Mini CPX Info and FAQs

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.

Preparing for the Exam

How do I prepare for the Mini-CPX?

The Mini-CPX is a cumulative exam, so the best preparation is to have been actively prepared and participating for your pre-clerkship courses during the first and second years of medical school. Additionally, some students have found it helpful, on their own, to think of common clinical scenarios and practice taking limited time H&Ps with a classmate or other colleague. 

You can also prepare for the examination by:

• Knowing differential diagnoses for common clinical problems and clinical scenarios;
• Reflecting on how these differential diagnoses may affect the approach you will take in your focused history and physical;
• Reviewing your physical examination skills and the appropriate techniques by which to perform them;
• Observing basic fundamentals of physical examination behavior, such as proper introductions, hand washing, and measures to keep the patient’s comfort and perspective in mind.

Where is the Mini-CPX held?

We are located in the Goodman Immersive Learning Center, on the ground floor of the Li Ka Shing Center for Learning and Knowledge on the Stanford University School of Medicine campus.

What do I need to bring to the Mini-CPX?

All you need is: (1) professional dress, including white coat; (2) a stethoscope; and (3) yourself.  All other medical supplies will be provided in the examination rooms. You will not be permitted to bring pocket guides or other “cheat sheets” into the exam. You will not be permitted to bring cell phones or other electronic devices into the exam.

What is the structure of the Mini-CPX?

There are four focused H&P stations with a standardized patient, with a brief post-interview exercise. There are also four inter-station exercise stations, consisting of multiple parts including but not limited to interpreting diagnostics or physical exam findings. Each patient encounter is 18 minutes.

Do I need to take the Mini-CPX before starting clinical clerkships?

Yes. All MD candidate students finishing strand B of SOM/POM will need to successfully complete the Mini-CPX prior to enrolling in clinical clerkships.

I am an MD-PhD student (or I will be taking a year or more off) and I will not be starting clinical clerkships yet. Should I take the Mini-CPX now or wait until I am about to start clerkships?

You should take the examination at the conclusion of your pre-clerkship courses before pursuing research or other non-clinical activities, while your clinical skills are freshest. Also note that as part of the clinical skills maintenance plan for the MSTP, you are usually recommended to take a continuity clerkship experience while you are doing your PhD work; should you not complete the MIni-CPX, you would not be eligible for this until you have done so. 

During the Exam

Do I need to take a blood pressure during every encounter?

No, you do not need to take a blood pressure every time – but you should if you think that you need to based on the clinical situation.

Do I need to do a heart and lung exam on all patients, regardless of chief complaint?

If you think that it is the most relevant exam based on the patient. Prioritize according to the chief complaint – in “real life” encounters, a cardiopulmonary exam would be performed on all patients, but keep in mind that the Mini-CPX is a time-limited examination.

Am I expected to discuss management issues with the patient, in addition to doing their H&P?

We cannot tell examinees specifically what to do in the encounters, but you may wish to share your thoughts with the patient about what is going on and what you’d like to do.  Each case is different, so it is not possible to say that “you must do X…” for each one.  What we usually tell examinees is that you are the provider during this encounter – so counsel and share information and next steps when it’s appropriate.

Will I be given paper on which to take notes? Can I write out a template on this notepaper before an encounter? Will I have time to write notes or gather my thoughts after a patient encounter?

Scratch paper will be provided for you – you cannot bring your own. You can write out a template on the notepaper given you if you would like. You may take notes during the patient encounter, but will not have time after the encounter is over to write out notes. All scratch paper will be collected after the examination is over.

These are just actors, right?

Not necessarily. For some exercises/exams, we hire professional actors for cases that involve simulations of exam findings or emotionally charged scenarios. Sometimes, however, we use real patients with real histories and physical exam findings. Remember that all standardized patients are people – and you should treat them as your patients, not as actors.

After the Exam

How am I being evaluated?

Generally, students are evaluated in several skill areas. These include: history taking, physical examination skills (not just whether you perform a certain maneuver but also if it is done correctly), the ability to communicate information to patients, and interpersonal skills. Following each patient encounter, you will be assessed on your knowledge and clinical reasoning.

Will I get feedback on the Mini-CPX?

Yes. After the entire class has completed the Mini-CPX, you will receive detailed feedback from the patient encounters along with your score reports.

What happens if I don’t pass the Mini-CPX?

When a student does not meet expectations on the Mini-CPX, they are required to develop and successfully complete a remediation plan with the Student Guidance Program (SGP) prior to entering clerkships. https://med.stanford.edu/md/academic-support/stanford-student-guidance-program.html

I signed up for clinical clerkships during the periods 11/12, right after POM Q6. Am I going to be able to enroll in these clerkships if I do not pass the Mini-CPX?

A student who does not pass the Mini-CPX will be eligible to start clinical clerkships during period 1 at the earliest. Eligibility to begin clerkships will ultimately be determined by the Committee on Performance, Professionalism and Promotion (CP3). Any clerkships scheduled before period 1 will have to be rescheduled.