How are you assessing students’ clinical decision-making skills?

The Aquifer Internal Medicine Clinical Decision-Making Exam in the key features format is:

  • included with your Aquifer Internal Medicine subscription.
  • a unique and effective tool for assessing the clinical decision-making skills of your students.
  • designed to assess students’ ability to prioritize a differential diagnosis, select which historical, physical exam, or testing data are necessary to diagnose the problem, and identify the most appropriate management of the problem.
  • created by expert CDIM educators, trained by international experts in writing and reviewing key features questions.
  • built to include a strategic sampling of key conditions and decisions from the CDIM national curriculum.
  • bringing a popular international exam format to US medical schools for the first time.
  • supported by validity evidence gathered in two multi-institutional studies published in Academic Medicine and Medical Teacher.
  • able to provide individual, class, and case-level performance.

Why Use the Exam?

The CDME provides a unique assessment of your students’ individual abilities to apply their knowledge to make the decisions needed to provide quality patient care. The typical evaluations of student clinical decision-making­—by residents and attendings working with students in a clinical setting—are important, but are limited due to the realities of clinical practice. The CDME helps to overcome some of these challenges and provides a way to enhance your understanding of students’ skills.

  • Students decisions can be assessed at each important step in the diagnostic and management process. The exam presents patients with undifferentiated symptoms and walks through different stages of patient care in a way that isn’t always feasible in clinic or on the wards.
  • Without the presence of residents, attending physicians and other team members, decisions on the exam reflect only the student’s own clinical reasoning skills.
  • The exam exceeds the typical number of cases included in a clinical evaluation, offering 15 carefully selected cases covering key internal medicine problems outlined in the CDIM curriculum.

Inside the Key Features Format

The exam includes 15 cases which cover a strategic sample of the CDIM  curriculum. Each exam case starts with a clinical vignette providing a realistic patient scenario, including relevant history, exam, and test results.

Exam cases include 2-3 questions requiring students to use prioritized critical decision-making skills to solve a clinical problem. Students select several answers to each multiple-choice question, allowing them to take multiple actions at once, just as they would in authentic practice. Questions are designed to identify essential steps and critical errors in the clinical decision-making process. Exam cases are solved in stages:

  • data gathering (history, physical, investigation)
  • problem definition
  • management
Sample Question:

Learn More

Download our printable Clinical Decision-Making Exam brochure to share with your colleagues.

View Brochure


To arrange a trial of the exam for your program, please contact our Exam Administrator.

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Exam Requests

For security purposes, an Aquifer exam may be requested only by your institution’s designated Course Administrator.  If you are the Course Administrator and would like to request an Aquifer Exam, please complete our Exam Request Form.