Mini-Clinical Evaluation Exercise

(Mini-CEX)

Tim Clinical Teaching and Assessment

Fakultas Kedokteran Universitas Padjadjaran
2012
What is mini-CEX?

Structured 10 min observation of a student

performing specified tasks during routine
practice
Feedback session (10 min)
Completion of a standardized one-page rating
form
Mini-CEX: Types of tasks
Focused history
Physical examination
Counselling

◦ advise patient regarding management options

◦ provide appropriate education
◦ make recommendations that address patient’s concerns
Clinical reasoning skills
◦ diagnostic and therapeutic skills
Case presentation
History-taking Form
Guidelines for marking
Implementing a Mini-CEX
Assessment Process
Implementing a Mini-CEX
Orientation
◦ Familiarize yourself with the mini-CEX rating form
and definition of the components of the student’s
performance you will be rating

Schedule the mini-CEX

◦ 1-2 / week
◦ Allow 20 minutes for each assessment
◦ Obtain patient permission
Assessment Process

Avoid interrupting the student during the patient

encounter
◦ no questions, comments or suggestions
◦ if you want to follow-up findings with patients, do this
after the student is finished
Conduct immediate feedback (10 minutes)
Complete rating form
Discuss rating or comments with student
Mini-CEX: Feedback
Immediate
Specific
Limited to key issues
Honest
Fair
Descriptive, not judgmental, e.g.
“you did not examine X”
NOT “you were way off base”
Mini-CEX: Feedback
Two-way process (inter-active)
Start by asking the student some questions
◦ how they felt they did with the patient
◦ what findings they found
◦ what they think is the most likely diagnosis
◦ why they ordered a particular investigation or
suggested a particular treatment
Answers can stimulate specific feedback and also
guide ratings of performance
Feedback challenge
Easy when the student does well
More difficult when the performance is poor
◦ do not hesitate to point out area of weakness
◦ multiple assessments with multiple examiners
(reliability)
◦ sampling performance across the spectrum of
clinical situations (validity)
Mini-CEX: Feedback
Closing the loop

Provide a recommendation
◦ interviewing/ examination/ counselling skills/
management/ presentation

Develop a specific action plan

◦ allows student to act on the recommendation
Example of use of Mini-CEX
ER
A man presents with abdominal pain
The student performs a focused abdominal
examination (10 minutes)
The preceptor notices that the student did not
examine the inguinal areas adequately
Feedback is given
◦ the preceptor demonstrates the correct technique
◦ recommends a review of hernias in clinical skills textbook
◦ suggests plan to practise exam technique
Summary: Key features of the Mini-CEX

Direct assessment of actual patient care

Allows assessment of performance
 good evidence supporting mini-CEX’s validity and
reliability
 cumulatively can infer student’s competence
Can be incorporated into daily activities
 efficient use of resources
Allows immediate and substantive feedback
Thank You