How to Prepare for the CPX

You will be assessed on your clinical skills with patients, mannequins, synthetic models, and other simulation devices.

Review videos (medical interviewing, communication, physical exam) used in Clinical Skills 2A & 2B (Physical Diagnosis). The videos can also be found in the "PSOM - Clinical Performance Experience (CPX)" Chalk site.

  • Genito-Urinary (male and female genital)
  • HEENT
  • Lymph
  • Abdomen
  • Cardiac
  • Cardiopulmonary
  • Musculoskeletal
  • Mental Status Exam
  • CAGE
  • Mini-mental State Exam

Review core clinical skills learned in clerkships such as:

  • EKG
  • Heart sounds
  • Lung sounds
  • Imaging

Complete selected readings:

  • On the physical exam:
    Rapid Access Guide to the Physical Examination
    Donald W. Novey (Year Book Medical Publishers, Inc., 1988)
  • For communication skills:
    The Patient’s Story: The Integrated Patient Interview
    Robert C. Smith (Little, Brown and Company, 1996)
  • For focused history and physical:
    Textbook of Physical Diagnosis: History and Examination
    Mark H. Swartz (W. B. Saunders Company, 1998)

Anticipate the Checklist (excerpted from “Mastering the OSCE,” Reteguiz, Cornel-Avenadano, McGraw-Hill, Inc., 1999):

  1. Develop the following checklist items for each patient:
    • History of present illness (pertinent +/-)
    • Past medical history
    • Family history/social history
    • Physical examination (pertinent +/-)
    • Communication skills
  2. The history: ask yourself
    • What organ system am I dealing with?
    • What are the likely causes of the problem?
    • What risk factors could have contributed to the problem?
    • What complications of the problem exist in this patient?
  3. For a systematic exploration of the patient's complaint of pain, ask:
    • Onset and chronology
    • Location and radiation
    • Quality of pain
    • Severity of pain (“On a scale of 1-10, with 10 being the most painful…”)
    • Alleviating factors
    • Precipitating factors
    • Associated symptoms
  4. Remember when doing the physical exam:
    • Do not do a comprehensive Physical Exam.
    • Do a focused Physical Exam based on the presenting problems. Once you choose to do an exam system (heart, for example), do that system thoroughly.
    • Perform maneuvers using the proper technique learned in Clinical Skills 2.
    • Some maneuvers may be painful to the patient. Get the data you need, but minimize the patient's discomfort.
    • Show consideration for the patient’s modesty and discomfort, but expose areas for examination as appropiate.
    • Never examine through the gown or drape: always skin-on-skin.

And practice with your peers!