Presented to the Medical Education Committee
8/8/2012
* Communication Scale was changed between 2009 and 2010 so the scores are
not comparable.
CPX 2012 Cases
Case
Demographics
Presenting
Problem
Category
DL
44 yo female
Period won’t stop Acute
EH
32 yo male
Lower back pain
Acute
LS
20 yo female
Syncope
Acute
MB
50 yo male
Cough
Chronic
RK
60 yo male
DM II
Chronic
RS
75 yo female
Falls
Acute
SW
45 yo AA female
HTN
Chronic
MC*
22 mo male
Asthma attack
Acute
* Excluded from scoring
Clinical Skills
&
Clinical Reasoning
Clinical Skills
Standards
Failure Rate
Remediation
To Pass:
Clinical Reasoning
To Pass:
HX = 60% + Reach the passing criterion on 5 or
PX = 60% + more cases (minimum number of
Communication = 60% + Critical Items per Case)
Overall = 65% +
57/185=31%
19/185=10%
(5 overlap w CR)
(5 overlap w CS)
• Individualized plan based • 1 hr. self-assessment + 1 hr.
on the pattern of fails.
w/ faculty, enroll in Adv. Dx
Skills
• Can not take Step 2 CS till
complete*
• The 14 with only CR fails can
take Step 2 CS anytime
* PX only fails are allowed to take Step 2 CS during remediation if the score
fell between 47% - 59%.
Type of Fails
Clinical Skills
HX only
Clinical Skills
PX only
Clinical Skills
PPI only
Clinical Skills
Multiple
Components
(any combo of HX,
PX, PPI & TTL)
# of
fails
Remediation
Retest
• 1-on-1 video review w faculty
• Individually prescribed remediation
based on video review
CPX Retest (multiple
station OSCE)
• Approved EM or Primary Care
elective plus one mini-CEX
CPX Retest (multiple
station OSCE)
2
• 1-on-1 video review w faculty
• 3 mini-CEXs
• Individually prescribed remediation
based on video review
CPX Retest (multiple
station OSCE)
CPX Retest (multiple
station OSCE)
5
• 1-on-1 video review w faculty
• Approved EM or Primary Care
elective plus one mini-CEX OR
3 mini-CEXs
• Complete any additional individually
prescribed remediation based on
video review.
2
54
Type of Fails
Clinical
Reasoning
# of
fails
Remediation
19
• 1-on-1 video review w faculty
• ME 250.05
• 4 DxR cases with a mean of
70% or higher on clinical
reasoning
5
• 1-on-1 video review w faculty
• Approved EM or primary care
elective plus one mini-CEX
• ME 250.05
• CPX Retest (multiple station
OSCE)
• 4 DxR cases with a mean of
70% or higher on clinical
reasoning
(must pass 5 out of
7 cases)
Multiple
Standards
(failed both CS &
CR standards)
Retest
Skills
History Taking
(M=73.4%, SD=6.3%)
Physical Exam
(M=64.1%, SD=9.0%)
Communication
(M=84.8%, SD=8.6%)
Overall
(M=74.1%, SD=4.8%)
Absolute cut score
# of fails
60%
2
60%
54
60%
2
65%
5
• 52 failed 1
• 4 failed 2
• 1 failed 3
Characteristics of PE Fails at 60%
(N=57)
Conclusion:
Most of the errors (points lost) were due to
omission of PE maneuvers.
Omission vs incorrect
Cases
Group mean on PE
(% of PE maneuvers)
Average of all 7 cases
64.1
28.2% vs 15.3%
HTN
45.5
43.9% vs 21.1%
Geriatrics-Falls
54.7
37.8% vs 14.9%
DM II follow-up
63.6
27.6% vs 17.7%
Difficult Cases
Type of Fails
Clinical Skills:
PX only
# of
fails
57
Remediation
• Approved EM or
Primary Care elective
• One mini-CEX
Retest
Retest-CPX (multiple
station OSCE)
OR
Online PX focused
case-based exam
Discussion:
What is the appropriate retest method for this
group of students based on their pattern of
mistakes?
1. multiple-station OSCE
2. case-based computer exam