4.14: Clinical Performance Examination (CPX) Series

The Clinical Performance Examination (CPX) series is comprised of the Mini-CPX taken at the end of the pre-clerkship period and the full CPX that may be taken at the end of the first year of clerkships.

Mini-CPX Overview

The Mini-CPX is a five-hour examination administered towards the end of strand B of the second year of the MD curriculum (March).  This examination is composed of both standardized patient encounters and computer-based exercises.  The goals of this assessment are to evaluate your history and physical examination skills, patient interaction skills, communication (oral presentation), clinical reasoning, and overall knowledge. It is also a means for you to identify skill areas on which to focus prior to entering clinical clerkships. Successful completion of the Mini-CPX is a requirement for MD candidate students to enroll in clinical clerkships. Students who do not attain an overall passing score on the exam will be identified for remediation and participation in the Student Guidance Program.

Students who meet or exceed a minimum passing score threshold on the Mini-CPX will be eligible to enter clerkships as soon as they successfully complete Q6 and provided all other minimum course requirements have been successfully completed.  Students who do not achieve the minimum passing score on the Mini-CPX will be referred for individualized coaching support and a reassessment of clinical skills.  Eligibility for starting clerkships will be determined by the Committee on Performance, Professionalism, and Promotion (CP3) upon review of the remediation plan completed, and no sooner than Period 1. Any clerkships scheduled prior to remediation may need to be rescheduled.

Additional information and FAQs can be found at http://cisl.stanford.edu/standardized-patient-program/for-students/mini-cpx-info-and-faqs.html.

CPX Overview

The Clinical Performance Examination (CPX) is a standardized patient examination administered to all medical students in the state of California, to be taken at or towards the end of the core clerkships. The examination is a standardized patient-based clinical skills assessment; demonstration of at least minimum competency on this exam is a requirement for graduation. It is designed by a consortium of clinicians and medical educators from all nine California medical schools to assess clinical skills essential to the practice of medicine regardless of specialty.

The purposes of the exam are:

1.     To evaluate students’ level of competency in clinical and interpersonal skills;

2.     To provide individual feedback on these skills in preparation for your residency training;

3.     To prepare for the USMLE Step 2 Clinical Skills Examination (CS – the standardized patient portion of the boards).

The CPX may be taken at the end of the first year of clerkships, but must be taken NO LATER THAN one year prior to graduation. The CPX is only administered at Stanford once per year, typically in July. Students planning away rotations should make sure their plans do not conflict with test administration dates, since failure to participate in and pass the CPX would prevent the student from graduating.

The exam involves a five-hour block of time. Each student’s exercise is videotaped and made available for review. Following the exam, students receive detailed feedback from the patient encounters and a set of scores with comparison standards.

During the CPX, students see eight patients with a broad range of problems, which may encompass subject material from any core clerkship. Students are expected to perform a focused history and physical examination, and are also expected to communicate their thinking and preliminary plans to the patients. Students also complete eight inter-stations designed to assess clinical reasoning.

Students must demonstrate at least minimum competency in each of four skill areas:

  • History taking
  • Physical examination
  • Communication skills
  • Clinical reasoning

Students who do not attain an overall passing score on the exam, or who fail individual skill domains, will be required to successfully complete a remediation program, including individualized feedback, self-reflection, and working with a faculty mentor in the School of Medicine to develop the skills necessary for improvement. Following this remediation, students will undergo reassessment to ensure minimum proficiency with all categories of clinical skills. Successful completion of this reassessment exam will be required for graduation.

Additional information and FAQs can be found at http://cisl.stanford.edu/standardized-patient-program/for-students/cpx-info-and-faqs.html

updated August 2020