized format documenting a common ambulatory case history that stresses the importance of integrating clinical data into a differential diagnosis and diagnostic plan.
- SP-student interaction that stresses the importance of the students' interpersonal communication skills.
HOW THIS WORKS IN PRACTICE
The student is asked to perform a focused history and physical on two patients presenting with different chief complaints. You are expected to ask appropriate and case specific questions. It remains important to perform the focused history and then to complete an appropriate physical examination. In one case, after the SP-interaction performing a focused history and physical, the student will utilize the CCX software format documenting the history and physical examination in the appropriate CCX area and from this information construct five differential diagnoses from these data and formulate a diagnostic plan. In the other case, following the performance of a focused history and physical examination on the SP, the student will develop his/her findings in a SOAP format in the computer. The student will also develop five differential diagnoses and list a minimum of five diagnostic tests or treatments. The student will have 20 minutes to conduct the focused history and physical and 20 minutes to develop the case in the computer using the CCX or SOAP format as directed by the case instructions.
Common Student Mistakes
- Based on the chief complaint, the student assumes he/she knows the answers to common history and physical questions. This assumption leads students to focus questions in the direction of their "hunch," thereby, "short-circuiting" the history and physical. This potentially causes loss of important points in the Subjective and Objective section of the SOAP or CCX.
- Listening to heart and lungs through clothing is incorrect.
- Not performing a physical examination because the student feels the patient has a behavioral problem. Also, if a behavioral or medical problem is identified early in the encounter, the rest of the physical exam should not be skipped.
- Expecting the patient to be forthcoming with answers to unasked questions. The CPX patients are trained to not volunteer information. In a sense, this is unlike the patients you see in a clinical setting. Some patients seen at their physician’s clinic are very forthcoming with information about their medical condition. However, since the CPX is an assessment tool, you will be assessed on your gathering of patient information and how well you organize and analyze this information.
- Asking non-productive questions. Asking if they "have any major medical problems" is not a productive question. The patient needs to know what in particular you are asking. They probably do not know what a "major medical problem" is.
- Not asking about part of the family and social history relevant to the chief complaint
INTERPERSONAL SKILLS (IPS) SECTION
Most students do a magnificent job on IPS skills. However, below are some useful items to remember when completing the CPX session.
- Failing to use a systemized approach to questions. Instead of following an organized logical review, which will provide answers, you may go off-track and pursue only issues relating to a prior answer the patient gave you. This "tunnel vision" can result in asking redundant questions, with a disjointed, disorganized, haphazard history. A unorganized, illogical history will affect your interpersonal skills score.
- Interrupting the patient, asking too many questions in a row, repeating the same question, focusing on the patient’s chart, writing instead of active listening, and displaying little compassion or sympathy for the patient are other areas of common student mistakes.
- Always wash your hands before each SP encounter
