Document Type : Original Article
Authors
1 Department of Medicine, All India Institute of Medical Sciences (AIIMS), Bathinda, Punjab, India
2 Department of Anatomy, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, Maharashtra, India
Abstract
BACKGROUND: The mini‑clinical evaluation exercise (mini‑CEX) is a formative assessment tool
designed to provide feedback on skills essential to good medical care by observing an actual clinical
encounter. However, the bigger advantage of mini‑CEX is the structured feedback that it provides to
the students as well as the faculty, thus helping them to make better decisions.
MATERIALS AND METHODS: This study was a cross‑sectional observational study. Sixteen surgery
residents volunteered for participation and five professors conducted sessions; hence, 80 mini‑CEX
encounters. Seven core clinical skill assessments were done, and the performance was rated on
a 9‑point scale (grouped into unsatisfactory, satisfactory, and superior). Immediate feedback to
the residents was given by the faculty. Delayed feedback from faculty and residents regarding the
perception of mini‑CEX was taken. Statistical analysis was done using SPSS version 20 and analysis
of variance (ANOVA) for inferential statistics.
RESULTS: As planned, 80 (100%) mini‑CEX encounters were conducted. Surgery residents showed
improvement that was statistically significant in the competencies of medical interviewing skills,
physical examination skills, humanistic qualities/professionalism, and counseling skills. Most of the
faculty (80%) were able to identify the gaps in the knowledge of students and areas of improvement
for their teaching. However, 60% of the faculty felt that it required more effort than traditional methods.
The mean time taken by the assessor for observation and feedback to residents was 12.51 min
and 5.68 min, respectively. The mean scores of evaluator satisfaction and resident satisfaction with
mini‑CEX sessions were 6.04 and 7.49, respectively.
CONCLUSIONS: Mini‑CEX improves the learning environment in residency and also leads to
improvement in medical interviewing skills, physical examination skills, humanistic qualities/
professionalism, and counseling skills. It is done in the actual patient encounter and hence prepares
the resident better for dealing with patients in the future.
Keywords
mini clinical evaluation exercise as a formative assessment tool for
workplace based assessment for surgical postgraduate students.
J Postgrad Med 2017;63:100‑5.
2. Tejinder S, PiyushG, Daljit S. Assessment of Practical/Clinical Skills
in Principles of Medical Education. 4th ed. Jaypee; 2013. p. 123‑35.
3. Tejinder S, Anshu. The Mini‑Clinical Evaluation
Exercise (Mini‑CEX) in Principles of Assessment in Medical
Education. 1st ed. Jaypee; 2012. p. 156‑65.
4. NorciniJJ, BlankLL, DuffyFD, FortnaGS. The mini‑CEX: Amethod
for assessing clinical skills. Ann Intern Med 2003;138:476‑81.
5. Singh T, Sharma M. Mini‑clinical examination (CEX) as a tool for
formative assessment. Natl Med J India 2010;23:100‑3.
6. Behre R. Introduction of Mini‑CEX in undergraduate dental
education in India. Educ Health 2014;27:262‑8.
7. Norcini JJ, Blank LL, Arnold GK, Kimball HR. The
Mini‑CEX (Clinical evaluation exercise): A preliminary
investigation. Ann Intern Med 1995;123:795‑9.
8. Goel A, Singh T. The usefulness of Mini clinical evaluation exercise
as a learning tool in different pediatric clinical settings. Int J Appl
Basic Med Res 2015;5(Suppl 1):S32‑4.
9. Liao KC, Pu SJ, Liu MS, Yang CW, Kuo HP. Development and
implementation of a mini‑Clinical evaluation exercise (mini‑CEX)
program to assess the clinical competencies of internal medicine
residents: From faculty development to curriculum evaluation.
BMC Med Educ 2013;13:31.
10. Chang YC, Chen CK, Chen JC, Liao CH, Lee CH, Chen YC,
et al. Implementation of the mini‑clinical evaluation exercise in
postgraduate year 1 residency training in emergency medicine:
Clinical experience at Chang Gung memorial hospital. J Acute
Med 2013;3:110‑5.
11. 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
2021;10:291.
12. Holmboe ES, Yepes M, Williams F, Huot SJ. Feedback and mini
clinical evaluation exercise. J Gen Intern Med 2004;19:558‑61.
13. Burch VC, Seggie JL, Gary NE. Formative assessment promotes
learning in undergraduate clinical clerkships. S Afr Med J
2006;96:430‑3.
14. Baraz S, Memarian R, Vanaki Z. Learning challenges of nursing
students in clinical environments: A qualitative study in Iran.
J Educ Health Promot 2015;4:52.
15. Malhotra S, Hatala R, Courneya CA. Internal medicine residents
perceptions of Mini‑Clinical Evaluation Exercise. Med Teach
2008;30:414‑9.
16. Jafarpoor H, Hosseini M, Sohrabi M, Mehmannavazan M. The
effect of direct observation of procedural skills/mini‑clinical
evaluation exercise on the satisfaction and clinical skills of nursing
students in dialysis. J Educ Health Promot 2021;10:74.
17. Bhattacharyya H, Vagha J, MedhiGK, Pala S, Chutia H, BoraPJ, et al.
Introduction of structured feedback for MBBS students: Perception
of students and faculty. J Educ Health Promot 2020;9:285.
18. Wellers JM, Jones A, Merry AF, Jolly B, Saunders D. Investigation
of trainee and specialist reactions to the Mini Clinical Evaluation
Exercise in anesthesia: Implications for implementation. Br J
Anesth 2009;103:524‑30.
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