Mini-CEX

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• Mini-clinical evaluation exercise
• Mini-CEX

Assessment of Overall Clinical Skills
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What is a mini-CEX ?

• A workplace-based assessment
• a short episode of real student-patient
  interaction within the workplace
• observed and judged by the supervising clinician
  (observer)
• followed by feedback

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• Why do mini-CEX ?
• Workplace-based assessment drives
  experiential learning?

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Are Clinical Skills Important?

• Clinical skills are essential for patient care
  
• Clinical skills
• Medical interviewing
• Physical examination
• Clinical judgment
• Communication skills
• Evaluation of clinical skills requires direct
  observation

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diagnosis and medical interview

• Hampton (BMJ, 1975)
• Medical interview 82
• Physical exam 9
• Laboratory 9
• Kirch (Medicine, 1996)
• Medical interview (Ph/Ex) 70
• Imaging 35

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Importance of complete Clinical Skills

• To decrease diagnostic errors
• Inaccurate/ incomplete medical interview is one
  important reason of diagnostic errors.
• Wrong information leads to wrong decisions
• To increase patient satisfaction
• Higher with better communication skills
• To improve patient self-care
• Better adherence and outcomes associated with
  better physician communication skills

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Millers Pyramid
Mini.cex Faculty Observation
DOES
Faculty Observation
SHOWS HOW
OSCE
PMP.KFP
KNOWS HOW
KNOWS
MCQ.SAQ
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how to do miniCEX ?

• too simple

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Triangulation
DESK
Patient
Resident(trainee)
Attending(observer)
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• In the mini-CEX, a single faculty
  Member(observer) observes the trainees interact
  with a patient in any of a variety of settings
  including the hospital, outpatient clinic, and
  E.D
• In fact, the mini CEX can assess a range of core
  competencies that a trainee uses during day
  to day encounters with patients.

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• Encounters should
• take place In the normal working environment .
• take place In different working environment.
• cover different cases and different specialty
  areas.
• be observed by different skilled observers.
• During the encounters
• Observer must assess trainees clinical skills
  fill the feedback form.
• Observer must note some extra information such as
  complexity of patients problem

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• One encounter takes 20 min has 2 steps
• Exam 15_20 min
• Feedback 5 min

The trainee conducts a focused history and
physical examination and then provides a
diagnosis and treatment plan. The faculty
member(observer) scores the performance using a
structured document and then provides educational
feedback.
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(No Transcript)
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FEEDBACK

• The feedback session is the most important part
  of the mini-cex it should occure immediately
  after the encounter.
• The observer should discuss both the positive
  negative aspects of encounter with the trainee.
• The observer should also discuss a plan to
  improve any areas of weakness.

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• To be most effective, feedback needs to be
  interactive
• strengths and weaknesses.
• ? (agreement signature)

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Mini_CEX program

• Trainees have to complete at least one encounter
  for every 3 months (4 encounters in a year) in
  order to be eligible for central exam at the end
  of the year.
• The trainee should meet an educational supervisor
  during the program . During this meetings they
  can map out a learning plan for next period,
  according to trainees rotations his/her past
  encounters.

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• The trainee is responsible for instigating each
  mini- CEX encounter.
• Each assessment should focus on a limited number
  of competencies different encounters should
  include a range of cases with each focusing on
  specific aspects of the clinical skills. (e.g.
  history taking, PH/EX, )

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• Each observer may have his/her own way to run the
  encounters with the trainees. One accepted format
  is
• To choose the last patient of a day ( e.g the
  last outpatient in the clinic or the last patient
  on the ward round)
• ?To be less disruptive to the flow of the
  clinical workload.
• ?To allow for feedback to occur straight after
  the encounter.

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How many encounters must be observed to provide a
reliable mean rating?
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Mini-CEX Reliability

• Reliability Coefficients
• gt 0.80 with 6 observations
• gt 0.90 with 12 observation
• gt 0.95 with 24 observations

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Mini-Clinical Examination (Mini-CEX)

• The evidence will be rated and recorded in the
  Portfolio.
• Immediate feedback will be provided by the
  observer rating the student.
• A learning plan will be developed, based on the
  strengths and developmental needs observed

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Summary

• Basic clinical skills are important
• so is the need to observe them!
• Observation is a complex skill that requires
  training and practice
• Direct observation by educators will remain a
  critical component of both evaluation and
  feedback