M2 Clinical Comprehensive
Assessment (CCA)
Michael Lukela, M.D.
Director, M2 CCA
October 30, 2012
Exam Composition
• Practical Exam
– Physical Exam
– History Taking
– History Presentation
– Case Write-up
• Written Exam
Exam Composition (Practical)
• Physical Exam
– Abdominal
– Cardiac
– Musculoskeletal
– Neurology
– Pulmonary
• History Taking
– History Taking
– History Presentation
– Communication Skills
Physical Exam
General Principles
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The patients are SPs
Grading is performed by SPs and faculty proctors
Targeted, but complete physical exam
Expectation is NOT to elicit abnormalities
No checklists, notes, or aides allowed
Required equipment will be posted on CCA website
Safety tip: Practice talking through your exam aloud
Musculoskeletal
• Split into two components (A & B)
• During the exam you will perform only either A or B, but are responsible
for content of both
• Musculoskeletal A
– Hands
– Wrists
– Elbows
– Shoulders
– Spine (cervical)
• Musculoskeletal B
– Hips
– Knees
– Ankle/Foot
– Spine (thoracolumbar)
Resources and Helpful Hints
• Clinical Foundations of Medicine (CFM) checklists are your friends
– Refer to course syllabus, M2 CCA website
• Practice the exam in “sections”
– e.g. Cardiac, Neurology, Musculoskeletal
– Become familiar with equipment (e.g. safety pins for sensory testing)
• Practice talking aloud while you are performing the exam
• Resources under development to assist in your preparation
– “Modified” CFM checklists to guide preparation
– Exam FAQ’s drawn from prior exams/student questions to be posted on
M2 CCA website
M2 CCA Website
Example Teaching (CFM) Checklist
History Taking
History Taking
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General Principles
– History of Present Illness focusing on key elements that lead to the visit and to address the
patient’s specific concern(s)
– Assessment of relevant risk factors based on the problem(s) identified
– Exploration of other relevant history based on understanding of problem(s)
– Knowing the patient’s PMH, Meds, Allergies
– Exploration of relevant family and social history
– Application of targeted and relevant review of systems to include, exclude other relevant
diagnoses
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History Taking Station Notes
– Goal is to elicit a focused, but complete history based on patient’s chief complaint
– Patients are “standardized”
– Communication skills will be assessed as a component of the history taking sessions
– Content of interview drawn from CFM curriculum and CEP experiences
– Time allocation is up to the student
Standard templates and ROS sheets will be provided at each station; no other notes may be used
History Presentation
• History presentation will occur as part of the an integrated station lasting 45
minutes during which students perform a history, targeted physical exam,
and verbal presentation in sequence
• During the station block students are expected to:
– Organize a verbal presentation
– Present his/her observations to a faculty physician/observer
Notes may be taken during history taking station and you may use these notes
to present to the faculty/observer
Preparation and Resources
• Review CFM teaching videos, interviews
– Practical history taking
– Patient interview
• Review prior interview topics covered during the M1/M2 year
• Review and practice ROS in a targeted manner
• Recognize that every clinical history is a story- not everything is PQRST
• Practice, practice, practice
Exam Format
BLOCK 1: 50 minutes
History Taking
Abdominal Exam
Verbal presentation
BLOCK 2: 50 minutes
History Taking
Cardiac Exam
Pulmonary Exam
Case Write-Up
BLOCK 3: 50 minutes
Neurology Exam
Musculoskeletal Exam
Groups rotate between sections every 50 minutes. Blocks 1 and 2 are integrated stations
following the sequence of History Physical Exam Presentation or Case Write-Up.
Written Exam
Exam Composition
• Written examination
– Closed-book, web-based exam
– Approximately 120-140 questions covering principles of physical exam
and basic pathophysiology
• Topic areas include: abdominal, cardiac, musculoskeletal,
neurologic, pulmonary, ENT, ophthalmology
• Content from exam covered in CFM lectures, course syllabus, exam
checklists
– Administered during CCA exam weekend
Note: You may take the written examination either before or after the clinical
portion of the CCA
Example Question #1
Which of the following is the ideal order in which to perform the
abdominal exam?
a.
b.
c.
d.
Auscultation, inspection, percussion, palpation
Inspection, auscultation, percussion, palpation
Inspection, palpation, auscultation, percussion
Inspection, palpation, percussion, auscultation
Example Question #2
A 17-year-old football player is seen in clinic for his sports physical.
Initial blood pressure is 160/90 with a pulse of 68 and repeat blood
pressure measurement in the exam room is 170/84 with a pulse of 65.
Previous blood pressure measurements have been normal and he is
otherwise healthy and asymptomatic. The most likely explanation for
this finding is:
a. Development of essential hypertension
b. He ate a Super size meal at McDonald’s just prior to the visit
c. He is nervous he may be withdrawn from practice
d. Use of a cuff that is too small for the patient
Preparation and Resources
• Review content specifications (M2 CCA website)
• CFM written exam
• Review physical exam outlines
• Review physical exam checklists
• Swartz: Textbook of Physical Diagnosis
Example: Content Specifications Outline
• Knowledge (Written Exam): Abdominal
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Know the anatomic location of intra-abdominal organs
Know the physical exam findings in patients with ascites
Know how to assess liver span
Know the physical exam findings in patients with abdominal aortic aneurysms
Know the physical exam findings in patients with diverticulitis
Know the technique for examination of the spleen
Know the physical exam findings in patients with peritonitis
Know the correct sequence of performing the abdominal exam
Know the physical exam findings in patients with pyelonephritis
Know the technique for auscultation of abdominal and renal bruits
Know the physical exam findings in patients with appendicitis
Know the terminology for associated physical exam findings in patients with
cirrhosis
– Know the anatomic location for referred pain from intra-abdominal organs
Exam Logistics
Exam Dates
Clinical Exam
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Friday, February 2, 2013
Saturday, February 2, 2013
Monday, February 4, 2013
Tuesday, February 5, 2013
Make-Up Exam
– Wednesday, March 13, 2013 (tentative)
Written Exam
The M2 CCA Written Exam opens on Thursday, January 31, 2013 at 8:00 a.m.
through Wednesday, February 6, 2013 at 12:00 a.m. (24h, midnight).
Sign up for the exam will open following the holiday break
Make-Up Exam
• Make Up Exam
– Wednesday, March 13, 2013
• Remediation
– Tentatively scheduled between March 1 through March 8, 2013
Note: Students who are unable to take the exam during February must
obtain approval to take the exam on March 13 from the M2 CCA
Committee and Director
Myths and Misconceptions
About the CCA
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Myth: The faculty get enjoyment by inflicting physical and emotional pain on the medical
students by making them take the M2 CCA.
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Fact: The faculty REALLY experience great joy inflicting physical and emotional pain on the
medical students by making them take the M2 CCA.
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Myth: Each year, many students FAIL the exam and do not begin their M3 year on time.
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Fact: Although there are a handful of individual station failures each year, the majority of the
students pass each section on the first attempt. We have NEVER had a student receive a failing
grade for the CCA recorded on his/her transcript. We have NEVER had a student’s matriculation
to the M3 year delayed because of his/her performance on the M2 CCA.
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Myth: Students are graded on/expected to perform tasks that are not on the teaching checklists.
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Fact: The exam is not designed to “trip up” students. The tasks to be completed at a given
physical exam station is based on what is taught during the CFM course using the teaching
checklists.
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Myth: There is no way that I will be able to complete these tasks during the allotted time.
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Fact: The overwhelming majority of students complete the exam/history taking stations without
difficulty and often have time to spare. Many times, students who run into time pressure have
not followed the door instructions and spend time completing tasks not required/expected at the
station. Practice, practice, practice.
Contact Information
• Michael Lukela, MD
– Director, M2 CCA
– E-mail: mlukela@umich.edu
• Amy Page
– Lead Administrator, M2 CCA
– E-mail: amypage@umich.edu