1. BCM Clinical Performance Examination Tyson Pillow, M.D., M.Ed. Anita Kusnoor, M.D. Tyson Pillow, M.D., M.Ed. Anita Kusnoor, M.D.

2. BCM CPX Goals 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) at this stage of training. Identify students performing clinical skills at BCM’s proficiency standard.

3. 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

4. BCM CPX 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 and treatment plan based on the SP scenario provided.

5. Framework Basic Clinical Skills Physical Examination Communication Context in Healing Problem Solving 6 Clinical Cases

6. Framework 6 Clinical Cases 20 minutes each Outpatient, time-limited cases Checklists to assess clinical skills 8-10 minutes for interstation exercises to evaluate problem solving

7. Basic Clinical Skills History based on complaint and patient setting Physical exam items performed according to BCM standards Draw upon experiences from core clerkships, LACE, and special sessions

8. Communication Introduced self Started with open-ended questions Asked what you thought was the matter Managed the narrative flow of your story Elicited your story using appropriate questions Clarified information by repeating Allowed you to talk without interruptions Nonverbal behavior enriched communication 15 items

9. Communication Acknowledged your emotions appropriately Was respectful and nonjudgmental Used words you understood and/or explained jargon Asked questions to see what you understood about his/her diagnosis/treatment strategy Provided clear explanations concerning diagnosis and treatment Paced the encounter well Brought the encounter to a close

10. Cases Problem solving tasks related to type of visit New problem Chronic illness Psychosocial

11. New Problem Visit Assess Presenting Complaint Information gathering and differential diagnosis HPI questions Associated symptoms Relevant review of systems

12. New Problem Visit History Thoroughness associated with accuracy Major error is “premature closure”

13. Chronic Visit 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 History

14. Psychosocial Visit Assess emotional needs of patient Background, Affect, Trouble, Handling, Empathy (BATHE) Evaluate for diagnosable mental illness Evaluate for suicide risk History

15. Areas of Weakness HPI Open-ended questions OLD CARTS/OPQRST Alleviating/aggravating factors Associated symptoms Pertinent review of systems

16. Areas of Weakness Differential diagnosis Vascular Infectious Traumatic Autoimmune Metabolic Idiopathic/iatrogenic Neoplastic Congential Vascular Inflammatory/Infectious Neoplastic Degenerative/Deficiency/Drugs Idiopathic/iatrogenic/intoxication Congential Autoimmune/Allergic/Anatomic Traumatic Endocrine/Environmental Metabolic

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

18. Areas of Weakness Psychosocial Effect on functioning Emotional reaction Social support

19. Areas of Weakness Physical exam Lymph nodes Thyroid Abdomen GU/rectal* Neurologic Lung Cardiovascular Neurologic TechniqueThoroughness Thoroughly test any organ system associated with the chief complaint. Don’t forget to look for complications of the disease.

20. 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!

21. 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!

22. Performance Information Passing the BCM CPX is a graduation requirement Available online after review and release of grades

23. Professionalism It is our expectation that you will show up ON TIME* and PREPARED for the exam *Please refer to the tardiness/late policy

24. Professionalism DO NOT share information on cases with your colleagues

25. Scheduling Exam administration: March 31 – April 11 Signup online: March 3 – March 21 Dates and times set are non-negotiable Dates for testing, remediation, and retesting will be posted in a timely fashion Refer to the website for specific scheduling questions http://www.bcm.edu/spprogram/bcmcpx

26. Further Information Lariza McBean - mcbean@bcm.edumcbean@bcm.edu http://www.bcm.edu/spprogram/bcmcpx

27. BCM Clinical Performance Examination Tyson Pillow, M.D., M.Ed. Anita Kusnoor, M.D. Tyson Pillow, M.D., M.Ed. Anita Kusnoor, M.D.