Introduction of Mini-clinical Evaluation Exercise for the Formative Assessment of Postgraduates in the General Surgery Discipline

Abstract

Introduction: The common practice prevalent in most of the Postgraduate (PG) teaching institutes is that while the PGs are clinically evaluating the patients for the traditional long case, they are mostly not directly observed by the faculty. The presentation of the case by PGs is the main focus of assessment. Workplace Based Assessment (WPBA) tools assess the clinical competence of students at the ‘does’ level of Miller’s pyramid, while they perform in a real setting. Aim: To assess the feasibility, acceptability and effectiveness of Mini-Clinical Evaluation Exercises (Mini-CEX) for the PGs in Surgery. Materials and Methods: This educational intervention study was conducted in the General Surgery Department, over a period of one year. Sixteen PGs of 1st, 2nd, and 3rd-year residency participated in the study, and 13 faculty as assessors. The Mini-CEX was conducted and the abim.org proforma was used to record the observations by the faculty. The perceptions of the PGs and faculty were obtained at the end of the study using a predesigned validated feedback questionnaire. The change in the level of acquisition of clinical skills of the PGs was evaluated using the group mean, median and rank. The Friedman test was applied to calculate the statistical significance at p<0.05 using Statistical Package for the Social Sciences (SPSS) version 20. Results: A total of 124 Mini-CEX encounters were conducted over a period of one year. The mean satisfaction score for the Mini-CEX encounters was 7.3±0.88 and 6±0.89 on the global rating (0-9) among the PGs and faculty respectively. While 14 PGs (87.5%) accepted that Mini-CEX was easy to conduct as compared to the traditional long case. Ten faculty (76.5%) accepted that it was feasible to conduct with the prevailing professional workload. Twelve PGs perceived that Mini-CEX was an effective tool for improving clinical skills. Statistically significant (p-value <0.05) improvement was found in the competencies of medical interviewing, physical examination, counseling skills, and professionalism. Conclusion: Mini-CEX was acceptable to the PGs and faculty. It was found to be an effective and formative assessment tool for learning clinical skills in a supportive workplace-based environment for clinical skills improvements