Abstract
This article was migrated. The article was marked as recommended. Introduction: The mini-clinical evaluation exercise (mini-CEX) allows for assessment and subsequent feedback across a range of individual clinical cases, although much of what is assessed is left implicit. After the performance by a trainee, further observation of appropriate clinical performance by the tutor provides a strong standard of reference for effective learning. Methods: In each mini-CEX encounter one final year resident clinically assessed an unfamiliar patient in the presence of peers and a tutor. The tutor then demonstrated the appropriate clinical behaviour. Twelve peers rated the performance of the resident before and after the tutor-demonstrated feedback (TDF). The encounters with the first cases by each of the participants were completed one by one and the cycles of encounters with the next cases by each resident were similarly continued. Results: All 13 participants completed six mini-CEX encounters over one year with an overall response rate of 95% for peer-assessment ratings (PARs). There was a total of 1772 PAR forms each with seven parameters and 1772 peer-satisfaction rating (PSR). Reliability coefficients of PARs ranged from .77 to .93. The PARs decreased significantly in each of the six cases after TDF (p<0.001). Peers rated the performance more negatively after the TDF than before the TDF. The mean PSRs, however, increased significantly in each of the six cases after the TDF (p<0.05). The mean observation time of participants' performance decreased from 26 minutes in the initial two cases to 14.5 in the last two (p<0.001). Conclusion: The feasibility and the positive educational impact of the TDF were shown in our exploratory study. The novel concept of TDF in the mini-CEX as supervised learning events and formative assessment deserves further investigation.
Highlights
The mini-clinical evaluation exercise allows for assessment and subsequent feedback across a range of individual clinical cases, much of what is assessed is left implicit
The mini-CEX is commonly used as part of supervised learning events (Joint Royal Colleges of Physicians Training Board, 2014) and formative assessment with trainees (American Board of Internal Medicine, 2020)
Apart from the time taken for each encounter, we studied the differences in their assessment and satisfaction ratings before and after the tutor-demonstrated feedback (TDF)
Summary
The mini-clinical evaluation exercise (mini-CEX) allows for assessment and subsequent feedback across a range of individual clinical cases, much of what is assessed is left implicit. A mini-CEX encounter typically consists of a single faculty member observing a resident while that resident conducts a focused history and physical examination. Miller and Archer (2010) in their systematic review concluded that though the subjective perception and satisfaction reports of the mini-CEX were positive, there was no evidence that it led to further improvement in the performance of doctors. In a recent meta-analyses Lorwald et al (2018) found some evidence of positive effects on trainee performance and reported two implementation characteristics associated with the educational impact of the mini-CEX: how well different program components are conducted (i.e. quality of the implementation) and the degree to which the program stimulates the interest or holds the attention of participants (i.e. participant responsiveness during implementation). How to maximize the quality of performance and participant responsiveness during implementation of the mini-CEX is a key issue
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