Mini-CEX Mini-clinical evaluation exercise لیلا پاداش بسم الله الرحمن الرحیم Mini-clinical evaluation exercise Mini-CEX Assessment of Overall Clinical Skills لیلا پاداش دانشگاه علوم پزشکی گلستان عضو هیات علمی و مسئول دفتر رشد و بالندگی اساتیددانشگاه

What is a mini-CEX ? A workplace-based assessment a short episode of real student-patient interaction within the workplace observed and judged by the supervising clinician (observer) followed by feedback

Why do mini-CEX ? Workplace-based assessment drives experiential learning?

Are Clinical Skills Important? Clinical skills are essential for patient care Clinical skills : Medical interviewing Physical examination Clinical judgment Communication skills Evaluation of clinical skills requires direct observation 4

diagnosis and medical interview Hampton (BMJ, 1975): Medical interview: 82% Physical exam: 9% Laboratory: 9% Kirch (Medicine, 1996) Medical interview (+Ph/Ex): 70% Imaging: 35%

Importance of complete Clinical Skills To decrease diagnostic errors Inaccurate/ incomplete medical interview is one important reason of diagnostic errors. Wrong information leads to wrong decisions To increase patient satisfaction Higher with better communication skills To improve patient self-care Better adherence and outcomes associated with better physician communication skills

Miller’s Pyramid Faculty Observation Mini.cex DOES SHOWS HOW OSCE KNOWS HOW PMP.KFP KNOWS MCQ.SAQ

how to do miniCEX ? too simple

Triangulation DESK Patient Resident(trainee) Attending(observer)

In the mini-CEX, a single faculty Member(observer) observes the trainee`s interact with a patient in any of a variety of settings including the hospital, outpatient clinic, and E.D In fact, the mini CEX can assess a range of core competencies that a trainee uses during day to day encounters with patients.

take place In the normal working environment . Encounters should … take place In the normal working environment . take place In different working environment. cover different cases and different specialty areas. be observed by different skilled observers. During the encounters … Observer must assess trainee`s clinical skills & fill the feedback form. Observer must note some extra information such as complexity of patient`s problem

Exam : 15_20 min Feedback : ~5 min One encounter takes 20 min & has 2 steps Exam : 15_20 min Feedback : ~5 min The trainee conducts a focused history and physical examination and then provides a diagnosis and treatment plan. The faculty member(observer) scores the performance using a structured document and then provides educational feedback.

FEEDBACK The feedback session is the most important part of the mini-cex & it should occure immediately after the encounter. The observer should discuss both the positive & negative aspects of encounter with the trainee. The observer should also discuss a plan to improve any areas of weakness.

To be most effective, feedback needs to be interactive strengths and weaknesses. → (agreement & signature)

Mini_CEX program Trainees have to complete at least one encounter for every 3 months (4 encounters in a year) in order to be eligible for central exam at the end of the year. The trainee should meet an educational supervisor during the program . During this meetings they can map out a learning plan for next period, according to trainee`s rotations & his/her past encounters.

The trainee is responsible for instigating each mini- CEX encounter. Each assessment should focus on a limited number of competencies & different encounters should include a range of cases with each focusing on specific aspects of the clinical skills. (e.g. history taking, PH/EX, … )

Each observer may have his/her own way to run the encounters with the trainees. One accepted format is : To choose the last patient of a day ( e.g : the last outpatient in the clinic or the last patient on the ward round) →To be less disruptive to the flow of the clinical workload. →To allow for feedback to occur straight after the encounter.

How many encounters must be observed to provide a reliable mean rating?

Mini-CEX: Reliability Reliability Coefficients > 0.80 with 6 observations > 0.90 with 12 observation > 0.95 with 24 observations

The evidence will be rated and recorded in the Portfolio. Mini-Clinical Examination (Mini-CEX) The evidence will be rated and recorded in the Portfolio. Immediate feedback will be provided by the observer rating the student. A learning plan will be developed, based on the strengths and developmental needs observed

Summary Basic clinical skills are important: so is the need to observe them! Observation is a complex skill that requires training and practice Direct observation by educators will remain a critical component of both evaluation and feedback