Mini Clinical Examination (Mini-CEX)Workshops on Clinical Teaching and AssessmentClerkship programMedical School of Universitas Padjadjaran

BackgroundDirect observation of residents clinical skill by faculty is essential to ensure that students have achieved a satisfactory level of competence to practice independently

Medical students are rarely observed by attending physicians performing history & physical examination in realistic clinical encounters

ABIM developed and validated the clinical exercise (CEX) as a method of assessing students history taking and physical examination skills

The Mini-CEX assessment method is intended to promote and facilitate the direct observation of history taking, physical examination and counseling skills

What is the mini-CEX?Mini-CEXs focus on the core skills that medical students demonstrate in patient encounters

Mini-CEX was designed as short, easy form to use in focused first-time or follow-up encounters in any clinical setting

It is used with medical students to augment the feedback they receive from their attending regarding their clinical skills

Why are Mini-CEXs valued?Mini-CEXs are designed to enhance assessment, promote education and provide an effective evaluation tool

The advantages the opportunity for medical students to be : - observed interacting with a broad range of patients in a variety settings- evaluated by number of different faculty members

What is needed ?A snapshot clinical performance, optimally taking between 15-20 minutes

To provide valid, reliable measures of performance, interaction is needed with - a range different patients - in a variety setting

Settings : - inpatients ward- outpatients clinic- emergency deptEvaluators :Supervising physiciansChief residentsSenior residentsCommunications :- convey written and verbal expectations for mini-CEXs to evaluators and evaluatees

Mini CEX in emergency setting

Competencies demonstrated during Mini-CEXMedical interviewing skillsPhysical examination skillsHumanistic qualities/ professionalismClinical judgmentCounseling skillsOrganization/efficiencyOverall clinical competenciesClinical reasoning skills

Medical interviewing skills :- facilitates patients telling of story- effectively uses questions/directions to obtain accurate, adequate information needed- respond appropriately to affect ,non- verbal cues

Physical examination skills :- follows efficient logical sequence- balances screening/diagnostic steps for problem- informs patients- sensitive to patients comfort, modesty

Humanistic qualities / professionalism - show respect, compassion, empathy, establishes trust- attends to patients needs of comfort, modesty, confidentially

Clinical judgment : - selectively orders/performs appropriate diagnostic studies- considers risks, benefits

Counseling skills : - explains rationale for test/treatment- obtains patients consent- educates/counsels regarding management

Organization/efficiency : - prioritizes- is timely- succinct

Overall clinical competence : - demonstrates judgment- synthesis- caring- effectiveness- efficiency

Mini-CEX forms

University of California introduced mini-CEX into the core internal medicine clerkship in 1999Each student is instructed to complete the mini-CEX during the first half of clerkship, spending 15-20 minutes on the encounter and 15 minutes on feedback

After the clinical encounter, the student immediately presents an assessment and plan, and the attending gives feedback

The attending evaluates the students history and physical examination, clinical judgment, humanism, and overall clinical competence as a student, using the standardized mini-CEX form

The form uses a standardized nine-point scale : - 1-3 (unsatisfactory)- 4 (marginal)- 4-6 (satisfactory) - 7-9 (superior)

Conclusion :The benefits of the mini-CEX :

- skills are evaluated in a short time- the students will receive a feedback - could be used for observing the student at the bedside, hear the students assessment - low cost

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