Document Type : Original Article


Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran


BACKGROUND: Role of multimedia training materials on Mini-CEX scores of internal medicine
residents. We aimed to assess the effect of multi multimedia training materials on Mini-CEX scores
of internal medicine residents of Isfahan University of Medical Sciences.
SETTINGS AND DESIGN: A quasi-experimental action research study on 1st, 2nd, and 3rd-year
internal medicine residents were implemented.
MATERIALS AND METHODS: The Mini-CEX test measures students’ performance in six core skills
necessary for medical practice. Mini-CEX scores of 135 internal medicine residents in 2017–2018
were compared before and after the training with prepared multimedia materials. We used repeated
measured ANOVA and Mann–Whitney U test to compare the distribution of Mini-CEX scores across
corresponding groups. Analysis was done using the SPSS software version 23 (IBM SPSS Statistics
for Windows. Armonk, NY, USA: IBM Corp).
RESULTS: The median Mini-CEX score (IQR) of students in preintervention and postintervention
groups were 16.14 (5.19) and 19.62 (3.13), respectively. Findings of this study showed a significant
increase in mini-CEX scores of the groups who used the multimedia learning material compared to
those who did not use it (P < 0.001).
CONCLUSIONS: Multimedia learning resources demonstrated a promising influence on internal
residents’ mini‑CEX scores in this study. They demonstrate significantly greater performance after
using multimedia learning materials compared to their same‑year residents who did not benefit from
it. This demonstrates the favorable effect of multimedia on the acquisition of practical skills such as
obtaining a history or performing a physical examination.


  1. 1. Asadi Z, Esmaeilinasab M, Yaghobi N, Ansarifar A. Comparison
    of the effect of written, figurative and written‑figurative
    training package of myocardial perfusion imaging on patients’
    cooperation. Iran J Cardiovasc Nurs 2014;3:18‑25.
    2. Rose S. Medical student education in the time of COVID‑19. JAMA
    3. Bickley, L. S, Bates, B., & Szilagyi, P. G. (2012). Bates' guide to
    physical examination and history taking. 11th ed. Philadelphia,
    Pa.: Lippincott Williams & Wilkins.
    4. Alsoufi A, Alsuyihili A, Msherghi A, Elhadi A, Atiyah H,
    Ashini A, et al. Impact of the COVID‑19 pandemic on medical
    education: Medical students’ knowledge, attitudes, and practices
    regarding electronic learning. PLoS One 2020;15:e0242905.
    5. Chiodini J. Online learning in the time of COVID‑19. Travel Med
    Infect Dis 2020;34:101669.
    6. Mian A, Khan S. Medical education during pandemics: A UK
    perspective. BMC Med 2020;18:100.
    7. Sahu PK, Chattu VK, Rewatkar A, Sakhamuri S. Best practices
    to impart clinical skills during preclinical years of medical
    curriculum. J Educ Health Promot 2019;8:57.
    8. Mohagheghi M, Vahidshahi K, Shakeri S. Development and
    Innovation in the Field Assisted Test Promotion. Tehran, Iran:
    Iranian Council for Graduate Medical Education; 2010.
    9. Mirzai V, Haghdoost AA, Azizi F. Formative evaluation of
    residents from the residents and their attending points of views.
    Strides Dev Med Educ 2014;10:413‑20.
    10. Wu Y, Gong M, Zhang D, Zhang C. Educational impact of the
    mini-Clinical Evaluation Exercise in resident standardization
    training: A comparative study between resident and
    professional degree postgraduate trainees. J Int Med Res. 2020
    May;48(5):300060520920052. doi: 10.1177/0300060520920052.
    PMID: 32459121; PMCID: PMC7278105.
    11. Martinsen SS, Espeland T, Berg EA, Samstad E, Lillebo B,
    Slørdahl TS. Examining the educational impact of the mini‑CEX:
    A randomised controlled study. BMC Med Educ 2021;21:228.
    2022. Available from: [Last cited on
    2022 Jan 04].
    13. Cook DA, Dupras DM, Beckman TJ, Thomas KG, Pankratz VS.
    Effect of rater training on reliability and accuracy of mini‑CEX
    scores: A randomized, controlled trial. J Gen Intern Med
    14. Kogan JR, Bellini LM, Shea JA. Feasibility, reliability, and validity
    of the mini‑clinical evaluation exercise (mCEX) in a medicine core
    clerkship. Acad Med 2003;78:S33‑5.
    15. Holmboe ES, Huot S, Chung J, Norcini J, Hawkins RE. Construct
    validity of the miniclinical evaluation exercise (miniCEX). Acad
    Med 2003;78:826‑30.
    16. Hill F, Kendall K. Adopting and adapting the mini‑CEX as
    an undergraduate assessment and learning tool. Clin Teach
    17. Norcini JJ, Blank LL, Duffy FD, Fortna GS. The mini‑CEX:
    A method for assessing clinical skills. Ann Intern Med
    18. Little WB, Artemiou E, Conan A, Sparks C. Computer assisted
    learning: Assessment of the veterinary virtual anatomy education
    software IVALA™. Vet Sci 2018;5:58.
    19. Vallée A, Blacher J, Cariou A, Sorbets E. Blended learning
    compared to traditional learning in medical education: Systematic
    review and meta‑analysis. J Med Internet Res 2020;22:e16504.
    20. Singh K, Bharatha A, Sa B, Adams OP, Majumder MA. Teaching
    anatomy using an active and engaging learning strategy. BMC
    Med Educ 2019;19:149.
    21. Vafamehr V, Dadgostarnia M. Evaluation of new program of
    ICM. Iran J Med Educ 2011;10:839‑50.
    22. Dadgostarnia M, Gholami RV, Ashoorion V, Esmaeili A, Shams B,
    Taban H, et al. Multistage problem‑based case discussion for
    medical students. J Med Educ 2003;4:17‑22.
    23. Dumford AD, Miller AL. Online learning in higher education:
    Exploring advantages and disadvantages for engagement.
    J Comput High Educ 2018;30:452‑65.
    24. Darling‑Hammond L, Flook L, Cook‑Harvey C, Barron B,
    Osher D. Implications for educational practice of the science of
    learning and development. Appl Dev Sci 2019;24:97‑140.
    25. Ghadrdoost B, Sadeghipour P, Amin A, Bakhshandeh H, Noohi F,
    Maleki M, et al. Validity and reliability of a virtual education
    satisfaction questionnaire from the perspective of cardiology
    residents during the COVID‑19 pandemic. J Educ Health Promot
    26. Rohlfsen CJ, Sayles H, Moore GF, Mikuls TR, O’DellJR, McBrien S,
    et al. Innovation in early medical education, no bells or whistles
    required. BMC Med Educ 2020;20:39.
    27. Guze PA. Using technology to meet the challenges of medical
    education. Trans Am Clin Climatol Assoc 2015;126:260‑70.
    28. Ryall T, Judd BK, Gordon CJ. Simulation‑based assessments in
    health professional education: A systematic review. J Multidiscip
    Healthc 2016;9:69‑82.
    29. Sadeqi H, Valiani A, Avizhgan M, Ebrahimi SA, Manteghinejad A,
    Miralai P, et al. The effect of teaching integrated course of physical
    examination and radiological anatomy in practical limb anatomy
    on medical students’ learning outcomes. BMC Med Educ
  2. 30. Schilling K. The impact of multimedia course enhancements
    on student learning outcomes. J Educ Libr Inform Sci
    31. Torgersen GE, Boe O. Which tools in multimedia are best
    for learning outcomes? A study grounded in cognitive load
    structures. Front Psychol 2021;12:545335.
    32. Zeng J, Parks S, Shang J. To learn scientifically, effectively, and
    enjoyably: A review of educational games. Hum Behav Emerg
    Technol 2020;2:186‑95.
    33. Neo M, Neo KT. Innovative teaching: Using multimedia in
    a problem‑based learning environment. J Educ Technol Soc
    34. Yazdani S, Homayoonizand R. Reform in General Medicine
    Degree Curriculum: Basic Science Phase. Tehran: Educational
    Development Center Shaheed Beheshti University of Medical
    Science and Health Services; 2007.
    35. Kaminsky J, Bianchi R, Eisner S, Ovitsh R, Lopez AM, Smith L,
    et al. Respiratory auscultation lab using a cardiopulmonary
    auscultation simulation manikin. MedEdPORTAL 2021;17:11107.
    36. Bernardi S, Giudici F, Leone MF, Zuolo G, Furlotti S, Carretta R,
    et al. A prospective study on the efficacy of patient simulation in
    heart and lung auscultation. BMC Med Educ 2019;19:275.
    37. Ward JJ, Wattier BA. Technology for enhancing chest auscultation
    in clinical simulation. Respir Care 2011;56:834‑45.