CPX Student Guidelines

The 2020 CPX will take place Thursday, February 27th through Saturday, March 7th. Sessions will run weekday afternoons and weekend mornings and afternoons.

What is the CPX?

The Clinical Practice Examination (CPX) is a simulated patient-based performance exam, which assesses the application of students’ clinical skills to patient care.  This cumulative exam includes 10 cases similar to those faced in outpatient practice.  Each case includes a unique patient encounter and a written patient note. The entire exam takes approximately five and a half hours to complete.

What skills are assessed?

The following skills are assessed during the CPX:

  • history-taking
  • information sharing
  • physical examination
  • interpersonal communication
  • diagnostic decision-making
  • diagnostic interpretation
  • management

What are the purposes of the CPX?

The purposes of the CPX are to:

1) Provide a standard and objective measure of medical students’ clinical skills at the end of the third year of undergraduate medical education.

2) Provide students with additional information about their readiness to move on to graduate medical education.

3) Provide the School of Medicine with information about group performance in order to assist in the refinement of existing curricula and in the development of new instruction.

4) Provide students with experience participating in an extended performance assessment as practice for Step 2 CS of the USMLE.

What happens on the day of the CPX?

Each student will complete a total of 10 patient cases.  Each case includes two components:

1) Patient encounter (15 minutes)

2) Written patient note (10 minutes)

At the beginning of your designated session, you will participate in a brief group orientation.  During this time, you will be given detailed instructions about the examination.

Before entering each patient room, you will log in to an electronic chart describing that patient, the vitals and the expectations for the encounter. You will then have 15 minutes to complete the patient encounter.  Following the patient encounter, you will have an additional 10 minutes to complete the computer-based patient note to document your patient findings.

What role should I portray during the CPX?

Students will take the role of PGY1 residents working in various ambulatory settings, such as a primary care doctor’s office, emergency room, or walk-in clinic.

Keep in mind that you may interact with a single patient, a patient and a family member, or you may even be asked to interview a patient over the telephone.

Where do the cases come from?

The cases for the CPX are representative of common types of clinical encounters experienced in primary care settings.  They are also typical of the types of cases that will be included in the USMLE Step 2 CS.

Specific cases are created and/or reviewed by the faculty in the OSCE Committee. These faculties assure the cases represent problems with which students should be familiar by the end of the third year.

How are my skills evaluated?

Your performance on the CPX will be assessed in the following manner:

  1. After each encounter, your simulated patient will enter information about your performance into a computer. This information will be converted into a numeric percent-correct score for history-taking, information sharing, and physical examination. Interpersonal communication scores will be computed by averaging the ratings from all patients.
  2. You will write a patient note for most cases using the USMLE Step 2 CS format.  For grading efficiency, the note is written on the computer, but paper copies will also be available for hand-written notes if requested. Physicians score patient notes using a patient note rubric that evaluates history and physical exam written findings as they are related to the differential diagnosis and follow-up plan.

What are the criteria for passing the CPX?

In order to receive a Pass for the CPX, you must pass both domains that are being assessed on the exam:  Patient Encounter Skills and Communication Skills. 

Patient Encounter Skills and Communication Skills are assessed on each station and your score across all of the stations will determine your final score for the examination. Your scores will be compiled from checklists completed by the standardized patients (physical exam and communication skills) and from scoring of the patient write-up by faculty on the OSCE committee (history, physical exam, differential diagnoses). Consistent with other national OSCEs and Step2CS, scoring checklists cannot be released following the exam. OSCE cases are reused across the curriculum.

What if I don‘t do well on a particular case?

Not doing well on one case will not affect whether you pass the CPX!  The criteria have been set so that weak performance on one or even three cases will not justify a recommendation for remediation.  Therefore, during the CPX, do not let one poor performance on a given case influence your performance on other cases.

What if I don‘t pass the CPX?

Student performance on the CPX will be reported as Pass or Not Meeting Passing Criteria.  Students who do not meet passing criteria may be given an opportunity to pass a retake exam after the mandatory remediation.  Other students interested in polishing their skills in a performance exam may also be invited to participate in the CPX remediation.

What are some common mistakes students make during the CPX?

  1. Not performing all important physical examination procedures.
  2. Assuming that no physical signs or symptoms will be present because the case is a simulation.  This is not true!
  3. Taking a disorganized and/or incomplete history from the patient.
  4. Narrowing too quickly to a specific diagnosis when more assessment is needed.
  5. Ruling out alternatives prematurely.
  6. Forgetting to include follow-up in the management plans.
  7. Forgetting to wash your hands in view of the patient.
  8. Requesting labs, tests, and procedures that are unwarranted or unjustified.

What should I bring to the CPX?

Please wear your white coat, and bring your stethoscope and ID badge.

You may not bring any outside materials or electronic devices (including even the most basic of watches or cell phones) into the testing area.  You will not have access to the Internet during the CPX.

When will I complete the CPX?

The CPX is scheduled a month or two in advance by all students receiving a link to a scheduling webpage where they can rank their top choices for times and mark one date as impossible.  The final schedule is then created and sent to the students by email.  Further scheduling conflicts can be resolved by students switching times and informing CSC staff (eb6yv@virgina.edu).

Students are excused from ALL clerkship duties on the date that they are scheduled to complete the CPX.  Students are also excluded from on-call duties the evening prior to the CPX session.

What if I’m on an out-of-town rotation?

Students who are attending away rotations are required to return to Charlottesville to complete the CPX.

What If I have questions or concerns regarding the CPX?

If you have scheduling question or concerns, contact:

Elizabeth Briere
Director of Clinical Skills
434-243-3295