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 history2. Include pertinent physical findings 3. Reach appropriate diagnostic conclusions and formulate appropriate plan4. 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
