Mini-clinical evaluation exerciseMini-clinical evaluation exercise

Mini-CEXMini-CEX

Ass

ess

men

t of

Overa

ll C

linic

al S

kills

Ass

ess

men

t of

Overa

ll C

linic

al S

kills

بسم الله الرحمن الرحیمبسم الله الرحمن الرحیم

لیال پاداشلیال پاداش

دانشگاه علوم پزشکی گلستاندانشگاه علوم پزشکی گلستانعضو هیات علمی و مسئول دفتر رشد و بالندگی

اساتیددانشگاه

What is a mini-CEXWhat is a mini-CEX? ?

A workplace-based assessmentA workplace-based assessment

a short episode of a short episode of real student-patientreal student-patient

interaction within the workplaceinteraction within the workplace

observed and judged by the supervising observed and judged by the supervising

clinician (clinician (observerobserver))

followed by followed by feedbackfeedback

Why do mini-CEX Why do mini-CEX ? ?

Workplace-based assessment drives

experiential learning?

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

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%

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

ToTo increase patient satisfaction– Higher with better communication skills

To To improve patient self-care– Better adherence and outcomes

associated with better physician communication skills

Miller’s Pyramid

KNOWS

KNOWS HOW

SHOWS

HOW

DOES

MCQ.SAQ

PMP.KFP

OSCE

Mini.cex

Faculty ObservationFaculty Observation

how to do miniCEX?

too simple too simple

Triangulation

DESK

Resident(trainee)

Patient

Attending(observer)

In the mini-CEX, a single faculty Member(observer) observes the trainee`s 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.

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 trainee`s clinical skills & fill

the feedback form. Observer must note some extra information such as

complexity of patient`s problem

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.

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.

To be most effective, feedback needs to be interactive

strengths and weaknesses.→ (agreement & signature)

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 trainee`s rotations & his/her past encounters.

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, … )

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.

How many encounters must be observed to provide a reliable mean rating?

Changes in reliability as a function of the number of observed encounters

0.5

0.6

0.7

0.8

0.9

1

1 4 6 8 10 12 14 16 18

Mini-CEX: Reliability

Reliability Coefficients > 0.80 with 6 observations > 0.90 with 12 observation > 0.95 with 24 observations

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

Mini-Clinical Examination (Mini-CEX)

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