1. Presented to the Medical Education Committee 8/8/2012

2. * Communication Scale was changed between 2009 and 2010 so the scores are not comparable.

3. CPX 2012 Cases CaseDemographics Presenting Problem Category DL44 yo femalePeriod won’t stopAcute EH32 yo maleLower back painAcute LS20 yo femaleSyncopeAcute MB50 yo maleCoughChronic RK60 yo maleDM IIChronic RS75 yo femaleFallsAcute SW45 yo AA femaleHTNChronic MC*22 mo maleAsthma attackAcute * Excluded from scoring

5. Clinical Skills & Clinical Reasoning

6. Clinical SkillsClinical Reasoning Standards To Pass: HX = 60% + PX = 60% + Communication = 60% + Overall = 65% + To Pass: Reach the passing criterion on 5 or more cases (minimum number of Critical Items per Case) Failure Rate 57/185=31% (5 overlap w CR) 19/185=10% (5 overlap w CS) Remediation Individualized plan based on the pattern of fails. Can not take Step 2 CS till complete* 1 hr. self-assessment + 1 hr. w/ faculty, enroll in Adv. Dx Skills The 14 with only CR fails can take Step 2 CS anytime * PX only fails are allowed to take Step 2 CS during remediation if the score fell between 47% - 59%.

7. Type of Fails # of failsRemediationRetest Clinical Skills HX only 2 1-on-1 video review w faculty Individually prescribed remediation based on video review CPX Retest (multiple station OSCE) Clinical Skills PX only 54 Approved EM or Primary Care elective plus one mini-CEX CPX Retest (multiple station OSCE) Clinical Skills PPI only 2 1-on-1 video review w faculty 3 mini-CEXs Individually prescribed remediation based on video review CPX Retest (multiple station OSCE) Clinical Skills Multiple Components (any combo of HX, PX, PPI & TTL) 5 1-on-1 video review w faculty Approved EM or Primary Care elective plus one mini-CEX OR 3 mini-CEXs Complete any additional individually prescribed remediation based on video review. CPX Retest (multiple station OSCE)

8. Type of Fails # of failsRemediationRetest Clinical Reasoning (must pass 5 out of 7 cases) 19 1-on-1 video review w faculty ME 250.05 4 DxR cases with a mean of 70% or higher on clinical reasoning Multiple Standards (failed both CS & CR standards) 5 1-on-1 video review w faculty Approved EM or primary care elective plus one mini-CEX ME 250.05 CPX Retest (multiple station OSCE) 4 DxR cases with a mean of 70% or higher on clinical reasoning

9. SkillsAbsolute cut score# of fails History Taking (M=73.4%, SD=6.3%) 60%2 Physical Exam (M=64.1%, SD=9.0%) 60%54 Communication (M=84.8%, SD=8.6%) 60%2 Overall (M=74.1%, SD=4.8%) 65%5 52 failed 1 4 failed 2 1 failed 3

10. Characteristics of PE Fails at 60% (N=57) CasesGroup mean on PE Omission vs incorrect (% of PE maneuvers) Average of all 7 cases64.128.2% vs 15.3% Difficult Cases HTN45.543.9% vs 21.1% Geriatrics-Falls54.737.8% vs 14.9% DM II follow-up63.627.6% vs 17.7% Conclusion: Most of the errors (points lost) were due to omission of PE maneuvers.

11. Type of Fails # of failsRemediationRetest Clinical Skills: PX only 57 Approved EM or Primary Care elective One mini-CEX Retest-CPX (multiple station OSCE) OR Online PX focused case-based exam Discussion: What is the appropriate retest method for this group of students based on their pattern of mistakes? 1. multiple-station OSCE 2. case-based computer exam