Standardized Patient Program - Student Information
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The Stanford Standardized Patient Program develops and administers clinical encounter-based exams throughout the medical school curriculum. We currently offer exams for both preclinical students (primarily during the two-year Practice of Medicine course) as well as for clinical students during core clerkship rotations and for the statewide Clinical Performance Examination (CPX), held each summer. Passing the CPX is a requirement for graduation.
Clinical Performance Examination (CPX)
The CPX is a standardized patient examination administered to all medical students in the state of California, to be taken at or towards the end of the core clerkships. The main purposes of this exam are:
1. To evaluate your current level of competency 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).
The CPX is designed by a consortium of clinicians and medical educators from all 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 problems, which may encompass subject material from any core clerkship. You will be expected to perform a focused history and usually a physical examination as well. You will also be expected to communicate your thinking and preliminary plans to the patients.
Passing the CPX is a requirement for graduation. Students who do not attain an overall passing score on the exam, or who fail any individual skill domain, will be required to successfully complete a remediation program and clinical skills examination. In the event that you need to take this exam, we will help you develop the skills necessary for improvement.
The exam will involve one five-hour block of time in the Immersive Learning Center in the LKC. Your course directors will be notified so that you may be excused from your scheduled rotation. Bear in mind that successful completion of the CPX examination is a graduation requirement.
FAQ about the CPX
How do I sign up for the CPX?
You can sign up for the Clinical Performance Examination by using our online registration system. You should take the CPX either after your first clinical year or the summer before you plan to graduate.
How do I prepare for the CPX?
You do not need to study any specific material for the CPX. However, you can prepare for the examination by:
- Knowing differential diagnoses for common clinical problems and clinical scenarios;
- Reflecting on how these differential diagnoses may affect the approach you will take in your focused history and physical;
- Reviewing your physical examination skills and the appropriate techniques by which to perform them;
- Observing basic fundamentals of physical examination behavior, such as proper introductions, hand washing, and measures to keep the patient’s comfort and perspective in mind.
What do I need to bring to the CPX?
All you need is: (1) professional dress, including white coat; (2) a stethoscope; and (3) yourself. All other medical supplies will be provided in the examination rooms. You will not be permitted to being pocket guides or other “cheat sheets” into the exam. You will not be permitted to bring cell phones or other devices into the exam.
What happens if I don’t pass the CPX?
Successful completion of the CPX is a requirement for graduation. Students who do not attain an overall passing score on the exam, or who fail any individual skill domain, will be required to successfully complete a remediation clinical skills examination, to be offered in the autumn. In the event that you need to take this exam, we will help you develop the skills necessary for improvement.
What if I can’t make any of the CPX dates?
The CPX is offered at all eight California medical schools. Although most students do, in fact, take the exam at their own school, on occasion there may be an extenuating circumstance that necessitates taking the exam at another location. If there is a serious conflict with dates, please contact Leslie Breton (lbreton@stanford.edu) at the SP program office to see if you can take the exam at another school.
Can I switch the date of my CPX?
You cannot change the date of your examination once you have signed up for the CPX. If there are extenuating circumstances, please contact the SP program office.
Mini CPX
The Mini-CPX is a four-hour examination offered towards the end (March) of the second year of the medical school curriculum. This examination is composed of both standardized patient encounters and computer-based exercises. The goals of this exercise are to evaluate your history and physical examination skills, communication (oral presentation) and patient interaction skills, clinical reasoning, and overall knowledge. It also is a means for you to identify skill areas on which to focus prior to entering clinical clerkships. Successful completion of the Mini-CPX is a requirement to complete the Practice of Medicine course. Students who do not attain an overall passing score on the exam will be identified for remediation.
The Micro-CPX is a two-station examination offered at the end of the first year of the medical school curriculum. Like the Mini-CPX, the Micro-CPX is similar in format to the CPX and is a good means to assess your skills at the conclusion of your first year of medical training.
Both the Mini-CPX and Micro-CPX are administered as part of the Practice of Medicine Course at Stanford.
FAQ about the Mini CPX
How do I prepare for the Mini CPX?
The Mini CPX is a cumulative exam, so the best preparation is to have been actively prepared and participating for your sessions in POM throughout the first and second years of medical school.
What do I need to bring to the Mini CPX?
All you need is: (1) professional dress, including white coat; (2) a stethoscope; and (3) yourself. All other medical supplies will be provided in the examination rooms. You will not be permitted to being pocket guides or other “cheat sheets” into the exam. You will not be permitted to bring cell phones or other devices into the exam.
What is the structure of the Mini CPX?
There are four focused H&P stations with a standardized patient, with a brief post-interview exercise. There are also four inter-station exercise stations, consisting of multiple parts including but not limited to interpreting diagnostics or physical exam findings. Each station is approximately 20 minutes.
Do I need to take a blood pressure during every encounter?
No, you do not need to take a blood pressure every time – but you should if you think that you need to based on the clinical situation.
Do I need to do a heart and lung exam on all patients, regardless of chief complaint?
If you think that it is the most relevant based on the patient. Prioritize according to the chief complaint – in “real life” encounters a cardiopulmonary exam on all patients, but keep in mind that the Mini CPX is a time-limited examination.
Am I expected to discuss management issues with the patient, in addition to doing their H&P?
We cannot tell examinees specifically what to do in the encounters, but you may wish to share your thoughts with the patient about what is going on and what you’d like to do. Each case is different, so it is not possible to say that “you must do X…” for each one. What we usually tell examinees is that you are the provider during this encounter – so counsel and share information and next steps when it’s appropriate.
What type of presentation can I be expected to make?
The Q5 mid-quarter assessment/oral presentation is a good gauge. You should be able to present an entire history and physical examination, and then summarize and explain your thought process and next steps in the management.
Will I be given paper to take notes on? Can I write out a template on this notepaper before an encounter? Will I have time to write notes or gather my thoughts after a patient encounter?
Scratch paper will be provided for you – you cannot bring your own. You can write out a template on the notepaper given you if you would like. You will not have time after a patient encounter to write out notes, however. All scratch paper will be collected after the examination is over.
What happens if I don’t pass the Mini CPX?
When a student does not pass the Mini CPX, s/he is required to develop and successfully complete a remediation plan with the E4C advisor in conjunction with POM prior to entering clerkships.
Other Frequently Asked Questions
Where are SP exercises held?
We are located in the Immersive Learning Center, on the ground floor of the Li-Ka Shing Center for Learning and Knowledge on the Stanford University School of Medicine campus.
How am I being evaluated?
Generally, students are evaluated in several skill areas. These include, but are not limited to, history taking, physical examination skills (not just whether you perform a certain maneuver but also if it is done correctly), the ability to communicate information to patients, and interpersonal skills. Sometimes there are additional exercises, following the patient encounter, that assess knowledge and clinical reasoning. Students are evaluated by both the standardized patients and faculty observers.
Will I get feedback on my SP exercise?
Yes. For the clinical performance examinations in general, after the entire class has completed a given exam, you will receive detailed feedback from the patient encounters and a set of scores with comparison standards. For many of the preclinical and clerkship exercises, rather than receiving written feedback, you will receive individualized one-on-one feedback from the standardized patient and/or a faculty observer.
What do I need to bring to my SP exercise?
With rare exception, you will only need professional dress (including white coat) and a stethoscope. For most SP exercises, all other materials you may need (ophthalmoscope, tuning fork, other medical equipment) are provided for you.
These are just actors, right?
Not necessarily. For some exercises, we hire professional actors for cases that involve simulations of exam findings or emotionally charged scenarios. Sometimes, however, we use real patients with real histories and physical exam findings. Remember that all standardized patients are people – and you should treat them as your patients, not as actors.
Links for students
History and physical examination
* Bates Guide to the Physical Exam training videos. Requires SUNET ID.
http://med.stanford.edu/irt/edtech/video/bates/
* Blaufuss multimedia – interactive tutorials and tests for cardiac physical examination skills.
www.blaufuss/org
* R.A.L.E. Repository – provides digital recordings of respiratory sounds in health and disease.
http://www.rale.ca
* The Auscultation Assistant – interactive website providing heart and lung sounds in order to help improve physical diagnosis skills.
http://www.med.ucla.edu/wilkes/intro.html
* The Stanford 25
http://stanford25.wordpress.com/
USMLE Step 2 CS
http://www.usmle.org/examinations/step2/step2cs.html
http://www.usmle.org/examinations/step2/step2cs_content.html
