Application of mini-CEX in community rotation of general practice residency training

Abstract

Objective To evaluate the effectiveness of mini clinical evaluation exercise(mini-CEX) in community rotation of general practice residency training. Methods Forty nine general practice residency trainees, who participated in community rotation during July 2012 to July 2014 in 3 community teaching bases, were randomly divided into two groups: 25 trainees in intervention group received conventional teaching and additional 2 rounds of mini-CEX in one month, and 24 trainees received conventional teaching only. The changes of self-evaluation scores of clinical competence after the community rotation were evaluated. Focus group discussions of 8 trainees and 8 teachers from intervention group were also adopted in January to February 2013 to assess the effectiveness of mini-CEX. Results Three trainees withdrew in the study and the interventional group completed 232 mini-CEXs. The self-evaluation scores of clinical competence were elevated in all items in interventional group after community rotation(from 7.03±0.68 to 7.30±0.77 in medical history, from 7.00±0.83 to 7.18±0.88 in physical examination, from 7.42±1.20 to 7.52±0.76 in humanistic qualities, from 6.79±0.82 to 7.12±0.70 in clinical judgment, from 6.85±1.06 to 7.18±0.81 in counseling skills, from 6.85±1.15 to 7.12±0.96 in organization, from 7.09±0.81 to 7.33±0.69 in overall competence), while in control group, scores of humanistic qualities(from 7.74±0.89 to 7.60±0.97), clinical judgment(from 6.94±0.77 to 6.77±1.10) and organization/efficiency(from 6.94±0.96 to 6.80±0.76) were declined. After adjusting self-evaluation score before rotation, the increased scores in clinical judgment(7.12±0.70 vs. 6.77±1.10, F=4.339, P=0.042)and organization(7.12±0.96 vs. 6.80±0.76, F=4.336, P=0.042)of intervention group were significantly higher than those of control group. In focus group discussions both trainees and teachers recognized that mini-CEX would enhance clinical competence, be more comprehensive in assessing and adaptable in training program than former rotation tests. The major concerns of using mini-CEX were subjective rating process, non-unified rating standards and insufficient teaching ability. Conclusions Application of mini-CEX in community rotation of general practice residency training can enhance clinical competency of trainees. Key words: General practioners; Teaching; Mini clinical evaluation exercise