CCA

Practical Advice

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.

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

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

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)

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

Warning The exam is designed to simulate

Step 2 Clinical Skills as much as possible

Any information from past exams may be misleading

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

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

Patient Encounter: History and Physical Exam Stations

History 7-8 minutes Physical exam 4-5 minutes Discuss plan with patient/ closure 1-

2 min

Patient Encounter: History only stations History – 12-13 min

Discuss plan with patient/closure – 2-3 min

History

HPI – pertinent positives and negatives (think checklist)

PMH ROS SH FH

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

Pediatric History

PMH Birth hx Feeding hx Growth and development Immunizations and screening Childhood illnesses Social development

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

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)

PMH Past medical illnesses Past surgical illnesses Psychiatric illnesses Medications/complimentary and

alternative tx, etc. Allergies

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.

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

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

Common reasons for failure Post Encounter Note

Illogical Omitting critical elements Premature closure re diagnosis Be careful with abbreviations

GOOD LUCK