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Association of Academic Physiatry San Diego, CA. March 3, 2000 David W. Musick, Ph.D. Susan M. McDowell, M.D. University of Kentucky College of Medicine Department of Physical Medicine & Rehabilitation.

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Association of Academic Physiatry

San Diego, CA. March 3, 2000

David W. Musick, Ph.D.

Susan M. McDowell, M.D.

University of Kentucky College of Medicine

Department of Physical Medicine & Rehabilitation

Evaluating Residents’ Clinical Skills & Professionalism via the PM&R Mini-Clinical Evaluation Exercise (CEX)

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How to Evaluate Clinical Competence?

  • K-S-A Triad (Knowledge, Skills, Attitudes)

  • Should ideally use multiple methods

  • Prominent issue for accreditation by RRC

    • Must “link” evaluation methods with educational objectives

    • Educational outcomes: better patient health, acceptable risk management, greater customer satisfaction

    • ACGME Core Competency project

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Evaluate Clinical Competence via Rating Scale Format

  • Clinical Competence: often based heavily on ratings of performance

  • Assumption: that individual resident performance is observed personally by attending physician(s) completing forms

  • Medical education literature reveals that such scales may have poor reliability and are often based on limited personal observation of performance

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Pilot Project: PM&R “Mini-CEX” Ratings Format

  • “Mini-CEX”: brief encounter w patients in either inpatient/outpatient settings

  • Goal: to emphasize evaluation of residents’ performance based on “real time” observation by attending faculty

  • Modeled new form after successful “clinical evaluation exercise” format used by Internal Medicine

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Overall clinical competence (global)

History-taking skills

Physical exam skills

Clinical diagnostic skills

Clinical judgment & synthesis skills

Patient management skills

Communication skills

Humanistic qualities (professionalism)

PM&R “Mini-CEX” Ratings Format: Eight Items

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Data collection for pilot study took place over two academic years

14 residents rated in 10 different rotations (7 inpatient, 3 outpatient)

11 different faculty

Total N=31 ratings forms

All items on Likert-type scale (1 to 9)

Primary diagnosis, faculty satisfaction

Pilot Project: PM&R “Mini-CEX” Ratings Format

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Mean rating all residents = 6.97 (SD=1.09; SEM=0.19) years

Average ratings higher for female residents (7.48) than for male residents (6.50)

Higher ratings for residents in outpatient rotations (7.14) than inpatient rotations (6.92)

Range: hi = 7.35 (humanistic qualities); lo = 6.81 (clinical diagnostic skills)

Pilot Project Results: Descriptive Statistics

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Mean inter-item correlation = .69; range from hi = .88 to lo = .41

Alpha reliability = .95

Residents interacted with patients who were diagnosed with nine different clinical conditions

Faculty satisfaction with ratings format was high (7.25)

Pilot Project Results: Descriptive Statistics

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Based on very small sample size

More rigorous analyses require larger sample

Based primarily on PGY-2 residents


Easy to use, acceptable to faculty

Brief but focused format

Allows for good formative feedback

Can supplement other methods of evaluation

Pilot Project Limitations & Conclusions

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Recommendations = .41

  • Drs. Scott & Blake, AAP 1998: “proactive establishment of specialty-wide critical competencies” and corresponding evaluative methods

  • Further refinement/testing of PM&R mini-CEX on national basis

  • Actively seeking other PM&R residency programs to collaborate on project

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  • Continue refinements of instrument

    • Addition of patient gender as variable

    • Feasibility of electronic data collection

      • Scannable “bubble” sheet format

      • Web-based format

    • Add qualitative comments section

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Future Plans = .41

  • Expand data collection to other PMR Programs

  • Consider collaboration with specialty board to eventually establish use of mini-CEX across all PM&R residency training programs