CPX Student Guidelines

The 2021 CPX will take place Monday, February 22nd through Tuesday, March 16th. 

What is the CPX?

The Clinical Performance Examination (CPX) is a standardized 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 computer-based patient note. The entire exam takes approximately six 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
  • time 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.

What happens on the day of the CPX?

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

1) Virtaul Patient encounter (20 minutes)

2) Computer-based patient note (10 minutes)

The CPX Orientation is offered on January 27th at 12:00 pm.  During this time, you will be given detailed instructions about the examination.

Before entering each patient room, you will lreveiw Examinee Instructions describing that patient, the vitals and the expectations for the encounter. You will have 20 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 3rd-year medical students working in various ambulatory settings, such as a primary care doctor’s office, emergency room, or walk-in clinic.

You will interact with a standardized patient over Zoom.

Where do the cases come from?

The cases for the CPX are representative of common types of clinical encounters experienced in primary care settings.

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, the standardized patient will enter information about your performance into a computer. This information will be converted into a numeric percent-correct score for communication skills and physical examination.
  2. You will type a patient note for most cases using the old USMLE Step 2 CS format.  For grading efficiency, the note is completed on the computer, but paper copies will also be available for hand-written notes if requested or in the event of technical issues. 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, and clinical reasoning). Consistent with other national OSCEs, 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 may not affect whether you pass the CPX.  The criteria have been set so that inadequate performance on a case may 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. Forgetting to include follow-up in the management plans.
  6. 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 (if required) 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 in advance by the Clinical Skills Center.  All students will receive an email regarding their assigned date.  Further scheduling conflicts can be resolved by students switching times and informing CSC staff (ces6d@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