CLINICAL PRACTICE EXAMINATION
                                  GUIDELINES FOR STUDENTS

1. During the Clinical Practice Exam (CPX), your clinical ability will be assessed in several areas:
            on whether or not you can perform an appropriate
                 focused history and
                 focused physical exam

             on how well you
                  communicate and share information with the patient

             and on your
                  interpersonal skills during the encounter with the patient.

       The interstation exercises are designed to assess your ability to:
                   synthesize information either obtained or given to you
                   come up with a plausible differential diagnosis
                   determine appropriate treatment and follow-up
                   interpret various findings and test results

2. This exam is not so much about getting the diagnosis correct (which can be assessed in a written
   exam) as it is about the process you use in working with the patients to come to a clinical
   understanding of what might be going on with them. In other words, the CPX is an assessment of
   your ability to work through a wide differential, and not simply try to “guess the disease.”

3. There are eight (8) patient stations in the CPX.
   You will have 15 minutes with 7 of the standardized patients and 20 minutes with one patient.
          Once you have logged in to a station, you will hear an announcement letting you know when
           you can review the station instructions and proceed with the encounter.
          You will hear an announcement over the intercom when there are 5 minutes remaining in the
          At the end of the encounter, you will hear:
           “Student doctor, you’re needed in the hallway.”
           You must leave the room at this time.
          You will then have 7 minutes to complete the interstation exercise for seven of the eight
          For one case, you will have 2 minutes to do a brief write-up.
          The proctor will let you know 2 minutes before the end of the follow-up exercise.
          You will be given instructions when it is time to move to the next station.

   There will be a break after your fourth patient encounter.

4. Treat all standardized patients as if they were real patients; all simulated encounters as if they
   were actual encounters.

                        2008 California Consortium for the Assessment of Clinical Competence
5. The patient information and instructions for each station are in two places: in a folder outside the
   door to the station and on the back of the door inside the exam room. If you wish, you may take the
   folder inside the exam room with you. Please remember to bring it with you when you leave the
   encounter and replace it in the holder outside the room where you found it.
   With information/instructions in both places, it should not be necessary for you to leave the room
   until you feel the encounter is complete.

   Conversely, YOU MAY NOT GO BACK INTO THE PATIENT ROOM once you come out.

6. In some stations, you will be asked to discuss treatment or management issues with the patient as
   part of the station requirements. Whether or not you are asked to do this, you will be expected to
   close the encounter with the patient, NOT just walk out of the room with whatever data you have
   An acceptable way to end the encounter might be by:
                   -- appropriately reassuring the patient
                   -- letting the patient know what you are going to do next and when you, or
                        someone else, will return. For example:

              "Mr./Ms. Miller, this is what I think is going on with you and what I'd
              like to do... (Give details to the patient). I'm going to consult with my
              supervisor and then I (we) will return to confirm what I've told you
              and proceed with the next steps in your care."

7. You will be completing an interstation exercise on all eight cases.

8. ALL patient encounters will be captured on digital video. Checklists that are completed by the
   standardized patients, along with the video files, will be used to determine how well you performed
   on this CPX. Faculty, in the monitoring room, will be intermittently observing your encounters with
   the standardized patients.

    of the patients in this CPX. However, in order to adequately assess what is going on with the
    patient, you may feel that one or another of these exams is necessary.

   IF YOU FEEL THAT ANY OF THESE EXAMS ARE APPROPRIATE, tell the standardized patient,
   "Mr./Ms. Miller, what I'd like to do now is a rectal (breast/pelvic/genital) exam." The standardized
   patient will tell you where in the room you can find the results of that exam.


10. You should have your own stethoscope and be wearing a lab coat. Please also remember to
    bring your blue student ID card with the picture of Geisel library on it.
    All equipment and supplies that you need are provided in each clinic room. You may bring your own
    panoptic ophthalmoscope and reflex hammer into the rooms with you if you wish. You may not take
    other equipment/supplies or reference materials with you.

                        2008 California Consortium for the Assessment of Clinical Competence

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