Clinical Performance Exam (CPX)

Mini-CPX 1: April of the core clerkship year (during Transitional Clerkship or Block 1)

This is the first in a series of standardized patient (SP) encounters during the core clerkship year, scheduled before or early in the first core clinical rotation. It is designed to provide students with experience conducting encounters with SPs in the UCSF Kanbar Center located on the 2nd floor of the Parnassus library, familiarize students with expectations in a Clinical Performance examination (CPX), introduce CPX checklists, and provide early feedback on clinical and communication skills.

In the Mini-CPX 1, students work in groups of three. Each student interviews an 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, a clinician faculty, and the three students rotate to a different SP case, 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 media room.

Learning Goals

The major learning goals of the 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 transitional clerkship or early in Block 1.

Mini-CPX 2: October of the core clerkship year (during Intersessions or Block 4)

The Mini-CPX 2 is a practice run for the CPX required of all UCSF students at the end of the core clerkship year. This exercise is designed to prepare students not only for the CPX but for the USMLE Step 2 Clinical Skills Examination. In the Mini-CPX 2, each student will see three patients independently in a clinic setting and receive verbal feedback directly from each standardized patient. There will be a teaching session with faculty after the encounters. All student encounters will be digitally recorded. Students are encouraged to review their video with a faculty member for further learning and feedback. All students will receive a score report indicating their scores on each of the cases in history taking, physical exam, information sharing, and communication skills. These individual scores will be compared to the class as a whole.

Mini-CPX 2 is scheduled in October during Intersessions 2 or early in Block 4 at the Kanbar Center. Your total time commitment for three patient encounters and feedback is about three hours. Your Intersessions or 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! The Mini-CPX 2 is required for all students with third-year standing. Participating in Mini-CPX 2 will help improve your performance on the CPX by familiarizing you with the CPX format. If you will be on a rotation outside of San Francisco, we will work with you and your clerkship director 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 Mentor. 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 required 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 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 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 Kanbar Center. Your course directors will be notified so that you may be excused from your scheduled rotation.

Students who do not achieve a passing score on the CPX will be notified, as well as their Advisory College Mentor. Students will be required to participate in the Clinical Skills Remediation Program in which they will work with a mentor and/or a preceptor to improve their skills.