Clinical Evaluation Exercise Research Articles

MiniCex as an Assessment Tool of a Medical Course Internship Program

Abstract: Introduction: Program assessment is the process of data collection about a course or teaching program that takes into consideration the aspects of cost-effectiveness, checking the adequacy of the evaluation according to the course purpose and the program capacity to yield changes in real life. Such regular assessments provide feedback to the decision-making process that aim at better teaching and learning practices. The Mini Clinical Evaluation Exercise (MiniCex) is a performance rating scale designed to assess the skills that medical students and residents need in real-life situations with patients. Considering the importance of program assessment for an institution, the utilization of the MiniCex data might be of great value for the follow-up of students and the course, helping the planning process and generating improvements in the institution. Therefore, the objective of this study is to assess the program using MiniCex in the beginning of the medical internship, aiming to determine in what areas of the basic and pre-clinical course the students have more difficulties. Methods: A cross-sectional descriptive study was carried out, using the retrospective data obtained by the MiniCex forms that were applied to the 9th-semester medical students, which correspond to the first semester of medical internship in the Federal University of Pará. A total of 111 students was assessed, among the 154 students eligible for internship, from August 2017 to July 2018. Results: Among the performed evaluations, with 97% being requested by the teachers, most of them (72%) were about new cases, and 45% and 38% had low or moderate complexity, respectively. There was a predominance of musculoskeletal system disorders (27.7%), followed by the gastrointestinal/hepatology system (14.8%). Concerning the skills in each domain, the performance was satisfactory in all of them. We observed that 12% of the students had difficulties in at least one area, followed by 6.3% of students with difficulties in 2 areas and 4.5% with an unsatisfactory performance in 3 or more areas. Conclusion: the MiniCex, when applied to internship students, showed to be a source of important and useful information, as part of a program assessment concerning the areas preceding the internship. The analysis of the obtained data was sent to teachers of the pre-internship, internship and course management areas. To the first ones, with the objective of reviewing their programs, detecting where they can intervene and, thus, make changes that aim a better acquisition of basic knowledge by the students and, consequently, improve their performance. To the second ones, to provide an overview of where they will have to focus their programs according to the needs of the medical students who reach the internship. Finally, to the course management, as a guide of what should be supervised by the professionals teaching the semesters that precede the internship.

Feasibility of an ethics and professionalism curriculum for faculty in obstetrics and gynecology: a pilot study

ObjectiveThere have been increased efforts to implement medical ethics curricula at the student and resident levels; however, practising physicians are often left unconsidered. Therefore, we sought to pilot an ethics...

Aplicação do Método de Avaliação 360º em Residentes Médicos de Ginecologia e Obstetrícia

Objetivo: Implementar a avaliação 360º no Programa de Residência Médica em Obstetrícia e Ginecologia de um Hospital de Referência em Obstétrica e Ginecologia, localizado em Belém-PA. Métodos: Pesquisa de caráter exploratório, descritivo, com abordagem quantitativa. Foi desenvolvida nos cenários reais de prática dos médicos residentes e abrangeu todos os setores da tocoginecologia de um hospital de referência em procedimentos obstétricos e ginecológicos, localizado em Belém/PA. Os residentes e preceptores receberam capacitação in loco para participação no estudo. Foi definido como instrumento de avaliação 4 questionários: o Mini Clinical Evaluation Exercise (Mini-CEx), o qual foi utilizado pelos preceptores, além de instrumentos avaliativos do American Board Internal Medicine, que foram utilizados na avaliação pelos pares, pacientes e autoavaliação. Resultados: Foi aplicado um quantitativo total de 92 questionários, sendo 4 tipos diferentes para cada residente, o qual foi possível observar durante uma consulta a sua autoavaliação, a avaliações dos pares, avaliação do preceptor e a avaliação da paciente. Conclusão: Espera-se que esse estudo possa contribuir para futuras possibilidades de ampliação do processo de avaliação dos residentes.

Impact of introduction of Mini-Clinical Evaluation Exercise in formative assessment of undergraduate medical students in pediatrics

Background: Student’s assessment is a systemic process of determining the extent to which the student has achieved the desired competency. Mini–Clinical Evaluation Exercise (Mini-CEX) is an assessment tool applicable in broad range of settings. Very little data is available in Indian settings about Mini-CEX in undergraduate. This study has been undertaken to understand its role in formative assessment.Methods: In this interventional study 47 students and 7 faculty of pediatrics participated. Students were assessed for two encounters of Mini-CEX. Assessment was as per Mini-CEX rating form followed by feedback.Results: Mean score range for different competency of data gathering were 1.76 to 2.5 during first mini-CEX and 4.38 to 5.14 during second Mini-CEX. Difference was significant (Cohen’s d >0.8). More than 90% of students felt that Mini-CEX is better way to assess clinical skills and would like to be assessed by Mini-CEX. One to one interaction was most important advantage felt about Mini-CEX. Though nearly all faculties felt that Mini-CEX is a better way for assessment half of them disagree to continue using it in future due to time constraints.Conclusions: In this study we found Impact of Mini-CEX in formative assessment is significant to improve clinical competency at undergraduate level. Improvement in Mini-CEX scores in consecutive encounter signifies its role even as Teaching Learning tool. Need to consider issues about its feasibility for Undergraduate level in settings with limited staff strength.

P325Incremental value of left atrial strain in predicting atrial fibrillation in heart failure with preserved ejection fraction

Abstract Atrial fibrillation (AF) is a frequent comorbidity in heart failure with preserved ejection fraction (HFpEF), worsening the clinical course. Although various contributors to the development of AF have been identified, effective screening strategies to prevent this arrhythmia are ill-defined. Aim To investigate the factors associated with incident AF in a well-characterized HFpEF population, with special focus on left atrial (LA) strain. Methods 170 pts with symptomatic HFpEF (mean age 65±8 yrs), free of baseline AF, underwent clinical evaluation, echocardiography and cardiopulmonary exercise testing. AF was diagnosed by clinical review, standard ECG, and single lead portable ECG monitoring. Results Over a median follow-up of 49 months, incident AF was identified in 39/170 pts (23%). Pts who developed AF were older, had higher clinical risk scores, BNP, creatinine, LA volume index (LAVI), LV mass, lower LA strain, exercise capacity, and more impaired LV diastolic function. The highest areas under ROC curves for AF prediction were for peak-atrial contraction strain (PACS; 0.76), total peak-atrial longitudinal strain (PALS; 0.71) and LAVI (0.72). Nested Cox regression models showed that the predictive value of LA strain was independent from and incremental to clinical data, LAVI and E/e' ratio estimating LV filling pressure (Figure). Addition of total PALS to the model including CHA2DS2VASc score, LAVI and E/e' improved classification by 37% (p=0.04), and subsequent addition of PACS improved classification by 54% (p=0.003). Figure 1 Conclusions LA strain, especially PACS, provides incremental predictive information about incident AF in HFpEF. The inclusion of LA strain to the diagnostic algorithm may help guide screening for AF risk in this population.

Telemedicine for Interfacility Nurse Handoffs.

To compare nurse preparedness and quality of patient handoff during interfacility transfers from a pretransfer emergency department to a PICU when conducted over telemedicine versus telephone. Cross-sectional nurse survey linked with patient electronic medical record data using multivariable, multilevel analysis. Tertiary PICU within an academic children's hospital. PICU nurses who received a patient handoff between October 2017 and July 2018. None. Among 239 eligible transfers, 106 surveys were completed by 55 nurses (44% survey response rate). Telemedicine was used for 30 handoffs (28%), and telephone was used for 76 handoffs (72%). Patients were comparable with respect to age, sex, race, primary spoken language, and insurance, but handoffs conducted over telemedicine involved patients with higher illness severity as measured by the Pediatric Risk of Mortality III score (4.4 vs 1.9; p = 0.05). After adjusting for Pediatric Risk of Mortality III score, survey recall time, and residual clustering by nurse, receiving nurses reported higher preparedness (measured on a five-point adjectival scale) following telemedicine handoffs compared with telephone handoffs (3.4 vs 3.1; p = 0.02). There were no statistically significant differences in both bivariable and multivariable analyses of handoff quality as measured by the Handoff Clinical Evaluation Exercise. Handoffs using telemedicine were associated with increased number of Illness severity, Patient summary, Action list, Situation awareness and contingency planning, Synthesis by receiver components (3.3 vs 2.8; p = 0.04), but this difference was not significant in the adjusted analysis (3.1 vs 2.9; p = 0.55). Telemedicine is feasible for nurse-to-nurse handoffs of critically ill patients between pretransfer and receiving facilities and may be associated with increased perceived and objective nurse preparedness upon patient arrival. Additional research is needed to demonstrate that telemedicine during nurse handoffs improves communication, decreases preventable adverse events, and impacts family and provider satisfaction.

Clinical evaluation exercises and direct observation of surgical skills in ophthalmology

Ophthalmology residency training programs need authentic methods of assessment to show that trainees have learned and can do what is expected upon graduation. Written and oral examinations are necessary to assess knowledge but other methods are needed to assess skill. Workplace-based assessments (WPBAs) should be utilized to observe resident skill in the clinic and during surgery. Several such assessment tools have been published and validated. These tools have the additional benefit of facilitating specific formative feedback and thus can be used for both teaching and assessing.

Construction of a standardized training evaluation system for novice nurses based on mini clinical evaluation exercise

Objective To establish a standardized training evaluation system for novice nurses based on Mini Clinical Evaluation Exercise (Mini-CEX) for the development of the novice nurses. Methods The initial framework of the evaluation system based on Mini-CEX was established through literature review and topic group discussion. From March to April of 2018, by Delphi expert consultation, the weight of each indicators were determined through 2 rounds of expert consultation and Analytic Hierarchy Process. Results The effective recovery rate of questionnaires in two rounds were 100% and 98.33%. The expert authority coefficients (Cr) of the two experts were 0.86 and 0.88. A standardized training evaluation system for novice nurses based on Mini-CEX was established which includes 8 first-level dimensions and 66 subclauses. Conclusions The standardized training evaluation system for novice nurses based on Mini-CEX built through Delphi expert consultation is scientific and reliable, and can provide evidence for the evaluation method of standardized training for novice nurses in China. Key words: Nurses; Mini Clinical Evaluation Exercise; Standardized training; Evaluation system; Delphi method

Deliberations on the contemporary assessment system

Deliberations on the contemporary assessment system

Workplace Based Assessment in Obstetrics and Gynecology Clerkship to Detect Learning Gaps

ABSTRACT Background An outcome-based curriculum helps to communicate expectations of performance to students and clinical teachers. The Mini Clinical Evaluation Exercise (mini-CEX) is a useful tool for workplace-based formative assessment. The objective of this study was to use workplace-based assessment and student feedback to evaluate an Obstetrics and Gynecology (Ob&Gyn) clerkship curriculum. Methods A cross-sectional study was conducted with faculty members and medical students in an Ob&Gyn clerkship. The Mini-CEX was introduced into the clerkship assessment system, together with multiple choice question (MCQ) tests. This tool evaluates the history collection, physical examination, clinical judgment, professionalism and humanism, and also gives an overall score at the end of the test. At the end of the rotation, questionnaires were used to collect the students’ perceptions about their skills acquisition during the program. The results of the Mini-CEX, the MCQ test, and questionnaire responses were compared, to determine the extent to which learning objectives were achieved. Results three faculty members assessed 84 medical students using the mini-CEX during the four-month clerkship. The scores for the physical examination and clinical judgment skills were lower, compared to those of the interviewing skills. Based on the students’ feedback, ratings for physical examination and counseling preparation were rated as “inadequate”, especially for the topic breaking bad news. The bivariate correlation between the mini-CEX skills and MCQ test scores showed a positive relationship (r = 0.27). Although they assess different skills on the Muller pyramid, there appears to be a relationship between “Knowing” and “Doing”. These findings will help curriculum managers to identify important gaps in the rotation design and delivery. Based on these results, training in the skills workshop during the first month of the rotation was initiated, in addition to previous simulated training during the third year of medical course. Conclusions The introduction of the mini-CEX offers critical information to identify and refine important curriculum elements in the clinical years. Based on this, physical examination and communications skills training were initiated in the skills workshop.

Examining the nature of feedback within the Mini Clinical Evaluation Exercise (Mini-CEX): an analysis of 1427 Mini-CEX assessment forms.

Background: Despite the growing use, studies have demonstrated some limitations related to the feedback provided in the context of the increasing use of the Mini Clinical Evaluation Exercise (Mini-CEX) in undergraduate medical education. This study examined the written feedback provided on the Mini-CEX form to determine its usefulness as a learning tool for students.Methods: 1427 Mini-CEX assessment forms of final year medical students were collected. Written feedback, both on students’ strength and weakness, was categorized and correlated with the variables of clinical case complexity, assessors’ clinical position and students’ clinical performance rating. Results: The number of general feedback comments for students’ strengths and development were 953 (65.3%) and 604 (38.64%) respectively. Less than 30% of the feedback for each domain was categorized as specific feedback. Significant associations were found between feedback on strength and clinical case complexity (Χ2=17.48, p<.01); and also with assessor clinical position (Χ2=37.10, p<.01). There was also an association between feedback for students’ development and assessor clinical position (Χ2=27.22, p<.01).Conclusion: Based on the Mini-CEX forms of student cohort this study examined, it can be concluded that the written feedback provided in the Mini-CEX assessment form was general and lacked specificity. This finding leads to the need to train clinical teachers in the provision of feedback.

The educational impact of Mini-Clinical Evaluation Exercise (Mini-CEX) and Direct Observation of Procedural Skills (DOPS) and its association with implementation: A systematic review and meta-analysis.

IntroductionMini Clinical Evaluation Exercise (Mini-CEX) and Direct Observation of Procedural Skills (DOPS) are used as formative assessments worldwide. Since an up-to-date comprehensive synthesis of the educational impact of Mini-CEX and DOPS is lacking, we performed a systematic review. Moreover, as the educational impact might be influenced by characteristics of the setting in which Mini-CEX and DOPS take place or their implementation status, we additionally investigated these potential influences.MethodsWe searched Scopus, Web of Science, and Ovid, including All Ovid Journals, Embase, ERIC, Ovid MEDLINE(R), and PsycINFO, for original research articles investigating the educational impact of Mini-CEX and DOPS on undergraduate and postgraduate trainees from all health professions, published in English or German from 1995 to 2016. Educational impact was operationalized and classified using Barr’s adaptation of Kirkpatrick’s four-level model. Where applicable, outcomes were pooled in meta-analyses, separately for Mini-CEX and DOPS. To examine potential influences, we used Fisher’s exact test for count data.ResultsWe identified 26 articles demonstrating heterogeneous effects of Mini-CEX and DOPS on learners’ reactions (Kirkpatrick Level 1) and positive effects of Mini-CEX and DOPS on trainees’ performance (Kirkpatrick Level 2b; Mini-CEX: standardized mean difference (SMD) = 0.26, p = 0.014; DOPS: SMD = 3.33, p<0.001). No studies were found on higher Kirkpatrick levels. Regarding potential influences, we found two implementation characteristics, “quality” and “participant responsiveness”, to be associated with the educational impact.ConclusionsDespite the limited evidence, the meta-analyses demonstrated positive effects of Mini-CEX and DOPS on trainee performance. Additionally, we revealed implementation characteristics to be associated with the educational impact. Hence, we assume that considering implementation characteristics could increase the educational impact of Mini-CEX and DOPS.

The Effectiviness of Mini-Cex Towards Clinical Competency Achievement in Neurological Examination of Clinical Practice Nursing Students

Introduction: Mini-CEX (Mini Clinical Evaluation Exercise) is a method of evaluation to assess the clinical skills of students through direct observation and provide constructive feedback. The aim of this study was to evaluate the effectiveness of Mini-CEX towards clinical competency achievement in neurological examination of clinical practice nursing students at General Hospital Medan.Methods: The research design was quasi experiment with the post-test only with control group approach. The samples were 60 respondents who divided into two groups: 27 respondents in the control group, and 33 respondents in the intervention group. Samples were chosen using the total sampling method.This study used the Mini-CEX to evaluate competency of nursing students and firstly developed in Indonesian by Nursing Study Program in Muhammadiyah University of Yogyakarta. The data were analyzed by descriptive and Mann Whitney test.Results :The study showed that mean score of neurological examination competence in the intervention group (77±8.33) was higher than the control group (68.19 ±7.53). There were significant differences of the clinical competency between two groups of samples with p value 0.000 (p&lt;0.05). Conclusions : Clinical practice nursing students competency were improved using Mini-CEX method. It is recommended that the nursing study program use Mini-CEX method to evaluate clinical nursing practice so that student’s learning competency is increasing.

Variability and dimensionality of students\u2019 and supervisors\u2019 mini-CEX scores in undergraduate medical clerkships \u2013 a multilevel factor analysis

BackgroundThe mini clinical evaluation exercise (mini-CEX)—a tool used to assess student-patient encounters—is increasingly being applied as a learning device to foster clinical competencies. Although the importance of eliciting self-assessment for learning is widely acknowledged, little is known about the validity of self-assessed mini-CEX scores. The aims of this study were (1) to explore the variability of medical students’ self-assessed mini-CEX scores, and to compare them with the scores obtained from their clinical supervisors, and (2) to ascertain whether learners’ self-assessed mini-CEX scores represent a global dimension of clinical competence or discrete clinical skills.MethodsIn year 4, medical students conducted one to three mini-CEX per clerkship in gynaecology, internal medicine, paediatrics, psychiatry and surgery. Students and clinical supervisors rated the students’ performance on a 10-point scale (1 = great need for improvement; 10 = little need for improvement) in the six domains history taking, physical examination, counselling, clinical judgement, organisation/efficiency and professionalism as well as in overall performance. Correlations between students’ self-ratings and ratings from clinical supervisors were calculated (Pearson’s correlation coefficient) based on averaged scores per domain and overall. To investigate the dimensionality of the mini-CEX domain scores, we performed factor analyses using linear mixed models that accounted for the multilevel structure of the data.ResultsA total of 1773 mini-CEX from 164 students were analysed. Mean scores for the six domains ranged from 7.5 to 8.3 (student ratings) and from 8.8 to 9.3 (supervisor ratings). Correlations between the ratings of students and supervisors for the different domains varied between r = 0.29 and 0.51 (all p < 0.0001). Mini-CEX domain scores revealed a single-factor solution for both students’ and supervisors’ ratings, with high loadings of all six domains between 0.58 and 0.83 (students) and 0.58 and 0.84 (supervisors).ConclusionsThese findings put a question mark on the validity of mini-CEX domain scores for formative purposes, as neither the scores obtained from students nor those obtained from clinical supervisors unravelled specific strengths and weaknesses of individual students’ clinical competence.

Evaluation of Mini Clinical Evaluation Exercise (Mini-CEX) for post-graduate students in Prosthodontics: Student and Faculty Perceptions

This article was migrated. The article was not marked as recommended. Background: The mini Clinical Evaluation Exercise or mini-CEX is method for simultaneously assessing the clinical skills of trainees and offering them feedback on their performance. Although it is a well established method of assessment for medical residents, in dental education are very scanty especially in post-graduate education.The aim of this study was to train the faculty for the use of Mini CEX in training post-graduate students in Prosthodontics and evaluate their perceptions regarding this novel assessment method. Methodology: Faculty training was carried out by conducting a workshop consisting of pre-test, video demonstration, small group discussion and post-test. Total 5 faculty members evaluated 12 postgraduate students in seven competency domains on 9 point likert scale on standard miniCEX form. Focused group discussion was carried out with students and faculty to evaluate their perceptions regarding the exercise. Results: there was a statistically significant improvement in cognitive knowledge by comparing the pretest and posttest results (7 ± 4 and 17 ± 2 respectively, p&lt;0.0001)Total 82 encounters were recorded by 5 faculty members and 12 postgraduate students. All seven competencies were evaluated. Mean time for observing students by evaluator was 15.25 min and evaluator giving feedback was 11.20 min. Students ratings for satisfaction with the format (mean) were 8.34 and evaluator 7.23. Main themes emerging from focus group discussions were constructive feedback, objectivity and useful for exam preparation. Conclusions: Data from this study supports the use of mini CEX for post-graduate training in Prosthodontics. It is a cost effective way of assessing and giving constructive feedback to the students in structured manner. Further studies in different settings are needed to generalize its use in routine post-graduate training.

Mini Clinical Evaluation Exercise (Mini-CEX) as a Learning Tool in the Resident Training Programme of a Rural Medical School

Mini Clinical Evaluation Exercise (Mini-CEX) as a Learning Tool in the Resident Training Programme of a Rural Medical School

Effectiveness of mini- clinical evaluation exercise (mini cex) in assessment of physiotherapy students

Effectiveness of mini- clinical evaluation exercise (mini cex) in assessment of physiotherapy students

Introducing mini clinical evaluation exercise for assessing preventive procedure - 1.23% acidulated phosphate fluoride gel application by final year dental students

Introducing mini clinical evaluation exercise for assessing preventive procedure - 1.23% acidulated phosphate fluoride gel application by final year dental students

Feedback and Assessment Tools for Handoffs: A Systematic Review.

Resident handoff communication skills are essential components of medical education training. There are no previous systematic reviews of feedback and evaluation tools for physician handoffs. We performed a systematic review of articles focused on inpatient handoff feedback or assessment tools. The authors conducted a systematic review of English-language literature published from January 1, 2008, to May 13, 2015 on handoff feedback or assessment tools used in undergraduate or graduate medical education. All articles were reviewed by 2 independent abstractors. Included articles were assessed using a quality scoring system. A total of 26 articles with 32 tools met inclusion criteria, including 3 focused on feedback, 8 on assessment, and 15 on both feedback and assessment. All tools were used in an inpatient setting. Feedback and/or assessment improved the content or organization measures of handoff, while process and professionalism measures were less reliably improved. The Handoff Clinical Evaluation Exercise or a similar tool was used most frequently. Of included studies, 23% (6 of 26) were validity evidence studies, and 31% (8 of 26) of articles included a tool with behavioral anchors. A total of 35% (9 of 26) of studies used simulation or standardized patient encounters. A number of feedback and assessment tools for physician handoffs in several specialties have been studied. Limited research has been done on the studied tools. These tools may assist medical educators in assessing trainees' handoff skills.

Developing and piloting a resource for training assessors in use of the Mini-CEX (mini clinical evaluation exercise)

Developing and piloting a resource for training assessors in use of the Mini-CEX (mini clinical evaluation exercise)