Mini-clinical evaluation exercise and feedback on postgraduate trainees in the emergency department: A qualitative content analysis

Abstract

Mini-clinical evaluation exercises (mini-CEXs) have been successfully adapted as a formative and summative assessment tool for various different postgraduate medical programs. However, only a few studies have evaluated its use in the setting of an emergency department (ED). The purpose of this study was to examine the quality of feedback given by preceptors to postgraduate Year 1 (PGY-1) residents during mini-CEXs in EDs. This prospective observational study involved EDs at 20 teaching hospitals and comprised 893 mini-CEX encounters involving 230 PGY-1 trainees and 242 preceptors. All feedback forms, which contained three sections, namely “Positive Feedback,” “Negative Feedback,” and “Action Plan,” were assessed using qualitative content analysis techniques. A total of 734 mini-CEX sessions (82.2%) contained positive feedback, 507 (63.8%) contained negative feedback, 350 (39.2%) contained action plans, and 131 (14.7%) had no feedback. These written feedback comments could be structured into 1,877 coded items and grouped into seven domains of clinical competence. These were: (1) medical interviewing, (2) physical examination, (3) professionalism, (4) clinical judgment, (5) counseling, (6) organization/efficiency, and (7) clinical procedures. During feedback from the mini-CEXs in the ED setting, preceptors to the PGY-1 students tend to emphasize clinical judgment and seemed to pay less attention to facilitate the development of reflective skills and communication skills.