More Related Content
Similar to BCM CPX Orientation 2018
BCM CPX Orientation 2018
- 1. BCM Clinical Performance Examination TysonPillow, M.D., M.Ed. Anita Kusnoor, M.D.
- 2. BCM CPX Goals •Assess the clinical skills performance of medical students after the completion of their third year of medical school. • Serve as a competence benchmark for clinical performance (history taking, physical exam, communication, clinical reasoning) at this stage of training.
- 3. Competence “The habitual andjudicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served.” -Epstein and Hundert. JAMA 2002;287:226.
- 4. BCM CPX Objectives Basedon BCM standards, students will: •Perform a focused history in a simulation environment. •Perform and interpret an appropriate physical exam given the simulated case. •Communicate effectively in a simulated encounter. •Demonstrate fundamental patient-centered skills that constitute the basis of safe and effective patient care. •Synthesize and construct a differential diagnosis, diagnostic plan & treatment plan based on the scenario provided.
- 5. Framework • Basic ClinicalSkills (H&P) • Interpret physical findings • Communication • Interpret labs/studies • Problem Solving • Differential diagnosis • Management plan • Post-encounter note • Verbal presentation 4 Clinical Cases
- 6. Framework Structure • Outpatient, time-limitedcases • Checklists to assess clinical skills • 10 minutes for interstation exercises to evaluate clinical reasoning
- 7. Framework 4 Stations Station Timing1 2 3 4 Patient 15 min Patient 1 Patient 2 SAM Patient 3 Post- Encounter 10 min Post- encounter note Verbal patient presentation EKG & CXR interpretation Extra 10 min with patient = total 25 min
- 8. Basic Clinical Skills •History based on complaint and patient setting • Physical exam items evaluated according to BCM standards (available on Blackboard) • No invasive exams (breast, rectal, pelvic, GU). If you need to do one, notify the patient as part of your plan Draw upon experiences from core clerkships, LACE, and special sessions
- 9. Communication • Address thepatient by name • Introduce self by name AND title • Involve patient when discussing the reason for the visit • Maintain appropriate eye contact • Use effective body language Opening the Interview
- 10. Communication • Legitimize patient’semotions • Reinforce positive behaviors Responding to the Patient
- 11. Communication • Encourage questionsor concerns • Elicit patient perspective • Avoid interrupting • Avoid leading questions • Avoid multiple questions • Conduct the interactions in an organized manner • Use open- and close-ended questions effectively • Check for accuracy during the interview Conducting the Interview
- 12. Communication • Summarize theinterview (history and exam, if applicable) • Avoid inappropriate language • Review next steps • Verify patient’s understanding Educating, Negotiating, Collaborating
- 13. Cases Problem solving tasksrelated to type of visit • New problem • Chronic illness • Psychosocial
- 14. New Problem Visit AssessPresenting Complaint • Information gathering (driven by the differential diagnosis) • HPI questions • Associated symptoms • Relevant review of systems • Thoroughness associated with accuracy • Major error is “premature closure” (differential too narrow)
- 15. Chronic Visit • Assessseverity and control of condition • Signs and symptoms of condition • Home monitoring • Target organ damage from condition • Evaluate adherence and treatment side effects • Review status of other risk factors History
- 16. Psychosocial Visit • Assessemotional needs of patient • Background, Affect, Trouble, Handling, Empathy (BATHE) • Evaluate for diagnosable mental illness • Evaluate for suicide risk History
- 17. Areas of Weakness HPI •Open-ended questions • OLD CARTS/OPQRST • Alleviating/aggravating factors • Associated symptoms • Pertinent review of systems • Don’t forget that the differential diagnosis drives what questions you ask in the HPI
- 18. Areas of Weakness Differentialdiagnosis • Vascular • Infectious • Traumatic • Autoimmune • Metabolic • Idiopathic/iatrogenic • Neoplastic • Congential • Vascular • Inflammatory/Infectious • Neoplastic • Degenerative/Deficiency/Drugs • Idiopathic/iatrogenic/intoxication • Congential • Autoimmune/Allergic/Anatomic • Traumatic • Endocrine/Environmental • Metabolic Be precise and specific: “CNS disease” versus “ischemic stroke in MCA territory”
- 19. Areas of Weakness Chronicillness • Level of control • Adherence to treatment plan • Signs/symptoms of end-organ damage • Other related risk factors • Counseling the patient For chronic disease case, you will get a total of 25 minutes with the patient, and there will be no post-encounter questions.
- 20. Areas of Weakness Psychosocial •Effect on functioning • Emotional reaction • Social support
- 21. Physical Exam • Lung •Cardiovascular • Neurologic • Lymph nodes • Thyroid • Abdomen • Neurologic Areas of Weakness Thoroughly test any organ system associated with the chief complaint. Don’t forget to look for complications of the disease. PE should be focused but thorough. Thoroughness Technique Drape patients appropriately. Don’t listen over gown/sports bra. Don’t abbreviate the heart/lung exam (e.g., don’t just listen to one valve). Don’t be overly aggressive with palpation.
- 22. Post-Encounter Note HISTORY: Describe thehistory you just obtained from this patient. Include only information (pertinent positives and negatives) relevant to this patient’s problem(s). •Write it like you would write a regular HPI on a rotation
- 23. Post-Encounter Note PHYSICAL EXAMINATION: Describe anypositive and negative findings relevant to this patient’s problem(s). Be careful to include only those parts of examination you performed in this encounter. •Write out your exam •Include vitals
- 24. DATA INTERPRETATION: Based onwhat you have learned from the H&P, list up to 3 diagnoses that might explain this patient’s complaint(s). List your diagnoses from most to least likely. For some cases, fewer than 3 diagnoses will be appropriate. Then, enter the positive or negative findings from the history and the physical examination (if present) that support each diagnosis. Lastly, list initial diagnostic studies (if any) you would order for each listed diagnosis (e.g., restricted physical exam maneuvers, laboratory tests, imaging, ECG, etc.) Post-Encounter Note Initial diagnostic studies do not have to correlate with each diagnosis. For example, if the chief complaint is chest pain, you may want chest x-ray and EKG for all of the items on your differential.
- 25. Verbal Patient Presentation •Post-encounter exercise on one station • Total of 10 minutes • Use the first portion to organize your thoughts • After 7 minutes if you have not begun your presentation, the Standardized Faculty Member will prompt you to start • Follow presentation style used when presenting new patients on clerkships • Don’t forget to state your differential diagnosis, the rationale for your differential, and your proposed management plan
- 26. The SAM Station •Three brief scenarios – examine SAM (heart/lung simulator) and identify abnormalities • SAM is available for practice • See Blackboard for location, dates, times
- 27. Chest X-ray Interpretation Answerchoices (in this order) A. Normal chest B. Right upper lobe pneumonia C. Right middle lobe pneumonia D. Right lower lobe pneumonia E. Left upper lobe pneumonia F. Lingular pneumonia G. Left lower lobe pneumonia H. Multifocal pneumonia I. Cardiomegaly J. Pulmonary edema K. Pleural effusion(s) L. Pneumothorax M. Widened mediastinum N. Lung mass O. Cavitary lesion P. Hyperinflated lungs (COPD)
- 28. EKG Interpretation Answer choices(in this order) A. Normal sinus rhythm B. Sinus bradycardia C. Sinus tachycardia D. Atrial flutter E. Atrial fibrillation F. Supraventricular tachycardia G. Ventricular tachycardia H. Ventricular fibrillation I. Torsades de Pointes J. 1st degree heart block K. 2nd degree heart block – type I L. 2nd degree heart block – type II M. 3rd degree heart block N. Electrical alternans O. Peaked T waves P. Anterior ST elevation MI Q. Inferior ST elevation MI R. Lateral ST elevation MI S. Left bundle branch block T. Right bundle branch block
- 29. How to Prepare •Preparation for the exam is strongly encouraged • Review BCM Physical Exam Standards, available on CPX website • Practice generating differential diagnoses • Review the PEN questions • Review the answer choices for chest x-rays and EKGs • Practice with SAM • Practice verbal presentations
- 30. Performance Information Passing theBCM CPX is a graduation requirement Available online after review and release of grades
- 31. Professionalism It is ourexpectation that you will show up ON TIME* and PREPARED for the exam *Please refer to the tardiness/late policy
- 32. Professionalism Professional dress +white coat enhances the standardized patient’s perception of your competence
- 33. Professionalism DO NOT shareexam content with your colleagues
- 34. Scheduling • Exam dates:March 27-29, April 2-4 • Online signup starts today. You will receive instructions by email. • Refer to Blackboard for specific scheduling questions • Dates for testing, remediation, and retesting will be posted in a timely fashion
- 35. Website • Search Blackboardfor “Simulation Learning Center” and enroll in this course • Click on BCM CPX on the left
- 38. Contact Information Contact Email Mrs.Kira Boerkircher Program Manager Simulation & Standardized Patient Programs Kira.Boerkircher@bcm.edu Dr. Anita Kusnoor CPX Director avk1@bcm.edu Dr. Tyson Pillow Medical Director Simulation & Standardized Patient Programs pillow@bcm.edu
- 39. BCM Clinical Performance Examination TysonPillow, M.D., M.Ed. Anita Kusnoor, M.D.
Editor's Notes
- #22 Example of thoroughness: If you want to listen to heart, auscultate all valves. Don’t necessarily have to look at JVP if it’s not indicated for the case.
- #28 Chest x-ray tutorials are available on online: https://internalmedicine.med.uky.edu/im-chest-x-ray-tutorial https://www.med-ed.virginia.edu/courses/rad/cxr/pathology2chest.html
- #31 Target is late May for grade release
- #36 See link for physical exam sheet