Clinical Evaluation Exercise Research Articles

Application of PBL-CBL and Mini-CEX methods in the standardized training of residents in nephrology department: A prospective study.

This study explores the application and feasibility of problem based learning (PBL), integrating case based learning (CBL), and the mini clinical evaluation exercise (Mini-CEX) into the standardized training of residents in nephrology department, in order to assess their clinical skills in a comprehensive manner. This prospective study enrolled 60, three years residents majoring in clinical medicine, from June 2022 to December 2023 in Nephrology Department of Baoding No.1 Central Hospital. These participants were randomly allocated into either the combined PBL-CBL and Mini-CEX teaching group (experimental group) or the traditional lecture-based teaching group (control group). Two groups were evaluated with Mini-CEX assessments and test scores upon exit the department, followed by a questionnaire survey to measure satisfaction levels for the teachers. There was no statistically significant difference in age, sex, year of graduate school, specialty and student source between the two groups of residents upon the entering the department (P>0.05). Upon the completion, the experimental group, which received PBL-CBL and Mini-CEX teaching methods, demonstrated significantly higher scores in all aspects compared to the control group, with a statistically significant difference (P<0.01). Furthermore, compared the control group, most residents in the experimental group agreed that the PBL-CBL and Mini-CEX teaching methods improve curiosity and enthusiasm for learning (73.3%), communication and expression abilities (73.3%), self-learning abilities (80%), understanding of diseases (76.7%), and like this teaching method (86.7%). PBL-CBL and Mini-CEX may be an effective method for improving medical residents' performance and enhancing their clinical skills, which is worthy of promotion in the standardized training of the residents.

Application of Mini-CEX combined with DOPS in standardized training of community outpatient residents

ObjectiveTo explore the application effect of mini clinical evaluation exercise (Mini-CEX) combined with direct observation of procedural skills (DOPS) in the standardized training of general practitioners in community clinics.MethodsFrom June 2022 to June 2023,20 general practitioners who received standardized training for residents in the general outpatient department of Changqing Community Health Service Center of Wuhan Fourth Hospital were collected as the research objects. Mini-CEX combined with DOPS was used to evaluate the general practitioners at the time of admission, 2 weeks of training and 4 weeks of training, and the results were fed back.ResultsThe scores of 20 general practitioners at 2 weeks and 4 weeks of training were compared with the scores at the time of admission, and the difference was statistically significant, p < 0.05.ConclusionMini-CEX combined with DOPS can improve the teaching effect of standardized training of residents in community general clinics.

Stress and value: the student perspective on utilizing real vs. actor patients in objective structured clinical examinations

BackgroundStudies have shown objective structured clinical examinations (OSCEs) to be one of the most reliable tools in assessing clinical performance; however in Pediatrics they primarily use manikins, simulators or parent actors which limits the comprehensiveness of the assessment. In our Pediatric Clerkship, medical students are evaluated using a standardized rubric during a clinical evaluation exercise (CEX) with real patients. This study assessed medical students’ perceived stress levels and the educational value of the CEX compared an OSCE. We hypothesized there would be equal stress and value for students with the CEX experience compared to the OSCE.MethodsThird year students anonymously completed questionnaires after required Pediatric CEX and Internal Medicine OSCE evaluations from July 2016-June 2017. The questionnaire included questions from the Intrinsic Motivation Inventory, a validated tool used to assess feelings of stress and perceived value of an exercise.ResultsA total of 147 and 145 questionnaires were completed after the CEX and OSCE. There were no differences between groups regarding levels of “nervousness” (p = 0.543) and “relaxation” (p = 0.055); students felt more “at ease” (p = 0.002) and less “pressure” (p < 0.001) during the CEX. Students perceived the CEX to be more useful and important to improve skills compared to the OSCE for the history taking, physical exam and interpersonal skills.ConclusionsOur results indicate that the CEX was associated with lower stress levels and had higher perceived value when compared to the OSCE. This study supports the usefulness of incorporating real patients into the clinical evaluation of medical students.

Evaluation par le miniclinical évaluation exercise (Mini-CEX) en réanimation

Mini Clinical Evaluation Exercise (mini-CEX) is one of the assessment tools in medical education. It includes three steps: overview of clinical situation, observation and feedback. To evaluate the feasibility of mini-CEX as a formative assessment tool for medical trainees in 5th year of medicine in a teaching intensive care unit (ICU). Single-center qualitative research conducted in ICU during the 2nd semester of the academic year 2022-2023. Seven core clinical skill assessments were done, and the performance was rated on a 9-point scale. An assessment of the method was conducted with both trainees and clinical educators. We conducted six mini-CEX recorded sessions. All medical students had marks under the average of 4.5. In the first period, the highest mark was obtained for counselling skills (4.5). The best score was obtained for clinical judgement (4) in the second period and for management plan (4) in the third period. Most of medical trainees (11 sur 12) were satisfied with the method and feedback was according to them the most useful step. Ten students agreed fully to introduce this assessment tool in medical educational programs. Two medical educators out of three did not practice this method before. They agreed to include mini-CEX in the program of medical education of the faculty of medicine of Tunis. However, they did not agree to use it as a summative assessment tool. Our study demonstrates that we can use the mini-CEX in medical teaching. Both trainees and educators were satisfied with the method.

Investigating the Effects of Simulation-Based Teaching on Learning Domains Designed for Physiotherapy Students

Introduction: Simulation-based teaching is a technique for imitating a situation’s behavior or process via a suitable analog situation for training or teaching purposes. Simulation-based teaching is widely used in various domains; however, there is limited literature on evaluating the role of simulated-based teaching in physiotherapy. This study investigates the effect of simulation-based teaching on learning domains for traumatic brain injury topics framed for final-year physiotherapy students.&#x0D; Materials and Methods: A total of 51 final-year physiotherapy students were randomly selected and allocated into two groups. Group A (n=25) includes didactic with PowerPoint presentation teaching session. Group B (n=26) includes simulated-based teaching sessions. There were eight simulators selected and trained for the Ranchos Los Amigos stages. The students were assessed using a self-designed pre-post multiple-choice questions (MCQ) test for knowledge and a clinical evaluation exercise for affective and psychomotor skills.&#x0D; Results: This study showed that group B significantly improved in the pre-post self-made MCQ test (t=17.34, P=0.00), and in the clinical evaluation exercise, group B performed 43.66% better than group A.&#x0D; Conclusion: The study concludes that simulation-based teaching significantly improves cognitive, affective, and psychomotor skills compared to traditional methods for traumatic brain injury topics framed for final-year physiotherapy students.

How COVID-19 pandemic affected clinical exposure of final year medical students: A comparison study of portfolio assessments

Background and Objective COVID-19 restrictions had a major impact on the academic sector globally. The aim of this study was to compare the clinical exposure of final year medical students at the professorial unit of Obstetrics and Gynaecology of Colombo South Teaching Hospital during the COVID-19 pandemic with those who attended clinical training prior to the pandemic. Methods Systematic sampling of 66 medical students belonging to two clinical groups, who had completed their professorial Obstetrics and Gynaecology appointment during the pandemic, was done, using their student portfolios recording the clinical skills and procedures performed during the appointment. The pre-COVID-19 data were gathered from a previous study carried out in the same unit in 2018. Results Most students managed to complete both the Gynaecological and the Obstetrics Mini–Clinical Evaluation Exercise (62.1% and 56.1% respectively) but, compared to the pre-pandemic era, a higher percentage presented only one case or none. All students completed the Objective Structured Assessment of Technical Skills in episiotomy suturing (100%) and a majority (90.9%) performed artificial rupture of membranes (ARM). However, only 36.4% had the opportunity to perform a PAP smear independently. Majority (95.1%) of the cases were presented to the registrars attached to the unit while only a minority was evaluated by a consultant (3.8%). The Obstetric and Gynaecological clinical procedures and skill acquisition showed slightly lower percentages than in the pre-COVID-19 period with the means and the medians lying in between the 1st and 2nd quartiles of the distribution. Conclusion On average, there was a slight decrease in the clinical exposure to procedures and skills during the COVID-19 outbreak compared to the non-COVID-19 period. Additionally, the opportunity of the medical students to be supervised by a consultant Obstetrician and Gynaecologist reduced drastically during the pandemic.

Actividad científica sobre Mini-Clinical Evaluation Exercise (mini-CEX) en áreas de ciencias de la salud: un estudio bibliométrico

IntroductionThe Mini Clinical Evaluation Exercise is an educational tool that allows the evaluation of various clinical competencies and work scenarios. The aim of this study was to analyze the bibliometric characteristics and impact of the scientific production of Mini-Clinical Evaluation Exercise (mini-CEX) in the health sciences. MethodsBibliometric study whose search source was Scopus, the query was performed on May 8, 2023, considering a search strategy consisting of Boolean operators and key terms. The SciVal tool and the RStudio Bibliometrix module were used to estimate and visualize the bibliometric parameters. ResultsWeller and Chen were representative authors and showed dissemination connections with the main countries (Australia and China). The journal Education for Primary Care (Q2) was the most productive. Among the subcategories, General Medicine (34 publications) and Anaesthesiology and Pain Medicine (21.1 citations per publication) had more publications and higher impact, respectively. Most manuscripts are published in Q3 quartile journals (30.9%), followed by Q1 quartile (25.5%); moreover, in the period 2017 to 2021 there was an increase in publications (50 articles). Publications with institutional were more frequent, but those with international collaboration had more citations per publication. ConclusionsIn the last five years there is an increase in the number of published research on mini-CEX, and the main journal for dissemination was Education for Primary Care. National and institutional collaboration were the most frequent; in addition, Australia, China and the United States led the scientific activity in this field.

A Novel Video-Based Skills Curriculum for Incoming Ophthalmology Residents

ABSTRACT Background Given limited pre-residency ophthalmology exposure, skill training for PGY-2 ophthalmology residents is essential. However, orientation experiences vary, and skills acquisition is often not measured. Objective A novel video-based orientation curriculum was developed and implemented to standardize and effectively teach ophthalmic examination skills to incoming ophthalmology residents. Methods An instructional video library (VL) on ophthalmic exam skills was created in 2020. Prior to any instruction, PGY2s were recorded performing basic ophthalmic exams (BOE) using slit-lamp recording smartphone adapters. After a 2-week orientation involving live teaching, practice, and self-directed library review, ophthalmic exams were again recorded. A 36-point ophthalmic exam skills checklist expanding upon the Ophthalmic Clinical Evaluation Exercise (OCEX) was developed for scoring videos. Residents also completed pre- and post- surveys assessing their comfort with the ophthalmic exam. Result 7 of 11 incoming PGY-2 residents (63.7%) ophthalmology residents participated. Average recorded OCEX score improved from 16.5 ± 5.8 to (p = .0002) to 30.9 ± 2.7. Surveyed resident comfort with the exam increased from 2.4 ± 0.6 to 4.2 ± 0.5 on a 5-point Likert scale (p < .0001). Conclusion Our video library orientation curriculum was effective in rapidly increasing resident comfort and BOE skills. With the launch of the integrated internship model, the VL curriculum may be effective for training ophthalmology PGY1s, medical students and non-ophthalmology providers.

The relation between left atrial and left ventricular size in a healthy population

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): The project was funded by grants from The Liaison Committee for Education, Research and Innovation in Central Norway, St. Olavs University Hospital (Trondheim, Norway), Nord-Trøndelag Hospital Trust (Levanger, Norway), and Simon Fougner Hartmann's Family Fund (Copenhagen, Denmark). Background The left atrium (LA) and ventricle (LV) are closely linked and adapt to meet metabolic demands. Reduced LV end-diastolic volume (LVEDV) and increased LA end-systolic volume (LAESV) is common in patients with diastolic dysfunction and with higher age. The remodeling of LA and LV in response to endurance exercise is thought to be balanced, and thus, the LA:LV ratio could help discriminate pathologic from physiologic LA enlargement. Purpose We aimed to describe the relative LA and LV chamber remodeling associated with the clinical characteristics age, sex, maximal oxygen consumption (VO2peak), HbA1C, body mass index, systolic blood pressure, and diastolic dysfunction. Methods Healthy participants included in a large longitudinal population study underwent clinical evaluation and cardiopulmonary exercise testing (CPET) in 2006–2008, followed by comprehensive echocardiography and CPET in 2017–18. Exclusion criteria were: 1) submaximal performance during CPET, 2) atrial fibrillation, or 3) presence of heart failure or a history of myocardial infarction. All examinations were performed by highly experienced personnel. All echocardiographic exams and analyses were performed by personnel affiliated a European Association of Cardiovascular Imaging accredited echo-laboratory. Results In total, 1,349 participants were included. Mean (SD) age was 58 (12) years, and 52% were women. The LA:LV ratio was higher with higher age due to lower LVEDV and stable LAESV (Figure 1). Age alone explained 12% (p&amp;lt;0.001) of variance for the LA:LV ratio and men had higher LA:LV ratios than women (0.55 vs. 0.50, p &amp;lt;0.001). All examined clinical characteristics showed significant associations with LA:LV ratios in univariate regression analyses. In adjusted analyses, increased VO2peak was significantly associated with increased LA:LV ratio, but with a small effect-size without clinical significance. In the subsample with indexed LAESV &amp;gt;34mL/m2, increased VO2peak was significantly associated with increased LA:LV-ratio in adjusted analyses (p &amp;lt;0.001). Ten-year change in VO2peak was not significantly associated with LA:LV ratio in adjusted models for the total population, nor in the subgroup with indexed LAESV &amp;gt;34 mL (p = 0.181). Multiple logistic regression showed that higher LA:LV ratio was associated with increased risk of diastolic dysfunction with an OR (95% CI) of 2.4 (1.5, 4.0) per SD increase in LA:LV-ratio, adjusted for age, sex, systolic blood pressure, HbA1c, and BMI (p &amp;lt; 0.001). LA strain measures, E/e’ ratio, and TR velocity were significantly associated with the LA:LV ratio, while other diastolic function parameters were not. Conclusion The LA:LV ratio increases with higher age due to reduced LVEDV and stable LAESV. VO2peak was not a robust predictor of LA:LV ratio in this population. Future studies should evaluate the relative remodeling of LA and LV with repeated measurements of echocardiographic indices and CPET to better define the role of this ratio.

Feasibility of Implementing Mini-Clinical Evaluation Exercise (Mini-CEX) as a Formative Assessment Tool in Postgraduate Surgical Training

Background: Mini-CEX (Mini Clinical Evaluation Exercise) is extensively used in the west as a Workplace-based Assessment (WPBA) tool. However, its utility remains an infrequent in postgraduate medical training in Pakistan. Methods: Forty-eight mini-CEX sessions involving 11 faculty members and 15 postgraduate trainees were conducted over a 3‐month study period. Standardized American Board of Internal Medicine Mini‐CEX evaluation form was used to evaluate the students. The faculty and trainees were asked to provide feedback for these sessions on questionnaires consisting of close‐ and open‐ended questions. Results: Faculty satisfaction with mini-CEX was high, with all agreeing that it was an appropriate method of trainees’ assessment and teaching, and that it should be included in the curriculum. However, two-third of the faculty felt that it was not possible to assess students through mini-CEX more frequently. All trainees agreed that the sessions made them aware of their weaknesses and strengths. However, majority (73.3) complained that they were not given a chance to give reflection on their performance during the feedback session. Both residents and faculty suggested to incorporate Mini‐CEX in curriculum. Conclusion: It is feasible to use mini‐CEX for formative assessment of residents. Keywords: Workplace-based assessment, mini-clinical evaluation exercise, feedback

Introduction of Mini Clinical Evaluation Exercise as an Assessment Tool for M.B.B.S. Interns in the Department of Orthopaedics.

Mini-CEX helps in judicious use of competencies in authentic settings by simultaneously assessing clinical skills of trainees and providing feedback on their performance. As assessment of M.B.B.S. Interns for their competency in clinical examination skills in Department of Orthopaedics is lacking, this study is taken up to introduce Mini-CEX for M.B.B.S. Interns, by sensitising faculty and interns. A Quasi-experimental study was conducted during June to December 2020, among 60 interns posted in the Department of Orthopaedics. After obtaining IEC Clearance and written informed consent from the study participants, they were sensitised and exposed to five Mini-CEX clinical encounters involving examination of a patient with knee/other joint disorder in the Outpatient/Inpatient clinical setting, with eight faculty. The study tool used was Mini-CEX questionnaire developed by American Board of Internal Medicine (ABIM). Case specific feedback was provided to interns using sandwich technique. The reflections and perceptions of interns and faculty were obtained after completion of all Mini-CEX encounters. 96.7% encounters were conducted in OPD during first encounter. On an average, one Mini-CEX encounter lasted for 17min. Interns had an overall score for the various domains ranging from 5.38 to 5.58. Comparison of mean scores showed a statistically significant improvement (p value < 0.0001). All the assessors were satisfied with Mini-CEX as an assessment tool. Interns and faculty opined that Mini-CEX improves clinical examination skills and professional development as focus is on the outcome and learning process, with multiple sampling in a longitudinal manner.

Effect of concurrent training in unilateral transtibial amputees using Paralympic athletes as a control group

ContextTranstibial Amputation (TA) predisposes to a sedentary lifestyle. ObjectivesTo evaluate the efficiency of a short-term (8-week) Concurrent Training (CT) program in Unilateral Transtibial Amputees (UTA) and to compare it with the physical condition of a group of Paralympic athletes in preparation for the Rio de Janeiro Paralympics. DesignThis was a longitudinal, prospective and controlled trial study. MethodsThirty-four male subjects with UTA and using prostheses for six months or more were selected for this study. They were divided into two groups: Group 1 (G1) ‒ 17 non-athlete and untrained UTA and Group 2 (G2) ‒ 17 paralympic athletes with active UTA in the training phase. G1 was evaluated before and after eight weeks of CT and G2 made a single evaluation for control. All were submitted to anamnesis, clinical evaluation (blood pressure, electrocardiogram, and heart rate) and cardiopulmonary exercise testing on a lower limb cycle ergometer, and isokinetic knee dynamometry. The CT of G1 included resistance exercise and aerobic interval training on a stationary bicycle and G2 followed the training of the Paralympic teams. ResultsPatients were retested by the same methods after CT. The two most important central dependent variables (maximal oxygen uptake and muscular strength) increased by 22% and knee extensor and flexor strength by 106% and 97%, respectively. ConclusionAfter eight weeks of CT, there was an improvement in general functional condition, muscle strength, and cardiorespiratory performance improving protection against chronic diseases and quality of life.

A novel strategy combining Mini-CEX and OSCE to assess standardized training of professional postgraduates in department of prosthodontics

ObjectiveMini clinical evaluation exercise (mini-CEX) and objective structured clinical examination (OSCE) are widely acknowledged as effective measures of resident standardization training (RST) in European and American countries. However, in China primary mini-CEX and OSCE forms are mainly limited in undergraduate clinical examination. Little knowledge is available regarding the validity and right way of mini-CEX /OSCE evaluation system in advanced dental clinical education so far. This study aimed to explore whether combination of mini-CEX and OSCE represents a global-dimension assessment for postgraduate clinical competence in RST.MethodsPostgraduates who received RST from June 2017 to June 2019 were selected and evaluated by modified mini-CEX/OSCE scales. Each student received evaluations at least twice in the initial and final stages of training (tested every 4 months). A questionnaire was conducted to investigate the satisfaction with the arrangement of RST.ResultsMini-CEX/OSCE test results indicated that postgraduates have significantly improved their comprehensive competence in RST projects in the department of prosthodontics (P < 0.05). Compared to other master of Stomatology students, postgraduates taking up prosthodontics master’s degree have made more progresses through a training period of up to 1 year and four sessions of face-to-face feedback tutoring (P < 0.05). Survey results revealed high level of satisfaction on clinical practice evaluation.ConclusionModified mini-CEX/OSCE combined evaluation system is an effective and reliable assessment tool for clinical comprehensive ability in the RST of professional graduates and can fully highlight their respective advantages on the improvement of students’ clinical competency, especially after several rounds of assessments.

Haemodynamic forces as predictors of cardiac remodelling and outcome in heart failure with reduced ejection fraction treated with sacubitril/valsartan

Abstract Background Angiotensin receptor-neprilysin inhibitor (ARNI) is a cornerstone of treatment in heart failure (HF) with reduced ejection fraction (HFrEF), but its effectiveness shows interindividual differences. Objectives To evaluate the predictive value of echo-derived hemodynamic forces (HDF), together with other echocardiographic, biohumoral and cardiopulmonary parameters on a) response to ARNI after 6 months; b) adverse cardiovascular events at follow-up. Methods Eighty-nine consecutive HFrEF patients from two HF centers performed clinical evaluation, laboratory analyses, rest echocardiography and cardiopulmonary exercise testing. Response to ARNI at 6 months was considered in patients without HF admissions, death, or urgent heart transplant and with a ≥50% reduction in NT-proBNP levels and/or ≥10% increase in left ventricle ejection fraction. After 6 months, patients were followed up for a composite endpoint of cardiovascular death, HF-related hospitalization and new-onset atrial fibrillation. Results Response to ARNI was documented in 45/89 (51%) of patients. At baseline, responders and non-responders were paired in clinical assessment, conventional echocardiography, functional status and therapy. At multivariate logistic regression analysis, HDF-derived whole cardiac cycle left ventricle strength (wLVS) was the only independent predictor of ARNI response at 6 months (odds ratio 1.36, 95% confidence interval 1.10–1.67; p=0.004). A wLVS ≥3.7% showed a good accuracy in predicting ARNI response (AUC = 0.736, 0.607–0.840; p&amp;lt;0.0001). During a median of 33 (IQR 23–41) months, wLVS increase from baseline to 6-month (ΔwLVS) showed a high discrimination ability at time-dependent ROC analysis (optimal cut-off: ≤0.5%; AUC=0.811, 0.69–0.90; p&amp;lt;0.0001), stratified prognosis at Kaplan-Meier analysis (log-rank p&amp;lt;0.0001), and remained an independent prognostic predictor of the composite endpoint (hazard ratio 0.76, 0.61–0.95; p&amp;lt;0.01) even after adjusting for clinical, functional and conventional echocardiographic parameters. Conclusions HDF analysis may help predict ARNI response and optimize follow-up and medical/device strategies in patients with HfrEF. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Fondazione Toscana Gabriele Monasterio, Pisa, Italy

Mini Clinical Evaluation Exercises (mini CEX) as Formative Assessment Tool in Pediatric Postgraduate Education

Background: Although there is an increasing emphasis on workplace-based assessment (WPBA) during postgraduate medical education, the current assessment relies mainly on summative assessment. Formative assessment is less valued and done only to fulfill regulatory requirements. Various methods have been described for WPBA; mini-clinical evaluation exercise (mini-CEX) is one of them. Mini-CEX is incorporated well in Western countries, but in India, it is rarely used. Aim and Objectives: The objective is to assess acceptability and feasibility of Mini-CEX as a formative assessment tool during pediatric postgraduation. Methodology: Twenty-one postgraduates and 10 faculty participated in the study. A total of 93 sessions were conducted, 65 with 3rd year and 28 with 2nd year residents. The perception of faculty and students about feasibility and acceptability was taken by a prevalidated questionnaire based on the Likert scale. Epi-Info 7.2.2.6 was used for data analysis. Percentage, ratio, mean, and median were calculated. The qualitative data were pooled, and conclusions were derived. Results: Ninety percent of faculty agreed mini-CEX can be adopted as a formative assessment tool, it is feasible with current time limit and existing faculties. Ninety percent of faculty opined that mini-CEX will not have an adverse impact on current teaching–learning and assessment activity and it had a positive impact on their attitude toward postgraduate teaching. 70% of residents found that it is a useful method. Conclusions: Mini-CEX is a useful formative assessment tool, feasible and can be adopted in postgraduate medical education.

Perception and Satisfaction of Undergraduate Medical Students of the Mini Clinical Evaluation Exercise Implementation in Orthopedic Outpatient Setting.

PurposeThe Mini Clinical Evaluation Exercise (mini-CEX) is a brief and direct observational assessment of trainee-patient interactions that helps to assess several clinical domains. There is limited evidence of mini-CEX implementation in orthopedics and undergraduate perceptions toward such an approach. This study investigated the perception of mini-CEX among undergraduate medical students through a questionnaire-based survey in an orthopedic outpatient setting.Patients and MethodsUndergraduate medical students completing their orthopedic clinical posting were invited to participate in an anonymous, self-administered questionnaire written in English to evaluate their perceptions toward mini-CEX implementation in the orthopedic outpatient setting for the 2016–2017 academic session. The questionnaire comprised 28 closed-ended questions with a five-point Likert rating-scale, and five open-ended questions. The survey responses were analyzed for reliability, validity, and quantitative and qualitative analyses.ResultsA total of 350 students completed the questionnaire; the questionnaire was proven to be valid and reliable. The closed-ended questions were designed to assess the knowledge of the mini-CEX as an assessment tool. The participants demonstrated a satisfactory understanding of the mini-CEX methodology, purpose, clarity, comprehensiveness, and as a self-assessment tool for undergraduate medical students. Instructor support for the implementation of mini-CEX appeared inadequate and was rated with non-confidence among most students. Most participants appreciated better clinical skills, which was reflected through improvements in clinical exam preparation, the Objective Structured Clinical Examination, and clinical judgment.ConclusionUndergraduate medical students perceived the mini-CEX as an effective tool for clinical teaching in an outpatient orthopedic setting. However, most students indicated suboptimal instructor involvement in the teaching and assessment process; this raises concerns regarding inadequate direct observation and limited feedback for student performance. Additional measures are needed to ensure high quality clinical encounters, teacher training, integration with other assessment tools, and standardized coverage mini-CEX implementation in orthopedics.

Assessment of the Performance of Orthopedic Residents in Clinical Practice.

Objective To evaluate the performance of orthopedic residents while conducting clinical examinations. Methods The Mini Clinical Evaluation Exercise (Mini-CEX) was applied by three teaching doctors at four different moments. The instrument was adapted by the authors for use in orthopedics, with the development of descriptors for each evaluated skill. Supervisors were trained to use the Mini-CEX by the principal investigator through teaching materials and discussions, with standardization of the instrument descriptors. Results The mean scores obtained in the 4 evaluations for each of the 21 residents reveal improvement in the performances of residents in all skills assessed from the 1 st to the 4 th meeting. Conclusions We have found that the performance of orthopedic residents presented a satisfactory evolution, with progressive improvement in all skills.

The Impact of Electronic Handoff Tool on Sign-Out Practices in an Internal Medicine Residency Program.

High-quality and efficient sign-outs are essential to ensure patient safety. To evaluate the impact of a new handoff tool by objective measures of handoff quality and residents' subjective experiences. Internal medicine residents working on a medical ward service completed a handoff clinical evaluation exercise (CEX) questionnaire and an anonymous survey on handoff quality and experiences prior to implementing a new handoff tool and at 2 and 6 weeks after implementation. CEX scores significantly improved from 5.3 ± 1.1 to 6.9 ± 0.7 in 6 weeks ( P < 0.05). Residents reported that they were contacted less frequently after work, information needed by the receiving resident was more often found in the sign-out, and that tasks signed out to the oncoming team were more often executed. Before implementing the new handoff tool, 87% of residents reported that they were contacted after work hours 1-2 times per week with questions, while 75% of participants reported that they were almost never contacted after work hours after the new tool was implemented. A standardized handoff tool that utilizes smart phrases to provide residents with templates for sign-out significantly improved the quality and experience of sign-out in a short time period.

Evolution of Post Graduate Curricula in Pakistan

Evolution of Post Graduate Curricula in Pakistan

Strain and Myocardial Work Index during Echo Exercise to Evaluate Myocardial Function in Athletes.

The aim of the study was to evaluate the application of global longitudinal strain (GLS) and myocardial work (MW) at rest and during exercise in healthy sedentary or trained participants, to test their ability to improve echocardiographic information and to complement prescribing exercise, cardiac screening, or rehabilitation programs.Methods:Thirty healthy males were divided into three groups of 10, sedentary (G1), resistance (G2) and power (G3) athletes, underwent a standard clinical evaluation protocol and exercise stress testing echocardiography.Results:During stress, all showed increased left ventricular ejection fraction and mitral annulus tissue Doppler (E'). G1 showed a decrease in left atrial volume (LAVi) as opposed to an increase in G3. E/E 'a decrease in G2, unlike the increase in G3. All groups showed increase of Strain (GLS average AV, Longitudinal LS, Medio-Basal MB Apical AP), global constructive work (GCW), and Global wasted work. G1 showed increase for global work efficiency, G2 and G3 for global work index (GWI). G3 showed a greater variation of E/E', LAVi, GWI and GCW compared to G1 and G2, greater of GLS AV, LS-AP compared to G2. Only G3 showed differences for GLS AV versus LS-AP. The relative regional strain ratio showed a greater value in G3 versus G1 at the end of stress compared to rest.Conclusions:The new echocardiographic applications to study the physiological adaptation could open new perspectives for the diagnostic and therapeutic development through the prescription of personalized exercises and screening and follow-up of the early pathological changes of the athlete's heart.