Student Name: __________________________________
Date: ______________
Psychiatry CEX: Clinical Demeanor and Therapeutic Interactions:
1) Conduction of interview
___ Seems demeaning, irritated, or inattentive to the patient. (1)
___ Appears unnecessarily impatient, aloof, or insincere. (2)
___Displays a satisfactory level of warmth, concern, and professionalism. (3)
___Demonstrates warmth. Both body and verbal language exhibits openness. Tone of voice
conveys sensitivity to patient’s feelings. (4)
2) Questioning skills
___Asks primarily close ended questions, leading questions, or rambling and unfocused
questions that don’t serve a therapeutic or treatment purpose. (1)
___Asks questions in a check list style with minimal follow up questions. Does not follow the
patient’s leads, does not further investigate or acknowledge important things. (2)
___Asks both open and close ended questions as indicated in a clear, concise way. Asks followup questions as information is uncovered. (3)
___Asks both open and close ended questions as indicated in a clear, concise way. Is able to let
the patient speak about their concerns and still elicits all of the information needed in a
naturalistic way rather than check-list fashion. Asks insightful follow-up questions as
information is uncovered. (4)
3) Reflection of feelings
___Misidentifies the feeling state of the patient. (1)
___Able to identify some feeling states of the patient but cannot communicate this
understanding to the patient. (2)
___Able to consistently identify feeling states of the patient and sometimes conveys this
understanding to the patient. (3)
___Able to consistently identify feeling states of the patient and conveys this understanding to
the patient in an effective manner. (4)
4) Empathy
___Is not able to understand the patient’s feelings and experienced world. Student failed to
understand what the patient explictly stated. Does not listen to what the pt actually says. (1)
___Reacts to patients to patient’s words but does not appear to understand how the patient
feels. (Lack of affective attunement.) (2)
___ Able to generally grasp the patient’s internal sense of reality, both with what the patient
explicitly said and communicated in more subtle ways. Usually understands the whole of the
patient’s expression and meaning. (3)
___Appreciates just how the things the patient is going though feel to her/him. Able to realize
what the patient means without the patient explicitly saying it or even when the patient has
difficulty saying it. (4)
5) Identifies and facilitates goals of treatment with the patient
___Unable to elicit or identify goals of treatment and fails to take either patient’s point of view
or the context of their illness into account. (1)
___Able to elicit goals of treatment; however, the student is so attached to their own ideas that
it interferes with their ability to see the patient’s point of view. Goals are unrealistic or
inappropriate to patients’ illness or life context. (2)
___Able to work with the patient to establish goals of treatment but has trouble assisting with
strategies to attain goals because the student is either excessively directive or fails to provide
adequate support/guidance. (3)
___Works collaboratively with the patient to establish goals of treatment and guides the
patient in discovery of strategies to attain goals. Helps to build hope in the patient. (4)
Clinical Reasoning and Assessment:
Prior to completing the CEX, the student will complete the Psychopathology Spectrum
Worksheet. For this portion of CEX, student will present the information from the worksheet to
the attending. The student will also report what he/she believe is the patient’s level of
psychological functioning and the supporting evidence for their conclusion.
6. Assessment of student performance of gathering relevant information and assessing level
of psychological functioning:
___Student failed to gather the relevant information. (1)
___Student gathered the relevant information but misinterpreted the history and current
situation, comes to an inaccurate conclusion. (2)
___Student was able to gather relevant information and make a correct determination of
patient’s level of psychological functioning. (3)
___Student gathers relevant information and formulates a complete conclusion, including both
apparent and subtle aspects of patients’ psychological make-up and current condition. (4)
Complexity/Difficulty of Patient:
1) Complexity of patient
___Low: fairly straight-forward patient who is able to participate with treatment and interviews
___Medium: patient poses some difficulty engaging in treatment or interviews
___High: patient is hard to engage in interviews and/or treatment
2) How much difficulty do you think that a fully trained psychiatrist would have with
establishing rapport with this patient?
___Low, no real difficulty
___Medium, challenging but usually possible
___High, challenging for even an experienced physician
How to score the CEX:
1) For each of the 6 questions select which sentence best describes the student’s performance
for that question. Place a check or X next to the one chosen.
2) Add the point value for each of the 6 questions (point value is from 1-4 and is shown at the
end of each option
3) The student must receive a total score of 17 to receive a passing score.
OVERALL PERFORMANCE RATING:
Total score for CEX: ________
Overall performance of student: Pass/Fail (Must receive > 17 to pass)
Faculty Evaluator (must be an attending physician) :_______________________________________________
(please print)
Date:__________________________