1. “You teach best what you most need to learn…..”
Good Afternoon
“You teach best what you most need to learn…..”
Mini-Clinical Evaluation Exercise (mini-CEX)

2. Mini-Clinical Evaluation Exercise (Mini-CEX)
Dr. Jatin G. Bhatt
Professor & Head
Dept. of Surgery
PDUMC
Rajkot

3. Long Case (CEX) Vs mini-CEX
Mini-Clinical Evaluation Exercise (mini-CEX)

4. Objectives 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)

5. Three Pillars of Education
Mini-Clinical Evaluation Exercise (mini-CEX)

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

7. Clinical Assessment Students need knowledge to perform.
We can’t do it if you don’t know how to do it.
Knowledge and performance are not separable.
Assessment of clinical competency: 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)

8. Domains of learning
Mini-Clinical Evaluation Exercise (mini-CEX)

9. Miller’s Pyramid
Mini-Clinical Evaluation Exercise (mini-CEX)

10. Mini-Clinical Evaluation Exercise (mini-CEX)

11. Mini-CEX: Performance assessment in vivo
Mini-Clinical Evaluation Exercise (mini-CEX)

12. Performance assessment - New methods
Portfolios
Clinical notes
Direct observation
Logs
OSCE
CEX
MiniCEX
Mini-Clinical Evaluation Exercise (mini-CEX)

13. Professional authenticity
Mini-Clinical Evaluation Exercise (mini-CEX)

14. Mini-CXE
Certification: entry to practice Education and assessment: based on real patients
Mini-Clinical Evaluation Exercise (mini-CEX)

15. Mini-Clinical Evaluation Exercise (mini-CEX)

16. Mini-Clinical Evaluation Exercise (mini-CEX)

17. You are the Chairperson of the examination committee
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)

18. Long Case Vs mini-CXE 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)

19. New: Performance Based assessment
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. mini-CEX: Description
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. mini-CXE
Primary purpose is to provide structured teaching and feedback
Focuses on formative assessment of clinical skills
Requires observation and feedback
Problems of traditional CEX
Problems of workplace
Mini-Clinical Evaluation Exercise (mini-CEX)

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

23. Evaluation Form
Mini-Clinical Evaluation Exercise (mini-CEX)

24. mini-CEX form
Mini-Clinical Evaluation Exercise (mini-CEX)

25. mini-CEX form
Mini-Clinical Evaluation Exercise (mini-CEX)

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

27. mini-CEX form: 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)

28. mini-CEX form: 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)

29. mini-CEX form 4. Clinical Judgement:
Selectively orders/performs appropriate diagnostic studies
Considers risks benefits
Mini-Clinical Evaluation Exercise (mini-CEX)

30. mini-CEX Form 5. Counselling Skills:
Explains rationale for test/treatment
Obtains patient’s consent
Educates/counsels regarding management
Mini-Clinical Evaluation Exercise (mini-CEX)

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

32. mini-CEX Form 7. Overall Clinical Competence: Demonstrates judgement
Synthesis
Caring
Effectiveness
Efficiency
Mini-Clinical Evaluation Exercise (mini-CEX)

33. CEX or Long Case 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.
Mini-Clinical Evaluation Exercise (mini-CEX)

34. Long Case Vs mini-CXE
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)

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

36. Mini-Clinical Evaluation Exercise (mini-CEX)

37. General Tips
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)

38. Tips….. 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)

39. Four Cardinal Principles in Assessment in Medical Education
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)

40. “Practice of Medicine is an art based on science”
Why MET ……………
Clinician Teacher Assessor
“Practice of Medicine is an art based on science”
-William Osler
“One Minute Preceptor” Model: Dr. Jatin Bhatt

41. Happy Teachers Day
Mini-Clinical Evaluation Exercise (mini-CEX)

42. Thanks Happy Teachers Day 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
Thanks
Mini-Clinical Evaluation Exercise (mini-CEX)