Transcript BCM CPX Orientation PowerPoint Presentation

BCM Clinical Performance
Examination
Tyson Pillow, M.D., M.Ed.
Anita Kusnoor, M.D.
BCM CPX Goals
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) at this stage of
training.
• Identify students performing clinical skills at BCM’s proficiency
standard.
Competence
“The habitual and judicious 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
BCM CPX Objectives
Based on BCM standards, the students will:
• Perform a focused history in a SP environment.
• Perform an appropriate physical exam given the SP case.
• Communicate effectively in a SP encounter.
• Demonstrate fundamental patient-centered skills that
constitute the basis of safe and effective patient care
• Synthesize and construct a differential diagnosis and
treatment plan based on the SP scenario provided.
Framework
Basic Clinical
Skills
Physical
Examination
Communication
Context in Healing
Problem Solving
6 Clinical
Cases
Framework
6 Clinical Cases
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20 minutes each
Outpatient, time-limited cases
Checklists to assess clinical skills
8-10 minutes for interstation exercises
to evaluate problem solving
Basic Clinical Skills
Draw upon experiences from core
clerkships, LACE, and special
sessions
• History based on complaint and patient
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setting
Physical exam items performed
according to BCM standards
Communication
15 items
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Introduced self
Started with open-ended questions
Asked what you thought was the matter
Managed the narrative flow of your story
Elicited your story using appropriate questions
Clarified information by repeating
Allowed you to talk without interruptions
Nonverbal behavior enriched communication
Communication
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Acknowledged your emotions appropriately
Was respectful and nonjudgmental
Used words you understood and/or explained
jargon
Asked questions to see what you understood
about his/her diagnosis/treatment strategy
Provided clear explanations concerning
diagnosis and treatment
Paced the encounter well
Brought the encounter to a close
Cases
Problem solving tasks
related to type of visit
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New problem
Chronic illness
Psychosocial
New Problem Visit
Assess Presenting Complaint
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Information gathering and
differential diagnosis
• HPI questions
• Associated symptoms
Relevant review of systems
New Problem Visit
History
• Thoroughness associated with accuracy
• Major error is “premature closure”
Chronic Visit
History
• Assess severity 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
Psychosocial Visit
History
• Assess emotional needs of patient
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Background, Affect, Trouble,
Handling, Empathy (BATHE)
• Evaluate for diagnosable mental
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illness
Evaluate for suicide risk
Areas of Weakness
HPI
• Open-ended questions
• OLD CARTS/OPQRST
• Alleviating/aggravating factors
• Associated symptoms
• Pertinent review of systems
Areas of Weakness
Differential diagnosis
• 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
Areas of Weakness
Chronic illness
• Level of control
• Adherence to treatment plan
• Signs/symptoms of end-organ damage
• Other related risk factors
Areas of Weakness
Psychosocial
• Effect on functioning
• Emotional reaction
• Social support
Areas of Weakness
Physical exam
Thoroughness
Technique
• Lymph nodes
• Lung
• Thyroid
• Cardiovascular
• Abdomen
• Neurologic
• GU/rectal* Thoroughly test any organ system
• Neurologic associated with the chief
complaint. Don’t forget to look for
complications of the disease.
The Neurologic Exam
Clarification of wording
• Focused - specific components of neurologic
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exam relating to the patient’s complaints
Screening - the 36 item checklist taught in PPS
and the neurology clerkship
Full - a complete, head-to-toe neurologic
examination with adjunct testing tools included
Any patient with a primary neurologic complaint
should get a screening examination!
The Neurologic Exam
Pitfalls and Tips
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Memorize the components – be sure to address all
of them (CN, motor, sensation, reflexes,
coordination, mental status)
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Full MMSE is not required, but you should ask ALL
orientation questions
Pay attention to details specified in BCM Physical
Exam Standards document (available on website)
Time management is crucial on this station
Practice the screening neuro exam. Time yourself!
Performance Information
Available online after review and
release of grades
Passing the BCM CPX is a
graduation requirement
Professionalism
It is our expectation that you will
show up ON TIME* and
PREPARED for the exam
*Please refer to the tardiness/late policy
Professionalism
DO NOT share information on
cases with your colleagues
Scheduling
• Exam administration: March 31 – April 11
• Signup online: March 3 – March 21
• Dates and times set are non-negotiable
• Dates for testing, remediation, and retesting
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will be posted in a timely fashion
Refer to the website for specific scheduling
questions
http://www.bcm.edu/spprogram/bcmcpx
Further Information
Lariza McBean - [email protected]
http://www.bcm.edu/spprogram/bcmcpx
BCM Clinical Performance
Examination
Tyson Pillow, M.D., M.Ed.
Anita Kusnoor, M.D.