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Tricio J., Salles P., Orsini C., Cacciuttolo F., Georgudis G., Morales R., Recabarren R., Tapia R.
Centre for Healthcare Education Develpmemt,
School of Dentistry, University of the Andes, Santiago, Chile.
Funding: Chilean National Commission for Scientific and Technological
Research, FONDECYT N. 11150123.
Disclaimer: The authors report no conflicts of interest.
Mini-CEX assessment as a tool to visualise learning
improvements and needs of undergraduate dental
students
Background
• What students “show how” in structure assessments (OSCE), does not ensure they
will be competent in the clinic.
• For two decades (+), the assessment venue has moved to the workplace.
• New direct observation workplace-based assessment (WPBA) standardised forms that
focus on the “Does” level, show good validity and reliability.
• The most commonly found WPBA tools in the literature is the
Mini-Clinical Evaluation Exercise (mini-CEX).
Does
Shows How
Knows How
Knows
Miller 1990; Rethans et al., 2002; Norcini and Burch, 2007; Norcini and McKinley, 2007; Cantillon and Wood, 2010; Boursicot et al., 2011.
Aim• Can we implement the Mini-CEX in a busy
undergraduate clinic setting?
• To explore the difference between below-
expectation and borderline year-4 and
year-5 dental students’ clinical skills,
formatively assessed through a modified
Mini-CEX.
• To examine the recurrent student-teacher
“agreed challenges” themes from Mini-CEX
forms, for course evaluation and to
improve our feedback to the students.
• 2016 Delphi panel of experts to develop and later pilot the Mini-CEX (14 items).
• 2017 Mini-CEX was implemented as a formative assessment for all students at the
child and adult dental clinics.
• All year-4 (81) and year-5 (63) student evaluated their patients while assessed by an
observing faculty using the modified 14-items Mini-CEX form.
• End of the courses, all Mini-CEX forms were counted and descriptively analysed.
• Those “below expectation” and “borderline” Y4 and Y5 Mini-CEX forms were
statistically compared.
• Free text from all Mini-CEX student-faculty “agreed challenges” were grouped into
themes and compered.
Methods
• 1252 Mini-CEX forms were collected
(average of 8.7 forms each student).
• There was a significant lower percentage of students “below expectation” and
“borderline” in Y5 compared to Y4 both in child and adult clinics (p<0.001).
• Y4 child clinic needed to improve significantly more than Y4 adult clinic (<0.002).
Results
Below expectation & Borderline Y5
Below expectation & Borderline Child Clinic
Items
Below expectation
+Borderline for Y4 completion
(81-146)
Below expectation
+Borderline for Y5 completion
(63-272)
Below expectation
+Borderline for Y4 completion
(81-487)
Below expectation
+Borderline for Y5 completion
(63-347)
Child Clinic Child Clinic Adult Clinic Adult Clinic
Shows ability to interview and take a complete patient history 2% 5% 5% 2%
Performs an appropriate and thorough clinical intra- and extra-oral
examination15% 7% 7% 4%
Demonstrates basic knowledge and diagnostic skills 16% 6% 8% 6%
Demonstrates adequate clinical judgment and decision making 12% 3% 6% 4%
Presents a complete treatment and prognosis plan congruent with the
diagnosis18% 4% 6% 4%
Shows a caring and respectful behaviour with patient / classmates /
staff1% 0.3% 2% 1%
Communicates and listens effectively using appropriate language 2% 0.3% 3% 1%
Organises, plans, manages time efficiently and works efficiently 6% 2% 6% 1%
Properly manages all the stages and established sequences 2% 0.7% 4% 2%
Wears a clean and tidy dress 1% 0.7% 2% 0.2%
Permanently respects the distribution of working areas 2% 0% 3% 0.2%
Observes established biosecurity measures 1% 0% 3% 0.6%
Overall clinical competence 6% 1% 3% 2%
Insight into performance
Recognises strengths, weaknesses and deficiencies?2% 0.7% 3% 1%
Results
Items
Below expectation
+Borderline for Y4 completion
(81-146)
Below expectation
+Borderline for Y5 completion
(63-272)
Below expectation
+Borderline for Y4 completion
(81-487)
Below expectation
+Borderline for Y5 completion
(63-347)
Child Clinic Child Clinic Adult Clinic Adult Clinic
Shows ability to interview and take a complete patient history 2% 5% 5% 2%
Performs an appropriate and thorough clinical intra- and extra-oral
examination15% 7% 7% 4%
Demonstrates basic knowledge and diagnostic skills 16% 6% 8% 6%
Demonstrates adequate clinical judgment and decision making 12% 3% 6% 4%
Presents a complete treatment and prognosis plan congruent with the
diagnosis18% 4% 6% 4%
Shows a caring and respectful behaviour with patient / classmates /
staff1% 0.3% 2% 1%
Communicates and listens effectively using appropriate language 2% 0.3% 3% 1%
Organises, plans, manages time efficiently and works efficiently 6% 2% 6% 1%
Properly manages all the stages and established sequences 2% 0.7% 4% 2%
Wears a clean and tidy dress 1% 0.7% 2% 0.2%
Permanently respects the distribution of working areas 2% 0% 3% 0.2%
Observes established biosecurity measures 1% 0% 3% 0.6%
Overall clinical competence 6% 1% 3% 2%
Insight into performance
Recognises strengths, weaknesses and deficiencies?2% 0.7% 3% 1%
Results
• Most frequent capabilities required to make progress (Y4):
“intra- and extra-oral examination”
“basic knowledge and diagnostic skills”
“treatment plan and prognosis congruent with diagnosis”
• Best assessed capabilities (Y4 & Y5):
“caring behaviour”
“clean and tidy dress”
“biosecurity measures”
“communicating and listening”
Lenguaje apropiado
Congruencia de diagnóstico con pronóstico y
controles
Garantía GES
Juicio clínico
Sistemática de dg
Detalles del examen
Engaño
CIN VMejor diagnóstico
Mejorar fotos
Mirar más
Dar sentido a lo que hace
Se ve avance en diagnóstico
Mejorar orden de ejecución de diagnóstico.
Más observación
Integrar examen clínico con diagnóstico
Ser más minucioso en examen
Estudiar ciencias básicas
Análisis de RX
Ubicación de puntos cefalométricos
Integrar patologías ortodóncicas
Separar lo importante de lo no importante
Mejorar toma de registro
Mejorar puntos cefalométricos
Mejorar organización y tiempos
Mejorar análisis de RX
CIN IV Mejorar evaluación y asesoría de dieta individualizado:
Diario dietario
Derivación oportuna
Trabajo ordenado y limpio
Respetar área de trabajo
Mejorar anamnesis
Mejorar conocimiento de IHO
Derivación a nutricionista
Respetar áreas de trabajo clínico
Ficha clínica
Más exhaustiva en examen clínico
Diagnóstico
Interpretación de riesgo social
Concepto de caries temprana de la infancia
Más detalle al realizar entrevista
Consignar info en ficha
DG incompleto
Historia clínica
Conocimiento de ceod significado
Importancia de los MB en el riesgo
Sobrepeso en riesgo biológico
Calendario de vacunas
Examen de oclusión: overjet & overbite
Entrevista
Lentes de bioseguridad
Incluir tejidos blandos en diagnóstico
Cálculo de IMC e interpretación y derivación
Evaluar tonsilas
• Recurrent themes from agreed challenges after feedback in both clinical years (Child):
Análisis de modelos
Falta orden en diagnóstico
No llega a un diagnóstico integral
Debe entender qué es un problema
Evaluación de riesgo cariogénico y plan de
tratamiento preventivo
Falla en diagnóstico de lesiones ICDAS
Organización y tiempos
Justificación de tratamiento preventivo
Importancia del pronóstico
HonestidadAnálisis crítico del índice de placaAINESAlternativas de tratamientoPlan de ttro en hábitosFrecuencia de controlesCongruencia de diagnóstico con pronóstico y controlesRiesgo biológico generalAspectos médicos en anamnesisIndicadores de riesgoOjo clínicoPlan de tto con enfoque de riesgoToma de decisión clínica
• Prognosis rationale*
• Integrated diagnosis*
• Multidisciplinary view*
• Reflection*
• Sequence of diagnosis
• Diet assessment & Body Mass Index
• Clinical language
• Prognosis congruent with diagnosis & controls
• Make sense of what is being done
• Risk factors
• ICDAS understanding
• Preventive treatment
Limpieza lingual
Diseño de ppr
Ex clínico
Correlación entre dg clínico y rx
CIA VPatología pulpar y periapical
Historia médica más acuciosa
Pronóstico endodóntico
Prolijidad con asepsia y bioseguridad
Toma rx
Entender e interpretar RX
Lentitud
Autonomía
Seguridad
Actitud atolondrada
Integrar teoría con clínica
Casos más complejos
Manejo del dolor
Secuencia de trabajo
Juicio clínico
Tiempos de tratamiento
Explicaciones al paciente
Dg
Orden de área clínica
Interpretar prueba dg
Comunicación
Autocrítica
Casos más complejos
Lenguaje clínico
Pruebas dg
CIA IVDg radiográfico
Dg endodóntico
Bioseguridad
Manejo del tiempo de trabajo
Anamnesis
Orden de área clínica
Anatomía
Farmacología
Patología médica
confidencia
Pruebas diagnósticas
Fundamentar dg
Exámenes
Pronostico
Distinción entre caries y surco profundo
Detección clínica y rx de caries
Justificación del pronóstico
Dg lesiones cervicales
Indicación en anfracciones
ICDAS 2-3-4
Alternativas de tto en piezas endo tratadas
Dg integral
Análisis de modelos
Pronóstico de atm
Sobrediagnóstico
Opciones de tto para paciente pros y cons
Dg oclusal
Toma de decisiones
Pronóstico general v. específico
Espacio para implante
• Recurrent themes from agreed challenges after feedback in both clinical years (Adult):
Integrar conceptos para mejor dg
Manejo de tiempo
Dif entre restauración directa e indirecta
Secuencia de tto
Riesgo cariogénico
Alternativas de tto para desgaste oclusal
Materiales para onlays
Determinación de dimensión vertical
Clasificación de kennedy-appelgate
Fotografías
Cronología de tto
Pronostico
Dg lesiones cariosas
Fundamentos de pronostico
Dg de atm articular
Dg salival en xerostomía
Dg oclusal
Análisis de FEL
Mecanismo de acción de enf periodontal
Dg periodontal
Fundamento de pronóstico periodontal
Ver paciente integralmente
Tabaquismo como factor de riesgo
Reforzar observación de detalles
Elementos de higiene interproximal
Análisis del FEL
Ver paciente de forma integral
HIO interprox
Fases del tratamiento
Registro de parámetros periodontales
Interpretación radiográfica
Exámenes de laboratorio
Diag. diferencial
• Prognosis rationale*
• Integrated diagnosis*
• Multidisciplinary view*
• Reflection*
• Self-assessment
• Working time, security & autonomy
• General versus specific prognosis
• ICDAS 2-3-4
• Alternative treatments
• The modified Mini-CEX can be implemented in university busy
clinical settings.
• As expected, there were more Y4 students below-expectation
and borderline compared to Y5 ones.
• Y4 and Y5 students shared a few challenges but the latter
were more demanding.
• The use of the Mini-CEX can help to tailor clinical skills
education to specific students’ needs.
Conclusions
Below expectation
+Borderline for Y4
completion
(81-146)
Below expectation
+Borderline for Y5
completion
(63-272)
Below expectation
+Borderline for Y4
completion
81-487
Below expectation
+Borderline for Y5
completion
63-347
Child Clinic Child Clinic Adult Clinic Adult Clinic
Shows ability to interview and take a complete patient history 18-12% 13-5% 23-5% 10-2%
Performs an appropriate and thorough clinical intra- and extra-oral examination. 22-15% 19-7% 32-7% 21-4%
Demonstrate basic knowledge and diagnostic skills
Exhibe habilidades de diagnóstico y conocimiento base 23-16% 16-6% 38-8% 28-6%
Demonstrates adequate clinical judgment and decision making
Demuestra un adecuado juicio clínico y toma de decisiones 17-12% 9-3% 29-6% 18-4%
Presents a complete treatment and prognosis plan congruent with the diagnosis
Presenta un plan de tratamiento y pronóstico apropiado completo y congruente con el diagnóstico26-18% 12-4% 30-6% 20-4%
Shows a caring and respectful behaviour with patient / classmates / staff
Muestra una conducta comprensiva y respetuosa con el paciente / compañeros / personal de apoyo2-1% 1-0.3 11-2% 5-1%
Communicates and listens effectively using appropriate language
Se comunica y escucha efectivamente utilizando lenguaje apropiado 3-2% 1-0.3 13-3% 6-1%
Organises, plans, manages time efficiently and works efficiently
Se organiza, planifica, maneja el tiempo eficazmente y trabaja eficientemente9-6% 6-2% 29-6% 7-1%
Properly manages all the stages and established sequences
Maneja adecuadamente todas las etapas y secuencias establecidas3-2% 2-0.7% 19-4% 9-2%
Wears a clean and tidy dress
Se presenta limpio y ordenado2-1% 2-0.7% 12-2% 1-0.2%
Permanently respects the distribution of working areas
Respeta permanentemente la distribución de las áreas de trabajo (clínica, limpia, sucia)3-2% 0% 16-3% 1-0.2%
Complies with established biosecurity measures
Cumple con medidas de Bioseguridad establecidas2-1% 0 14-3% 3-0.6%
Overall clinical competence
Competencia Global (evaluación general considerando todo lo observado)9-6% 3-1% 13-3% 8-2%
Insight into performance
Recognises strengths, weaknesses and deficiencies?
Results
Tricio J., Salles P., Orsini C., Cacciuttolo F., Georgudis G., Morales R., Recabarren R., Tapia R.
Centre for Healthcare Education Develpmemt,
School of Dentistry, University of the Andes, Santiago, Chile.
Funding: Chilean National Commission for Scientific and Technological
Research, FONDECYT N. 11150123.
Disclaimer: The authors report no conflicts of interest.
Mini-CEX assessment as a tool to visualise learning
improvements and needs of undergraduate dental
students
