m 2 cca overview

7/28/2019 m 2 Cca Overview

1/27

M2 Clinical ComprehensiveAssessment (CCA)

October 7, 2009


2/27

Exam Composition

Practical Exam

Physical Exam

History Taking

History Presentation

Written Exam


3/27

Exam Composition

Physical Exam (6)

Abdominal

Cardiac

Musculoskeletal A or B

Neurology A Neurology B

Pulmonary

History Taking (3)

History Taking A

History Taking B


Communication Skills


4/27

Physical Exam


5/27

General Principles

Each station 15 minutes in length

Patients are volunteers

Faculty proctor present during exam

Targeted, but complete physical exam Expectation is NOT to elicit abnormalities

No checklists, notes, or aides allowed

Required equipment posted on CCA website

Safety tip: Practice talking through your exam aloud


6/27

Neurology

Split into two stations (Neurology A & B)

Neurology A Mini-mental state*** (new for 2010- students will be able to use MMSE

card during exam) Cranial nerve exam Ophthalmologic exam*** (new addition for 2010)

Neurology B Motor Reflexes

Sensory Coordination/gait

Paper, safety pins will be provided. You must have a tuning fork (seerequired equipment list)


7/27

Musculoskeletal

Split into two stations (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

Musculoskeletal B Hips Knees Ankle/Foot Spine


8/27

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. Neurology, Musculoskeletal Become familiar with equipment (e.g. safety pins for sensory testing)

Practice talking aloud while you are performing the exam

New resources under development to assist in your preparation

Modified CFM checklists to guide preparation

Exam FAQs drawn from prior exams/student questions to be posted onM2 CCA website


9/27

M2 CCA Website


10/27

Example Teaching (CFM) Checklist


11/27

History Taking


12/27

History Taking

Each station is 15 minutes in length

Patients are standardized patients

Goal is to elicit a focused, but complete historybased on patientschief complaint

Communication skills will be assessed as a component of the historytaking sessions

Content of interview drawn from CFM curriculum and CEPexperiences

Standard templates and ROS sheets will be provided at each station;no other notes may be used


13/27

Preparation and Resources

Review CFM teaching videos, interviews (portal)

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


14/27



15/27


Station 15 minutes in length

History taken from prior station (History A) will be presented

Gather thoughts; generate differential diagnosis (10 min)

Present your observations to a faculty physician (5 min) List differential diagnosis (top 2-3 possibilities)

Notes may be taken during history taking station and you may usethese notes to present to faculty


16/27


Review CFM outlines on history presentation

Review feedback from presentations to faculty

Practice, practice, practice


17/27

Written Exam


18/27

Exam Composition

Written examination

Closed-book, web-based exam

Approximately 90-100 questions covering principles of physicalexam 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 afterthe clinical portion of the CCA


19/27

Example Question #1

Which of the following is the ideal order in which to perform theabdominal exam?

a. Auscultation, inspection, percussion, palpation

b. Inspection, auscultation, percussion, palpationc. Inspection, palpation, auscultation, percussion

d. Inspection, palpation, percussion, auscultation


20/27

Example Question #2

A 17-year-old football player is seen in clinic for his sports

physical. Initial blood pressure is 140/85 with pulse of 98 andrepeat blood pressure measurement in the exam room is 126/84.Previous blood pressure measurements have been normal and he

is otherwise healthy. Initially, he is fidgety and anxious duringthe visit. The most likely explanation for this finding is:

a. Development of essential hypertension

b. He ate a Super size meal at McDonalds 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


21/27


Review content specifications (M2 CCA website)

CFM written exam

Review physical exam outlines

Review physical exam checklists Swartz: Textbook of Physical Diagnosis


22/27

Example: Content Specifications Outline

Knowledge (Written Exam): Abdominal

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


23/27

Exam Logistics


24/27

Exam Dates

Clinical Exam

Friday, January 29, 2010 Saturday, January 30, 2010 Monday, February 1, 2010 Tuesday, February 2, 2010

Make-Up Exam

Wednesday, March 17, 2010

Written Exam

The M2 CCA Written Exam opens on Thursday, January 28, 2009 at 8:00 a.m.through Tuesday, February 2, 2009 at 12:00 a.m. (24h, midnight).

Sign up for the exam will open following the holiday break


25/27

Make-Up Exam

Make Up Exam

Wednesday, March 17, 2010

Remediation

Tentatively scheduled between March 1 through March 12, 2010

Note: Students who are unable to take the exam during Februarymust obtain approval to take the exam on March 17 from the M2CCA Committee and Director


26/27

Myths and MisconceptionsAbout the CCA

Myth: Each year, many students fail the exam and do not begin their M3 year on time.

Fact: Although there are a handful of individual station failures each year, the majority of thestudents pass each section on the first attempt. We have NOT had an overall clinical exam failuresince 2006. We have NEVER had a student receive a failing grade for the CCA recorded onhis/her transcript. We have NEVER had a students matriculation to the M3 year delayed becauseof his/her performance on the M2 CCA.

Myth: Students are graded on/expected to perform tasks that are not on the teaching checklists.

Fact: The exam is not designed to trip up students. The tasks to be completed at a givenphysical exam station is based on what is taught during the CFM course using the teachingchecklists.

Myth: There is no way that I will be able to complete an exam/history in less than 15 minutes.

Fact: The overwhelming majority of students complete the exam/history taking stations within 15

minutes and often have time to spare. Many times, students who run into time pressure have notfollowed the door instructions and spend time completing tasks not required/expected at thestation. Practice, practice, practice.

Myth: Drs. Lukela and DiPonio enjoy inflicting physical and emotional pain on the medicalstudents by making them take the M2 CCA.

Fact: Drs. Lukela and DiPonio REALLY enjoy inflicting physical and emotional pain on themedical students by making them take the M2 CCA.


27/27

Contact Information

Michael Lukela, MD

Director, M2 CCA

E-mail: [email protected]

Lisa DiPonio, MD

Assistant Director, M2 CCA E-mail: [email protected]

Kelly Poszywak

Manager, Standardized Patient Program

E-mail: [email protected]
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]

m 2 cca overview

Documents