1. CCA Practical Advice

2. CCA Demonstration of fundamental clinical skills essential to safe and effective patient care. Designed to measure student competency across U of M specific intended learning outcomes.

3. Comparison CCA vs CSE Broader than the Step 2 CS Exam May include video of patient interviews, x-rays, EKGs, EBM May be followed by post-encounter note, presentation to a faculty member, or no post-encounter activity No pediatric patients; but may need to interview parents

4. CCA Content Broad spectrum of cases: common and important symptoms and diagnoses: presenting complaints and conditions – balanced by age and gender Designed to measure U of M Medical School Intended Learning Outcomes Approximately 10 stations

5. CCA: Scoring by Standardized Patient Specific checklists and rating scales are used to record examinee’s performance: 1.Content 2.Communications Skill in interviewing Skill in counseling/delivering information Rapport Personal Manner (e.g., draping)

6. CCA:Tasks Some stations may include a focused history, physical exam, and closure Other stations may or may not include a physical exam Be sure to read the instructions on the door and to understand the task/s at each station

7. Warning The exam is designed to simulate Step 2 Clinical Skills as much as possible Any information from past exams may be misleading

8. CCA: Post Encounter Note Scoring Post-encounter notes are scored based on: 1. Ability to gather appropriate history 2.Include pertinent physical findings 3.Reach appropriate diagnostic conclusions and formulate appropriate plan 4.Record findings and impressions clearly and concisely

9. At the Door Read instructions, understand the task/s Review patient’s name, cc, vital sx Quickly formulate your checklist Knock, enter, introduce yourself Address patient by name

10. Patient Encounter: History and Physical Exam Stations History 7-8 minutes Physical exam 4-5 minutes Discuss plan with patient/ closure 1-2 min

11. Patient Encounter: History only stations History – 12-13 min Discuss plan with patient/closure – 2-3 min

12. History HPI – pertinent positives and negatives (think checklist) PMH ROS SH FH

13. HPI/ SX Timing – onset, duration, frequency Location Quality Severity Aggravating factors Alleviating factors Associated symptoms

14. Pediatric History PMH Birth hx Feeding hx Growth and development Immunizations and screening Childhood illnesses Social development

15. Geriatric History ADLs (Activities of Daily Living) IADLS (Instrumental Activities of Daily Living) Social supports Living environment Medications Incontinence Falls Cognition Affect

16. Geriatric Physical Assessment Mobility Observed Gait Timed up & Go Test Cognition Mini-Cog Exam Mini Mental Status Exam (MMSE) Affect Two-Question Depression Screen Geriatric Depression Screen (GDS)

17. PMH Past medical illnesses Past surgical illnesses Psychiatric illnesses Medications/complimentary and alternative tx, etc. Allergies

18. Physical Exam Perform relevant physical exam May need to perform a breast exam on the CCA Do not need to perform pelvic or rectal but if indicated, need to inform the patient that it will be done later Also can indicate any further physical exam needed in the post-encounter note.

19. Post Encounter Note 10 minutes History – significant positives and negatives Physical exam- pertinent positives and negatives relative to chief complaint Differential Dx – in order of likelihood Diagnostic work up, treatment – immediate plans, no more than five studies Do not include consultations, referrals

20. How to Avoid Common Reasons for Failure Patient Communication (Evaluated across all stations) Do not interrupt /use technical terminology Explain what you are doing Follow up on pt concerns or response Other - wash hands, extend table, drape, introduce yourself, call the patient by name Remember actions, appearance, body language

21. Common reasons for failure Post Encounter Note Illogical Omitting critical elements Premature closure re diagnosis Be careful with abbreviations

22. GOOD LUCK