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Participants will be able to  Analyze reliability and validity of long case in assessing clinical skills  Describe how mini-CEX works  Define nine domains of scoring in mini- CEX  Incorporate mini-CEX in formative assessment in their settings Mini-Clinical Evaluation Exercise (mini-CEX) 3

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“Assessment drives learning in at least four ways : its contents, its formats, its timing and any subsequent feedback given to the examinee.” Mini-Clinical Evaluation Exercise (mini-CEX) 5 “Assessment Drives Student Learning.” George E Miller

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 Knowledge and performance are not separable.  Students need knowledge to perform.  We can’t do it if you don’t know how to do it.  For assessment of clinical competency, we need both knowledge (cognition) and performance measures.  Knowledge measurement should not replace the performance measurement and performance measurement should not replace knowledge measurement. Mini-Clinical Evaluation Exercise (mini-CEX) 7

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You are the Chairperson of the examination committee. In which situation (Scenario A or Scenario B) more reliable examiners decision to pass the candidate ? Mini-Clinical Evaluation Exercise (mini-CEX) 13

 In depth assessment of clinical competence in setting uninfluenced by time constraints  Limitations  Unstructured  Subjective  Limited observations of clinical skills  Narrow sampling of contents  Each student gets different case  Case specific Mini-Clinical Evaluation Exercise (mini-CEX) 14

Mini-Clinical Evaluation Exercise (mini-CEX) 15 Single Long Case with or Without Viva Serious doubts about reliability and consistency Poor content validity: only 1-2 cases are tested Generalizability across other domain is poor Performance on one or a few problems tells you next to nothing. We can not deduct a student’s overall performance based on one or two clinical case or one or two long (essay) questions.

The only solution is multiple samples  Questions  Cases  Problems  Examiners, etc  Any single/limited item based test will be faulty regardless of efforts that are put into development. Mini-Clinical Evaluation Exercise (mini-CEX) 16

 Portfolios  Clinical notes  Direct observation  Logs  OSCE  CEX  MiniCEX Mini-Clinical Evaluation Exercise (mini-CEX) 17

As trainees approach entry to practice their education and assessment needs to be based on real patients. Mini-Clinical Evaluation Exercise (mini-CEX) 18

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 Mini CEX  Direct Observation of Procedural skills (DOPS)  Procedure Based Assessment (PBA)  Case-based Discussion (CBD)  Multiple source feedback Mini-Clinical Evaluation Exercise (mini-CEX) 20

 Examiner /Assessor observes a trainee with a patient in any setting: OPD, IPD, A & E  Trainee performs a focused task  Examiner/Assessor rates along several dimensions on a form  Feedback  Takes minutes, feedback 5-7 min  Multiple encounters expected  Intended to be short and routine Mini-Clinical Evaluation Exercise (mini-CEX) 21

 Primary purpose is to provide structured teaching and feedback  Focuses on formative assessment of clinical skills  Responds to assessment problems of traditional CEX  Responds to educational problems of workplace  Requires observation and feedback Mini-Clinical Evaluation Exercise (mini-CEX) 22

A second year resident undergoing mini CEX session in OPD setting. A Case of Multi-nodular Thyroid Swelling Mini-Clinical Evaluation Exercise (mini-CEX) 23

1. Medical Interviewing Skills/History Taking:  Facilitates patient’s telling of story  Effectively uses questions/directions  to obtain accurate, adequate information needed  responds appropriately to affect, non- verbal clues Mini-Clinical Evaluation Exercise (mini-CEX) 24

2. Physical Examination Skills:  Follows efficient, logical sequence  balances screening/diagnostic steps for problem  informs patient  sensitive to patient’s comfort, modesty Mini-Clinical Evaluation Exercise (mini-CEX) 25

3. Humanistic Qualities/Professionalism:  Shows respect  compassion  empathy  establishes trust  attends to patient’s needs of comfort, modesty, confidentiality, information. Mini-Clinical Evaluation Exercise (mini-CEX) 26

4. Clinical Judgment:  Selectively orders/performs appropriate diagnostic studies  considers risks benefits Mini-Clinical Evaluation Exercise (mini-CEX) 27

5. Counselling Skills:  Explains rationale for test/treatment  obtains patient’s consent  educates/counsels regarding management Mini-Clinical Evaluation Exercise (mini-CEX) 28

6. Organization/Efficiency:  Prioritizes  is timely  Succinct (expressed in few words) Mini-Clinical Evaluation Exercise (mini-CEX) 29

7. Overall Clinical Competence:  Demonstrates judgment  Synthesis  Caring  Effectiveness  efficiency Mini-Clinical Evaluation Exercise (mini-CEX) 30

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 Assess to focus and prioritize diagnosis and management of real clinical practice.  More reliable  Assess in a broader range  More opportunity for observation and feedback. Mini-Clinical Evaluation Exercise (mini-CEX) 34

 Assessment should be designed prospectively and methodically with the purpose in mind.  Multiple assessment instruments targeting all levels in Miller’s pyramid are necessary to capture reasonable breadth of competency.  Compromise is inevitable, but it should be based on sound judgment.  Students need to be tested with multiple cases and scenarios to achieve an acceptable degree of reliability. Mini-Clinical Evaluation Exercise (mini-CEX) 35

Consider characteristics of the method:  Relative validity  Relative Reliability  Relative Educational Impact  Relative Practicality  View assessment of competency as a whole rather than only function of knowledge or performance. Mini-Clinical Evaluation Exercise (mini-CEX) 36

 Principle One : A sound knowledge base that is contextual is essential in clinical setting  Principle Two : Knowledge and performance are not separable. We need to assess both  Principle Three : There is no generic problem solving skills. We need to assess students across multiple domains  Principle Four : Mastery of knowledge is not an “all or none” phenomenon Mini-Clinical Evaluation Exercise (mini-CEX) 37

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The work of a teacher... exhausting, complex, idiosyncratic, never twice the same... is at its heart, an intellectual and ethical enterprise. Teaching begins in challenge and is never far from mystery. William Ayres Mini-Clinical Evaluation Exercise (mini-CEX) 39