Class of 2009

General Directions

1. Please arrive by 8:00. We will distribute schedules at that time, the confidentiality statements for you to sign, and answer any questions you have.

2. Wear your white coat with your SIU name badge and bring the usual diagnostic tools: penlight, stethoscope, reflex hammer, and tuning fork. All other tools will be in the exam rooms (oto-ophthalmoscope, sphygmomanometer, gloves, tongue depressors, etc.).

3. Your badge number is your ID number on the computer stations and on your chart notes. SCCX date assignments are on the CCX Assessments website (http://www.siumed.edu/oec/html/year_41.html).

4. The only reference book allowed during the exam is a pocket pharmacopoeia. We will have several copies of the Tarascon Pocket Pharmacopoeia available on the proctor’s table in the Computer Lab. If you want to use your own, see Linda before starting.

5. You may not take food or beverages into the exam rooms or into the Computer Lab.

6. While in the Computer Lab, you may not open any other program or application. As soon as you are done with your case you are expected to leave the Computer Lab.

7. You may not leave the PDL area during the exam except during lunch breaks.

8. All patient encounters will be recorded. No one will be routinely observing your performance during the exam, but staff will be observing periodically to assure the SP accuracy and consistency.

9. For the Day 2 morning cases, we will give you 5 minutes to list your top 4 differential diagnoses (based on the patient’s complaint) and up to 12 pieces of key information you want to collect to help sort among these diagnoses. This information will be collected before you see your SP.

10. If you have not already taken the Longitudinal Performance Assessment, you will take it on the second day of your SCCX at the time specified on your schedule. It is not part of the SCCX.

11. After you have finished the SCCX, we will e-mail you the link to a short SCCX Feedback Questionnaire. We ask that you complete the questionnaire for us by September 1. The CCX Committee uses your feedback for quality control and to plan revisions for next year.

Examination Logistics (all cases)

12. The SCCX consists of 14 standardized patients (SPs):

The first 10 SPs will be followed by a CCX computer station. You have 20 minutes with the SP and 35 minutes for the CCX.
The last 4 cases will be in the format used in the USMLE Step 2 Clinical Skills (CS) exam. You have 15 minutes with the SP and 10 minutes to write a patient note.

13. Presenting situation folders are posted on the exam room doors. They provide basic patient information and specify your tasks. Read these carefully before entering the room, as your task will differ from patient to patient. If the vital signs listed in the presenting situation folder differ from those you take from the SP, use the ones listed in the folder. You may take the folder into the room with you, but please leave it on the door as you exit. Do not write on these folders.

14. The performance standards outlined in the Head-To-Toe Physical Examination Guidelines will be used to evaluate your physical exam skills. These guidelines are on the CCX Website (address given above) for your convenience. CCX Committee faculty recommend that if a particular physical examination is indicated, do the whole exam, not just part of it.

15. You may take notes during the patient encounter and use them in the Computer Lab. You must turn all notes in to the proctor after completing each case.

16. Documentation clarification (all cases):

If you list patient vital signs you are expected to interpret any abnormal signs in order to receive credit. (eg: BP 160/95 High)
You may order Labs in all cases, but this doesn’t mean you need to order labs in every case. If you believe no labs are indicated, don’t order any.

Getting Assistance

17. If you have any problems during the exam, please see Linda Morrison for immediate assistance.

18. If you need assistance in the Computer Lab, please ask the proctor. Possible problems include locking up, being unable to find a lab test, not receiving lab results, getting an error message, etc. Please whisper when you do this so that you do not unnecessarily disturb your colleagues.

19. If you have questions, comments or concerns about the exam, either now or later, contact Linda Morrison (545-4970 or lmorrison@siumed.edu) or Dr. Nelson (enelson@siumed.edu).

CCX Cases

20. You may read the presenting situation several minutes before you are scheduled to begin the case, but DO NOT enter the exam room until instructed by PDL staff. All rooms will begin simultaneously.

21. Please keep track of your time with your patients. Allow several minutes to bring the interview to a close and to advise the patient of your assessment and recommendations. When there are five minutes left, we will knock on the door. When your time is up, you will get a second knock, and are expected to leave promptly. If you don’t, Linda will come in and tell you that you’ve been paged.

22. You should ask any history question or perform any physical examination that you feel is appropriate:

Do not assume that the patient has normal findings. You will receive cards for abnormal findings that can’t be simulated, but only after the appropriate physical exam has been performed.
Faculty expect you to listen for heart, lung, and abdominal sounds on skin: you will not get checklist credit if you listen over the gown.
If you would normally have a nurse in the room with you during a specific exam, consider the camera as proxy for the nurse.

23. After you finish with each patient, go to the Computer Lab, identify yourself to the proctor, and she will direct you to an appropriate computer. Click on the appropriate icon on the desktop, enter your badge number and complete the exam for that case. If you have any difficulty OR any questions, please ask the proctor for assistance.

24. In the CCX cases, you will briefly state the problem, report key positive and negative findings from the SP encounter, list your diagnostic hypotheses, order and interpret labs, make your diagnosis, enter the problem list and write a treatment plan. Not every case includes all sections, so we will include a note about what you will be completing at the beginning of the computer station. Please pace yourself so that you are able to complete all sections. If you haven’t done a CCX since December, you may want to review the program: the Keller practice case is available in the Computer Lab until July 21.

25. Please keep your CCX program clock (upper left/right corner) open during the case. It will help you keep track of your time. A warning screen will pop up when you have 10 minutes left.

CCX program reminders:

· Hypotheses: You do not get credit for hypotheses entered after the initial Hypotheses section.

· Labs: To locate a lab test using the Search feature, enter only the first 3-4 letters of the lab. Remember to review your lab results before you move on. You can order more labs in the Management section, but you cannot re-order tests you’ve already seen. A cost list for labs is kept, and points may be deducted if your work-up is excessive or endangers the patient’s unnecessarily.

· Management: If you are unsure which category to use, use nursing orders for inpatient care and follow-up for outpatient care. When prescribing medications, include the medication name and route. You do not generally need to include the dosage, except for common medications when you need to differentiate between a standard dose which may be inadequate and a higher therapeutic dose. If you refer a patient to a specialist, you must specify what you want done in order to get credit for the referral. You may not delete or modify a lab after you order it: the program will lock-up. If this happens, notify the proctor and she will help you re-start.

Patient Note Cases (USMLE 2CS style)

26. You may not read the presenting situation until given the signal to begin, but you may still take it into the room with you. You have 15 minutes with the SP, with a 5 minute warning knock on the door.

27. You should continue to ask any history question or perform any physical examination procedure that you feel is appropriate, EXCEPT you should not ask to do breast/genital/rectal exams. If you believe these exams are indicated, include them in the Diagnostic Work-up section of your patient note. We may use other findings cards in these cases, however, if necessary.

28. When you finish with the SP, go directly to the Computer Lab. Time not used with the SP can be added to the 10 minutes you are given for the patient note.

29. You may either hand-write or type the patient notes. Our forms are based on the USMLE Step 2CS forms and you can access our written form, along with the list of USMLE-approved abbreviations, on the CCX Assessment website (see above). Both paper and computer forms have space limitations.

30. You will be given a verbal warning when there are two minutes remaining for the patient note. The instruction “Stop Writing” will be given when your time is up. If you are using the computer form, hit the submit button and leave the room. The proctor will print your note and reset the computer. If you are hand-writing your note, give it to the proctor.

31. Additional instructions specific to these cases are on the website at the address above. Copies will be put on the table in the reception area at the end of the CCX part of the exam. Linda Morrison will be available a few minutes before the start of this part of the exam to answer questions.

32. The USMLE Step 2 CS website (http://www.usmle.org) contains detailed instructions for this type of station. We recommend that you review this information before taking the SCCX exam.

Expectations for Conduct and Performance

33. The CCX examination assumes student adherence to the SIU honor system. Prior knowledge of the cases and their content, or sharing/discussing cases or case content with other students during or after the exam is inappropriate and a serious breach of professional conduct.

34. Do not discuss the cases in the hallway or at lunch with other students. In the Computer Lab, keep your eyes on your own screen or your own notes. This is a secure exam and information about the cases must not be divulged, even by accident. Please also refrain from casual conversation while waiting outside the exam room.

35. You are being evaluated based on the assumption that your performance during the exam is representative of the way you would take care of actual patients, so treat each standardized patients as you would treat a real patient with the same complaint. Because competency is being inferred from your actions during this exam, best-practices behavior is recommended.

Scoring and Reporting the SCCX

36. All cases on the SCCX were developed by clinical faculty based on accepted standards of care and reviewed in detail by the multidisciplinary CCX Committee.

37. The SCCX will be scored after all students have completed it (mid August). Student performance will be reviewed by the CCX Committee in August and reported to the Student Progress Committee in September, along with remediation recommendations (generally to take the remediation course).

38. The remediation course will be October 27-November 21, 2008, for those students who fail the SCCX.

39. Your results packet will be mailed to the address you have on file with Student Affairs in mid-September. If you want it sent elsewhere, provide the address to Linda Morrison.

Any questions you have regarding the SCCX should be directed to

Dr. Erica Nelson via e-mail or Linda Morrison via e-mail or at 545-4970.