FORMULIR MINI- CEX

(Mini Clinical Examination)

UNTUK UJIAN KOMPEENSI Klinik ( Ujian Ruangan)
PROGRAM STUDI ORTHOPAEDI & TRAUMATOLOGI PROGRAM
SPESIALIS FK UNAND

Name of Supervisor : Date of Examination :

Name of Resident : Level : Junior / Madya / SeniorDiagnosis of
patient _
Patient : Age : Gender:  New patient  Follow-up
Level of Difficulty :  Low  Medium  THigh

SCORE < 50 50-59 60-69 70-79 80-100

E D C B A

1. Medical Interviewing Skills

2. Physical Examination Skills

3. Humanistic Qualities/Professionalism

4. Clinical Judgment/ Diagnosis

5. Management Skills

6. Counseling Skills

7. Organization/Efficiency

8. Overall Clinical Competence

Score
ANNOTATION
86 - 100 A 62 - <70 BC <40 E
78 - <86 AB 54 - <62 C
70 - <78 B 40 - <54 D NBL: 70 Mean Score

FEED BACK:

Good already Need improvement

Mutually agreed action:

NOTES:
1. Duration of case discussion: observation: _ minute, Feed back minute
2. Supervisor satisfaction with the case discussion:
a. Very low b. Low c. Enough d. Good e. Very good
3. Resident’s satisfaction with the case discussion:
a. Very low b. Low c. Enough d. Good e. Very good
4. Have you ever received training to use this evaluation tool?

Joint training Face to face Reading the guideline WEB/ CD dll

Sign,

( )
 FORMULIR DOPS
(Direct Observation Procedural Skill)
UNTUK UJIAN KOMPEENSI Klinik ( Ujian Ruangan)
PROGRAM STUDI ORTHOPAEDI & TRAUMATOLOGI PROGRAM
SPESIALIS FK UNAND

Name of Supervisor : Date of Examination :

Name of Resident : Level : Junior / Madya / Senior
Room situation : ER Outpatient Inpatient Others
Jenis Tindak medic :
No.of similar medical actions were observed by the supervisor: ( ) 0 ( ) 1 ( ) 2 ( ) 3 ( ) 4 ( ) 5-9 ( ) >9
No. of similar medicat action were done by the resident : ( ) 0 ( ) 1 ( ) 2 ( ) 3 ( ) 4 ( ) 5-9 ( ) >9

< 50 50-59
SCOR 60-69
E D C
E

1. Have knowledge of indications,

the relevance of anatomic and
follow-up medical techniques
( ) Not observed

2. Get informed consent

( ) Not observed

3. Able to show preparation adequately

before medical procedur
( ) Not observed

4. Able to give safe analgetic/sedation

( ) Not observed

5. Technical skill
( ) Not observed

6. Aseptic technique (
) Not observed

7. Ask for help if needed

( ) Not observed

8. Management post procedure

( ) Not observed

9. Communication skill
( ) Not observed

10. Professionalism
( ) Not observed

11. Skill to do medical procedure in general

( ) Not observed

ANNOTATION Total score

86 - 100 A 62 - <70 BC <40 E
78 - <86 AB 54 - <62 C
70 - <78 B 40 - <54 D NBL: 70 Mean score

FEED BACK:

NOTES:
1. Duration of DOPS: observation: _ minute, Feed back minute
2. Supervisor satisfaction with DOPS:
a. Very low b. Low c. Enough d. Good e. Very good
3. Resident’s satisfaction with DOPS:
a. Very low b. Low c. Enough d. Good e. Very good
4. Have you ever received training to use this evaluation tool?

Joint training Face to face Reading the guideline WEB/ CD dll

Sign,

( )