• Mini-CPX 1
• Mini-CPX 2
• Clinical Performance Exam (CPX)

Mini-CPX 1: July-August of the core clerkship year

This is the first in a series of standardized patient (SP) encounters during the core clerkship year, scheduled towards the end of the second core clinical rotation. It is designed to provide students with experience conducting encounters with SPs in the UCSF Clinical Skills Center at Mt. Zion, familiarize students with expectations in a Clinical Performance examination (CPX). introduce CPX checklists, and provide early feedback on clinical and communication skills.

In Mini-CPX 1, students work in groups of three. Each student interviews a SP while the other two students observe in the room, filling out checklists and preparing their own feedback to give to their peer. After a feedback session with peers, the SP, and a clinician faculty, the three students rotate to a different SP, and the next student takes the role of interviewer. This sequence occurs a total of three times.

In the role of “student doctor,” each student is expected to perform a focused history and physical examination based on the patient’s chief complaint, generate a working differential diagnosis, and present an assessment and plan to the patient. During the student’s interaction with the SP, a clinician will observe the encounter via video from the faculty monitor room.

Learning Goals
The major learning goals of mini-CPX 1 are to:
• Establish rapport quickly and effectively with patients
• Generate a differential diagnosis based on chief complaint
• Perform a focused history and physical examination based on the differential diagnosis
• Communicate thinking/plan to the patient
• Treat the SP interaction as a real encounter

You will be scheduled for a half-day slot during your clerkship; clerkship directors will be notified and you will have the opportunity to trade timeslots if you have a conflict.

Mini-CPX 2: November-December of the core clerkship year

In the mini-CPX 2, you will see three patients independently in a clinic setting and receive feedback on your clinical skills directly from the patients. There will also be a teaching session with faculty after the encounters. You will be videotaped seeing the patients and you will receive a copy of your tape to keep and review with a faculty member of your choice for further learning and feedback. You will receive a score report showing your scores on the cases in history taking, physical exam, and communication, and comparing your performance to that of the class as a whole.

The mini-CPX 2 is scheduled in November-December of the core clerkship year in the Clinical Skills Center. Your total time commitment for three patient encounters and feedback is about three hours. Your clerkship director will excuse you from clerkship duties for a half-day to participate. There are no implications for your clerkship grades -- the mini-CPX 2 is meant to be an opportunity for your learning! All third year students who have completed two clerkship blocks by the time of the mini-CPX 2 are required to participate. However, the mini-CPX 2 is strongly recommended for all students with 3rd year standing. Participating in the mini-CPX 2 should help improve your performance on the CPX by familiarizing you with the Clinical Skills Center and the exam format. If you will be on a rotation outside of San Francisco, we will work with you and your clerkship director to try to accommodate you.

Students whose performance raises concerns about whether they have achieved a minimum standard of competence will be notified, as will their advisory college mentors. We will help those students to work with their mentor and/or a preceptor to improve their skills.

Clinical Performance Exam (CPX): May-June after the core clerkships

The Clinical Performance Examination (CPX) is a standardized patient program for all UCSF students at the end of the core clerkships.

The four purposes of this exam are:

1. To evaluate your current level of competence in clinical and interpersonal skills.
2. To provide individual feedback on these skills in preparation for your residency training.
3. To prepare you for the USMLE Step 2 Clinical Skills Examination (standardized patient portion of the boards).
4. To evaluate the effectiveness of our overall curriculum.

The CPX is designed by a consortium of clinicians and medical educators from all eight California medical schools to assess clinical skills essential to the practice of medicine regardless of specialty. Over 1000 students take this exam each year. During the exam, you will see eight patients with a broad range of ambulatory problems. The exam runs similarly to the mini-CPX 2. You will also be expected to communicate your thinking and preliminary plans to the patients. All students must pass the CPX before graduation. The exam is designed to be taken at the end of the core clerkships. Students who have completed at least four core clerkship blocks by the time of the CPX are required to take the exam; students who have completed three blocks are strongly encouraged to take it. Any student planning on extending curriculum should plan on taking the CPX before taking time off.

After the entire class has completed the exam you will receive detailed feedback from the patient encounters and a set of scores with comparison standards. We will formulate specific remediation plans for those students who do not demonstrate a minimum standard of competence. All students are encouraged to work with a faculty preceptor to identify strengths and make plans for potential improvement.

The exam will involve a one four-hour block of your time and will take place at the end of the May block and beginning of the June block in the UCSF Clinical Skills Center at Mt. Zion. Your course directors will be notified so that you may be excused from your scheduled rotation. Maureen Mitchell of Curricular Affairs will help coordinate schedules in order to minimize any disruption of rotations.