Using the Mini-Clinical Evaluation Exercise (Mini-CEX) as an assessment tool for medical students
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Using the Mini-Clinical Evaluation Exercise (Mini-CEX) as an assessment tool for medical students April 29, 2011. Why consider the Mini-CEX? Year 4 OSCE 2011 Overall Results. Number sitting OSCE248 Number passing245 (98.8%). Competency Domains. What is mini-CEX?.

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Why consider the mini cex year 4 osce 2011 overall results

Using the Mini-Clinical Evaluation Exercise (Mini-CEX) as an assessment tool for medical studentsApril 29, 2011


Why consider the mini cex year 4 osce 2011 overall results

Why consider the Mini-CEX?Year 4 OSCE 2011 Overall Results

  • Number sitting OSCE248

  • Number passing245 (98.8%)


Competency domains

Competency Domains


What is mini cex

What is mini-CEX?

Structured 10 min observation of a student performing specified tasks during routine practice

Feedback session (10 min)

Completion of a standardized one-page rating form


Mini cex types of tasks

Mini-CEX: Types of tasks

Focused history

Physical examination

Counselling

advise patient regarding management options

provide appropriate education

make recommendations that address patient’s concerns

Clinical reasoning skills

diagnostic and therapeutic skills

Case presentation


History taking form

History-taking Form


Guidelines for marking

Guidelines for marking


Why consider the mini cex year 4 osce 2011 overall results

Reliability of the Mini-CEX Average Composite Ratings


Implementing a mini cex assessment process

Implementing a Mini-CEXAssessment Process


Implementing a mini cex

Implementing a Mini-CEX

Orientation

Familiarize yourself with the mini-CEX rating form and definition of the components of the student’s performance you will be rating

Schedule the mini-CEX

1-2 / week

Allow 20 minutes for each assessment

Obtain patient permission


Implementing a mini cex1

Implementing a Mini-CEX

Select the patient encounters to be observed

Year 3 “must see” list of medical conditions

new or existing medical problem

acute vs. chronic illness

different age groups and both genders

different clinical settings (e.g. office, hospital) if possible

Ask the student to perform the task without prompting about the possible diagnosis

perform an abdominal examination

Not: examine the patient for possible appendicitis


Assessment process

Assessment Process

Avoid interrupting the student during the patient encounter

no questions, comments or suggestions

if you want to follow-up findings with patients, do this after the student is finished

Conduct immediate feedback (10 minutes)

Complete rating form

Discuss rating or comments with student


Mini cex feedback

Mini-CEX: Feedback

Immediate

Specific

Limited to key issues

Honest

Fair

Descriptive, not judgmental, e.g.

“you did not examineX”

NOT “you were way off base”


Mini cex feedback1

Mini-CEX: Feedback

Two-way process (inter-active)

Start by asking the student some questions

how they felt they did with the patient

what findings they found

what they think is the most likely diagnosis

why they ordered a particular investigation or suggested a particular treatment

Answers can stimulate specific feedback and also guide ratings of performance


Feedback challenge

Feedback challenge

  • Easy when the student does well

  • More difficult when the performance is poor

    • do not hesitate to point out area of weakness

    • multiple assessments with multiple examiners (reliability)

    • sampling performance across the spectrum of clinical situations (validity)


Mini cex feedback closing the loop

Mini-CEX: FeedbackClosing the loop

Provide a recommendation

interviewing/ examination/ counselling skills/ management/ presentation

Develop a specific action plan

allows student to act on the recommendation


Example of use of mini cex

Example of use of Mini-CEX

ER

  • A man presents with abdominal pain

  • The student performs a focused abdominal examination (10 minutes)

  • The preceptor notices that the student did not examine the inguinal areas adequately

  • Feedback is given

    • the preceptor demonstrates the correct technique

    • recommends a review of hernias in clinical skills textbook

    • suggests plan to practise exam technique


Summary key features of the mini cex

Summary: Key features of the Mini-CEX

Direct assessment of actual patient care

Allows assessment of performance

good evidence supporting mini-CEX’s validity and reliability

cumulatively can infer student’s competence

Can be incorporated into daily activities

efficient use of resources

Allows immediate and substantive feedback


Assessor s training

Assessor’s training

Paper-based orientation

Familiarize with the process, specific observation task and ratings form

All assessors who participated received this form of training

Workshop* - video-based training

Videos exemplifying three levels of performance

Rated at the end on the form by all participants

*(Modeled after ABIM/NBME ‘Direct observation of Competence Training Program’, Holmboe et al., 2004)


Effects of training

Effects of training

Assessors of the post-graduate trainees

Raters not trained in workshop were more lenient:

3.17 vs. 2.31

6.17 vs. 4.85

8.29 vs. 7.38

Both the scenario and training-group effects were significant


Reliability

Reliability

Generalizability-theory approach to reliability

Allows for estimating the variance-components attributable to the different factors of the measurement situation

Calculating G-coefficient (reliability coefficient)

Modeling the effect of changes in these factors (e.g., number of items needed to achieve certain level of precision)

Number of mini-CEXs needed was the main factor followed through all studies (in one case, the effect of blueprinting was also explored)


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