Assessment tools MiniCEX, DOPS AH Mehrparvar,MD Occupational Medicine department Yazd University of Medical Sciences

What is a mini-CEX (Miniclinical evaluation exercise) 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

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

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

Triangulation DESK Resident(trainee) Patient 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  In fact, the mini CEX can assess a range of core competencies that a trainee uses during day to day encounters with patients

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

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 occur 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

 The direct observation of procedural skills  A workplace based assessment (WBA) instruments  The use of DOPS is most prevalent amongst surgical residents due to the higher frequency of procedures  DOPS is the observation and evaluation of a procedural skill performed by a trainee on a real patient DOPS

 The procedural skills assessed using DOPS may range from simple and common to complex  The key features of DOPS include: assessment of procedural skills evaluation of a specific patient encounter performance of procedure on actual patient immediate feedback on performance  DOPS is not widely used in undergraduate medical education or for assessing working doctors