Finalized Mini-CEX Form (FCPS Radiation Oncology)-finalized by the concerned Members on 16-Feb-21 +

Modifications as per Meeting discussion on 22-Jan-22. Updated 21-Sep-22.

COLLEGE OF
PHYSICIANS AND
MINI CLINICAL EVALUATION EXERCISE (CEX)
SURGEONS
PAKISTAN
Specialty: ______FCPS Radiation Oncology_________

Time Duration = 20 mins (15 mins assessment and 5 mins feedback)

PLEASE COMPLETE THE QUESTIONNAIRE BY FILLING/CHECKING APPROPRIATE BOXES
Assessor:________________________________________________________Assessment Date: ________________________
Resident's Name: _________________________________________________________________________________________
Hospital Name:___________________________________________________R&RC Number: ___________________________
Year of Residency: □ R1 □ R2 □ R3 □ R4
Quarter: □ 1st □ 2nd □ 3rd □ 4th
Setting: □ Ward □ Outdoor (Hospital/Community) Others: ____________________________
Diagnosis of Patient:_______________________________________________Patient Age:____________Sex: ______________
Clinical Area: ____________________________________________________________________________________________
Complexity of Case/ Procedure: □ Low/Easy □ Moderate/Average □ High/Difficult □ N/A
Focus of Clinical Encounters: □ History taking □ Physical Examination □ Communication Skills
□ Management □ Radiation Treatment Planning
□ Systemic Treatment Planning □ Other__________
Please grade the following areas on the Not Observed / Below Expectations Satisfactory Above Expectation Excellent
Applicable
given scale: 1 2 3 4 5
Informed Consent of patient
Interviewing Skills
Systematic Progression
Presentation of positive & significant
negative findings
Justification of actions
Professionalism
Organization/Efficiency
Overall clinical skills

Assessor's Satisfaction with Mini-CEX:

(Low) 1 2 3 4 5 (High)

Resident's Satisfaction with Mini-CEX:

(Low) 1 2 3 4 5 (High)

Strengths Suggestions for Improvements

Encounter to be repeated □ YES □ NO

Signature