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Khalid Bashir, Wajeeha Arshad, Aftab Mohammad Azad, Shukri Alfalahi, Ashid Kodumayil, Amr Elmoheen Hamad Medical Corporation, Doha, QatarCorrespondence: Wajeeha ArshadHamad General Hospital, PO Box 3050, Doha, QatarEmail WArshad@hamad.qa; wajeeha_arshad44@yahoo.comBackground: Mini Clinical Evaluation Exercise (Mini-CEX) has been adapted to different specialties in clinical practice but with very little evidence documented about its use for residency training in the emergency department (ED). This study aims to assess its acceptability and feasibility as a formative tool in the busy emergency department.Materials and Methods: Both the faculty members and the emergency medicine residents were sent a validated questionnaire using Google forms, and the results were analyzed using simple statistical tools.Results: Forty-nine residents and 58 faculty participated in the survey. The study was carried out over a period of 4 months. The resident’s completion rate was 96% (49 out of 51), while faculty completion rate was 96% (58 out of 60). The time for Mini-CEX completion ranged from 10 to 20 minutes. Most of the residents were satisfied with Mini-CEX as an assessment tool. Twelve residents expressed their concern regarding available time during busy clinical shifts. Most of the faculty agreed with the benefits of using Mini-CEX as a formative assessment tool. Several of them commented that they need “protected time” and “more training” to use this tool to provide maximum benefit to the residents.Conclusion: Despite busy nature of ED, Mini-CEX has been identified as an acceptable learning tool for residents in emergency medicine. Based on the faculty’s feedback and comments, several faculty development workshops were conducted to improve faculty skills in carrying assessments by using Mini-CEX, and protected time is provided to some faculty members to carry out these formative assessments for the benefit of the residents.Keywords: Mini-CEX, emergency medicine department, residency training, rater, faculty member

Khalid Bashir, Wajeeha Arshad, Aftab Mohammad Azad, Shukri Alfalahi, Ashid Kodumayil, Amr Elmoheen Hamad Medical Corporation, Doha, QatarCorrespondence: Wajeeha ArshadHamad General Hospital, PO Box 3050, Doha, QatarEmail WArshad@hamad.qa; wajeeha_arshad44@yahoo.comBackground: Mini Clinical Evaluation Exercise (Mini-CEX) has been adapted to different specialties in clinical practice but with very little evidence documented about its use for residency training in the emergency department (ED). This study aims to assess its acceptability and feasibility as a formative tool in the busy emergency department.Materials and Methods: Both the faculty members and the emergency medicine residents were sent a validated questionnaire using Google forms, and the results were analyzed using simple statistical tools.Results: Forty-nine residents and 58 faculty participated in the survey. The study was carried out over a period of 4 months. The resident’s completion rate was 96% (49 out of 51), while faculty completion rate was 96% (58 out of 60). The time for Mini-CEX completion ranged from 10 to 20 minutes. Most of the residents were satisfied with Mini-CEX as an assessment tool. Twelve residents expressed their concern regarding available time during busy clinical shifts. Most of the faculty agreed with the benefits of using Mini-CEX as a formative assessment tool. Several of them commented that they need “protected time” and “more training” to use this tool to provide maximum benefit to the residents.Conclusion: Despite busy nature of ED, Mini-CEX has been identified as an acceptable learning tool for residents in emergency medicine. Based on the faculty’s feedback and comments, several faculty development workshops were conducted to improve faculty skills in carrying assessments by using Mini-CEX, and protected time is provided to some faculty members to carry out these formative assessments for the benefit of the residents.Keywords: Mini-CEX, emergency medicine department, residency training, rater, faculty member

Background The traditional curriculum for medical students in Japan does not include sufficient opportunities for students to develop their skills for musculoskeletal (MSK) examination and clinical reasoning and diagnosis. Therefore, an effective programme is required to help medical students and residents improve their clinical skills in MSK. This paper aims to assess the clinical skills of medical students who have participated in a peer role-playing simulation programme using a mini clinical evaluation exercise (mini-CEX). Methods Participants were 90 female medical students who were completing their first orthopaedic clinical clerkship. They were divided into two groups. The simulation group participated in a role-play focussed on MSK cases as low-fidelity simulation, a structured debriefing with the course supervisor, and a self-reflection on Day 1 (n = 64). The control group did not participate in the role-play due to randomised clerkship schedules (n = 26). On Day 2 of the intervention, we observed and assessed all participants’ performances during MSK outpatient encounters using the mini-CEX. We compared the mini-CEX score between the simulation group and the control group; the Wilcoxon rank-sum test was used for statistical analysis. Results The mini-CEX scores for physical examination, clinical reasoning and diagnosis, and overall clinical competency were significantly higher in the simulation group than in the control group (p p = .014, clinical reasoning: p = .042, overall: p = .016). These findings suggest that medical students who partake in a peer role-playing simulation programme could experience improved clinical skills for physical examination, clinical reasoning and diagnosis, and overall clinical competency in real-life MSK outpatient encounters. Conclusions Through a mini-CEX assessment, our findings indicate that medical students who participated in our peer role-playing simulation programme have improved clinical skills. Peer role-playing as a low-fidelity simulation and practical educational opportunity will enable educators to polish the competency of medical students in musculoskeletal physical examinations and clinical reasoning and diagnosis in a clinical setting.

Objectives Since their introduction, workplace-based assessments (WBAs) have proliferated throughout postgraduate medical education. Previous reviews have identified mixed findings regarding WBAs' effectiveness, but have not considered the importance of user-tool-context interactions. The present review was conducted to address this gap by generating a thematic overview of factors important to the acceptability, effectiveness and utility of WBAs in postgraduate medical education. Method This review utilised a hermeneutic cycle for analysis of the literature. Four databases were searched to identify articles pertaining to WBAs in postgraduate medical education from the United Kingdom, Canada, Australia, New Zealand, the Netherlands and Scandinavian countries. Over the course of three rounds, 30 published articles were thematically analysed in an iterative fashion to deeply engage with the literature in order to answer three scoping questions concerning acceptability, effectiveness and assessment training. As each round was coded, themes were refined and questions added until saturation was reached. Results Stakeholders value WBAs for permitting assessment of trainees' performance in an authentic context. Negative perceptions of WBAs stem from misuse due to low assessment literacy, disagreement with definitions and frameworks, and inadequate summative use of WBAs. Effectiveness is influenced by user (eg, engagement and assessment literacy) and tool attributes (eg, definitions and scales), but most fundamentally by user-tool-context interactions, particularly trainee-assessor relationships. Assessors' assessment literacy must be combined with cultural and administrative factors in organisations and the broader medical discipline. Conclusions The pivotal determinants of WBAs' effectiveness and utility are the user-tool-context interactions. From the identified themes, we present 12 lessons learned regarding users, tools and contexts to maximise WBA utility, including the separation of formative and summative WBA assessors, use of maximally useful scales, and instituting measures to reduce competitive demands.

Objectives Since their introduction, workplace-based assessments (WBAs) have proliferated throughout postgraduate medical education. Previous reviews have identified mixed findings regarding WBAs' effectiveness, but have not considered the importance of user-tool-context interactions. The present review was conducted to address this gap by generating a thematic overview of factors important to the acceptability, effectiveness and utility of WBAs in postgraduate medical education. Method This review utilised a hermeneutic cycle for analysis of the literature. Four databases were searched to identify articles pertaining to WBAs in postgraduate medical education from the United Kingdom, Canada, Australia, New Zealand, the Netherlands and Scandinavian countries. Over the course of three rounds, 30 published articles were thematically analysed in an iterative fashion to deeply engage with the literature in order to answer three scoping questions concerning acceptability, effectiveness and assessment training. As each round was coded, themes were refined and questions added until saturation was reached. Results Stakeholders value WBAs for permitting assessment of trainees' performance in an authentic context. Negative perceptions of WBAs stem from misuse due to low assessment literacy, disagreement with definitions and frameworks, and inadequate summative use of WBAs. Effectiveness is influenced by user (eg, engagement and assessment literacy) and tool attributes (eg, definitions and scales), but most fundamentally by user-tool-context interactions, particularly trainee-assessor relationships. Assessors' assessment literacy must be combined with cultural and administrative factors in organisations and the broader medical discipline. Conclusions The pivotal determinants of WBAs' effectiveness and utility are the user-tool-context interactions. From the identified themes, we present 12 lessons learned regarding users, tools and contexts to maximise WBA utility, including the separation of formative and summative WBA assessors, use of maximally useful scales, and instituting measures to reduce competitive demands.

Ihab Shafek Atta,1,2 Rajab A Alzahrani3 1Pathology Department, Faculty of Medicine, Al-Azhar University, Assuit, Egypt; 2Pathology Department, Faculty of Medicine, Albaha University, Albaha, Saudi Arabia; 3Surgery Department, Otolaryngology Division, Faculty of Medicine, Albaha University, Albaha, Saudi ArabiaCorrespondence: Ihab Shafek AttaPathology Department, Faculty of Medicine, Al-Azhar University, Assuit 71524, EgyptTel +20882148103/4Fax + 20882148119Email Ihab.bassyouny@azhar.edu.egRajab A AlzahraniSurgery Department, Otolaryngology Division, Faculty of Medicine, Albaha University, Saud ArabiaTel +966509766298Email drrajabg@gmail.comAim: Multidisciplinary, as a term, is used to define people from different scientific backgrounds working together, each drawing on their field of expertise. Some related terms are frequently used interchangeably, such as interdisciplinary and transdisciplinary, but they are confusing and ambiguous. Introduction of a multidisciplinary teaching method in the early phases of medical curricula is insufficient for effective learning. Here, we aim to implement a multidisciplinary approach in the early phase of medical education and identify outcomes.Methods: Two groups were evaluated in this study, each representing phases II and III of the Albaha medical curriculum, and including 90 and 86 students, respectively. “Hearing tests and their clinical applications” was selected as a subject to evaluate the understanding of special senses as studied by the phase II group, while “pathology of otolaryngology-related tumors and clinical correlations” was selected as a subject to evaluate the understanding of otolaryngology as studied by the phase III group. These subjects were selected by faculty members from otolaryngology, pathology and physiology departments and taught in successive stations. Teaching sessions were followed by a formative test that included 10 multiple-choice questions and a mini-clinical evaluation exercise (mini-CEX). A questionnaire to evaluate student satisfaction was completed after the exam.Results: Students’ satisfaction for the “hearing tests and their clinical applications” and “pathology of otolaryngology-related tumors and clinical correlations” subjects were 80% and 90.5%, respectively. The formative assessment revealed good student performance at 63.28%, and 60.46% of all students in both phases attained scores above 80%.Conclusion: Introduction of a multidisciplinary approach early in the medical curriculum improves knowledge and skill acquisition. This is reflected in student performance, especially if evaluated using the mini-CEX format, thus providing rapid feedback to students concerning their performance.Keywords: integration, multidisciplinary, mini-CEX, otolaryngology, pathology, student performance

Aim Multidisciplinary, as a term, is used to define people from different scientific backgrounds working together, each drawing on their field of expertise. Some related terms are frequently used interchangeably, such as interdisciplinary and transdisciplinary, but they are confusing and ambiguous. Introduction of a multidisciplinary teaching method in the early phases of medical curricula is insufficient for effective learning. Here, we aim to implement a multidisciplinary approach in the early phase of medical education and identify outcomes. Methods Two groups were evaluated in this study, each representing phases II and III of the Albaha medical curriculum, and including 90 and 86 students, respectively. “Hearing tests and their clinical applications” was selected as a subject to evaluate the understanding of special senses as studied by the phase II group, while “pathology of otolaryngology-related tumors and clinical correlations” was selected as a subject to evaluate the understanding of otolaryngology as studied by the phase III group. These subjects were selected by faculty members from otolaryngology, pathology and physiology departments and taught in successive stations. Teaching sessions were followed by a formative test that included 10 multiple-choice questions and a mini-clinical evaluation exercise (mini-CEX). A questionnaire to evaluate student satisfaction was completed after the exam. Results Students’ satisfaction for the “hearing tests and their clinical applications” and “pathology of otolaryngology-related tumors and clinical correlations” subjects were 80% and 90.5%, respectively. The formative assessment revealed good student performance at 63.28%, and 60.46% of all students in both phases attained scores above 80%. Conclusion Introduction of a multidisciplinary approach early in the medical curriculum improves knowledge and skill acquisition. This is reflected in student performance, especially if evaluated using the mini-CEX format, thus providing rapid feedback to students concerning their performance.

Background Mini-CEX is a popular workplace exam that includes direct observation and a feedback conversation. This evaluation occurs in a workplace setting as part of the daily work. Self-efficacy is a mandatory soft skill for nursing students during an internship. Therefore, this study aims to identify the effect of Mini-CEX on self-efficacy among these students. Design and methods A quasi-experiment design was conducted with a control group. All the nursing student intents of the Sari Mutiara Indonesia University were considered as the study population. This population was then divided into one control and one intervention group of 24 and 25 students, respectively. Subsequently, data collection was carried out using general selfefficacy. Results The results showed the self-efficacy was low in the control group (66.7%), and Mini-CEX was discovered to have a significant effect on self-efficacy among nursing students undergoing internships (p=0.000). Conclusions The Mini-CEX was concluded to effectively increase self-efficacy among nursing students and is suggested as a mandatory method for evaluating these students.

Background Clinical pharmacists must have a complex combination of academic knowledge and practical experience that integrates all aspects of practice. Taiwan’s Ministry of Health and Welfare in 2007 launched the Postgraduate Year (PGY) training program to increase the standard of pharmaceutical care. This study aims to develop a pharmacist-specific Chinese-language Mini-Clinical Evaluation Exercise (Mini-CEX) to evaluate the professional development of postgraduate year trainees. Method The specialized Mini-CEX was developed based on the core competencies of pharmacists, published literature, and expert opinion. A pilot test and evaluator workshop were held prior to the administration of the main test. Fifty-three samples were recruited. The main study was conducted at two regional teaching hospitals and a medical center teaching hospital in Taiwan between February and June 2012. The results were analyzed with the kappa statistic (inter-rater reliability) and descriptive statistics, while the Kruskal-Wallis test was used to examine the PGY trainees’ Mini-CEX scores based on their performances. Results Trainees who had recently completed PGY programs (C-PGY) and 2nd year PGY trainees (PGY2) earned excellent scores, while the 1st year PGY trainees (PGY1) earned satisfactory scores in overall performance. C-PGY and PGY2 trainees also performed significantly better than PGY1 trainees in the organization and efficiency domain, and the communication skills domain. Conclusion This study demonstrates the feasibility of using the newly developed pharmacist-specific Chinese-language version of the Mini-CEX instrument to evaluate the core competencies of PGY trainees in clinical settings. Electronic supplementary material The online version of this article (10.1186/s12909-019-1602-2) contains supplementary material, which is available to authorized users.

Purpose: This study investigated whether the mini-clinical evaluation exercise (mini-CEX) has been successfully integrated into the Chinese context, following its introduction as part of the national general training programme. Materials and methods: Online questionnaires (N = 91) and interviews (N = 22) were conducted with Year 1 trainee doctors and clinical supervisors at a cancer hospital in China to explore users’ experiences, attitudes and opinions of the mini-CEX. Results” Trainees were more likely than supervisors to report understanding the purpose of the mini-CEX and agree that it encouraged reflection and helped improve overall performance. Both trainees and supervisors felt that it provided a framework for learning, that it was useful in identifying underperformance, and that it informed learning progression. Groups were equally positive about the commitment of their counterpart in the process and valued the focus on detailed feedback. It was perceived as cultivating the learner–teacher relationship. Overall, both groups felt they ‘bought in’ to using the mini-CEX. However, concerns were raised about subjectivity of ratings and lack of benchmarking with expected standards of care. Conclusions: Chinese trainees and supervisors generally perceived the mini-CEX as an acceptable and valuable medical training tool, although both groups suggested enhancements to improve its efficacy.

Introduction: The goal of this work is to validate tools to assess clinical competences of undergraduate medical students in the workplace. One of the most well-known scales is the Mini-Clinical Evaluation Exercise (Mini-CEX). This scale has been vastly studied, however, its validity is very variable amongst studies and it has never been validated to the EU-Portuguese language and context. Subjects and methods: The translation process of the Mini-CEX was conducted by 2 bilingual individuals and overseen by four physicians specialized in medical education. We performed methods of both qualitative (translation, assessment of the translation, back translation) and quantitative nature (internal consistency, construct and content validity analysis). The scale was applied to 3rd year medical students in a simulated assessment environment with a final sample size of 818 assessments. Results: The results show that the Portuguese version of the Mini-CEX is a valid scale and fit its purpose for the assessment of clinical competencies. The Cronbach's alpha coefficient (0.927), confirmed the internal consistency of the scale. Additionally, the validity analysis also proved to be satisfactory, with confirmatory results for all domains of the analysis. Conclusions: This work intends to provide a scale, translated, adapted and validated to Portuguese that is focused on clinical competencies. Given the confirmatory results of the scale's validity, supporting its feasibility and applicability, we believe this tool is ready to be implemented as a complement to clinical skills assessment. Introducción: El objetivo de este trabajo es validar herramientas para evaluar las competencias clínicas de los estudiantes de medicina de pregrado en el lugar de trabajo. Una de las escalas más conocidas es el Mini-Clinical Evaluation Exercise (Mini-CEX). Esta escala se ha estudiado ampliamente, pero su validez es muy variable entre los estudios y nunca se ha validado para el idioma y el contexto portugués europeo. Sujetos y métodos: El proceso de traducción del Mini-CEX fue realizado por dos personas bilingües y supervisado por cuatro médicos especializados en educación médica. Se llevaron a cabo métodos de naturaleza cualitativa (traducción, evaluación de la traducción, traducción inversa) y cuantitativa (consistencia interna, construcción y análisis de validez de contenido). La escala se aplicó a estudiantes de medicina de tercer año en un entorno de evaluación simulada, con un tamaño final de la muestra de 818 evaluaciones. Resultados: Los resultados muestran que la versión portuguesa del Mini-CEX es una escala válida y se ajusta a su propósito para la evaluación de las competencias clínicas. El coeficiente alfa de Cronbach (0,927) confirmó la consistencia interna de la escala. Además, el análisis de validez también demostró ser satisfactorio, con resultados confirmatorios para todos los dominios del análisis. Conclusiones: Este trabajo pretende proporcionar una escala, traducida, adaptada y validada al portugués, que se centre en las competencias clínicas. Dados los resultados confirmatorios de la validez de la escala, que respaldan su viabilidad y aplicabilidad, creemos que esta herramienta está lista para implementarse como complemento de la evaluación de habilidades clínicas.

Introduction: Mini-CEX is an evaluation method that covers the domains: anamnesis, physical examination, counseling, clinical judgment, organization, and professionalism. It has been tested and validated for use in any practice scenario. With its characteristic of providing feedback after a clinical assessment, the Mini-CEX can also be used as a training method to guide the professional development of students and teachers, promoting greater knowledge retention in undergraduate students and continuously providing information for students to realize how far they are from the desired objectives. The aim of this study was to assess the perception of interns, residents, and preceptors of Internal Medicine (IM) regarding the Mini-CEX instrument. Methods: Qualitative study, using the focus group technique, carried out from February to July 2017. Twenty interns, thirteen residents, and five IM preceptors participated. It consisted of six focus groups, two with interns, two with residents, and two with preceptors, using semi-structured questions that identified perceptions, through the methodology used, on the quality of the evaluation and possible repercussions for the teaching-learning process. Results: In the focus group of interns, the feedback moment of the assessment was considered essential for the learning process, although the bedside assessment was tense due to the preceptor’s presence. The residents reported that the evaluation was a valid one, as it led them to review some points in the medical literature, in addition to stimulating clinical reasoning in the face of a real situation. The preceptors validated the importance of the feedback for those who were evaluated and identified the bedside assessment as a moment for the best analysis of the individualities. Conclusion: Through the perceptions of the groups in focus, the mini-CEX was identified as a fundamental instrument for the teaching and learning process of all those involved and the need to structure the moment of feedback aiming to attain a more effective result. During the bedside assessment, the stimulus to clinical reasoning was identified as a positive point and the strangeness, anxiety, and tension as negative points. Resumo: Introdução: O Mini-CEX é um método de avaliação que abrange os seguintes domínios: anamnese, exame físico, aconselhamento, julgamento clínico, organização e profissionalismo. Foi testado e validado para utilização em qualquer cenário de prática. Com sua característica de fornecer feedback após uma avaliação clínica, o Mini-CEX também serve como um método de formação para guiar o desenvolvimento profissional de formandos e formadores, promovendo maior retenção de conhecimento no corpo discente e fornecendo, continuamente, informações para que o estudante perceba o quão distante está dos objetivos almejados. O objetivo deste estudo foi verificar a percepção de internos, residentes e preceptores da clínica médica (CM) sobre instrumento Mini-CEX. Método: Trata-se de um estudo qualitativo realizado pela técnica de grupo focal no período de fevereiro a julho de 2017. Participaram 20 internos, 13 residentes e cinco preceptores de CM. Constituíram-se seis grupos focais, dois com os internos, dois com residentes e dois com docentes, com perguntas semiestruturadas que identificaram as percepções, por meio da metodologia empregada, na qualidade da avaliação e eventuais repercussões para o processo de ensino-aprendizagem. Resultados: No grupo focal dos internos, o momento de feedback da avaliação foi considerado essencial para o processo de aprendizado embora a avaliação a beira-leito tenha se mostrado tensa pela presença do tutor. Os residentes relataram que a avaliação foi válida, pois os levou a revisar alguns pontos da literatura médica, além de estimular o raciocínio clinico diante de uma situação real. Os preceptores validaram a importância do feedback para os avaliados e identificaram a avaliação a beira-leito como momento de melhor análise das individualidades. Conclusão: Por meio das percepções dos grupos em foco, identificamos o Mini-CEX como ferramenta fundamental para o processo de ensino-aprendizagem de todos os envolvidos e a necessidade de estruturação do momento de feedback para um resultado mais eficaz. Durante a avaliação a beira-leito, foi identificado o estímulo ao raciocínio clínico como ponto positivo e o estranhamento, a ansiedade e a tensão como pontos negativos.

BackgroundIt is assumed that portfolios contribute to self-regulated learning (SRL). Presence of these SRL processes within the documentation kept in portfolios is presupposed in common educational practices, such as the assessment of reflective entries. However, questions can be asked considering the presence of SRL within portfolios. The aim of this study was to gain insight into the documentation of SRL processes within the electronic (e)-portfolio content of medical trainees. SRL consists of numerous processes, for this study the focus was on self-assessment via reflection and feedback, goal-setting and planning, and monitoring, as these are the processes that health professions education research mentions to be supported by portfolios.MethodsA database containing 1022 anonymous e-portfolios from General Practitioner trainees was used to provide descriptive statistics of the various available e-portfolio forms. This was followed by a quantitative content analysis of 90 e-portfolios, for which, a codebook was constructed to rate the documentation of the included SRL processes.ResultsThe numbers of forms in the e-portfolios varied to a great extent. Content analysis showed a limited documentation of reflective entries, and available entries mainly described events and experiences without explanations and context. Feedback was generally limited to comments on what went well and lacked specificity, context and suggestions for future action. Learning goals and plans were short of specificity, but did contain challenging topics and different goals were compatible with each other. 75% of the e-portfolios showed (limited) signs of monitoring.ConclusionsThe e-portfolio content showed limited documentation of SRL processes. As documentation of SRL requires time and asks for a high level of introspection and writing skills, one cannot expect documentation of SRL processes to appear in e-portfolio content without efforts.

This article was migrated. The article was marked as recommended. Introduction: The mini-clinical evaluation exercise (mini-CEX) allows for assessment and subsequent feedback across a range of individual clinical cases, although much of what is assessed is left implicit. After the performance by a trainee, further observation of appropriate clinical performance by the tutor provides a strong standard of reference for effective learning. Methods: In each mini-CEX encounter one final year resident clinically assessed an unfamiliar patient in the presence of peers and a tutor. The tutor then demonstrated the appropriate clinical behaviour. Twelve peers rated the performance of the resident before and after the tutor-demonstrated feedback (TDF). The encounters with the first cases by each of the participants were completed one by one and the cycles of encounters with the next cases by each resident were similarly continued. Results: All 13 participants completed six mini-CEX encounters over one year with an overall response rate of 95% for peer-assessment ratings (PARs). There was a total of 1772 PAR forms each with seven parameters and 1772 peer-satisfaction rating (PSR). Reliability coefficients of PARs ranged from .77 to .93. The PARs decreased significantly in each of the six cases after TDF (p

Background Cultural differences might challenge the acceptance of the implementation of assessment formats that are developed in other countries. Acceptance of assessment formats is essential for its effectiveness; therefore, we explored the views of students and specialists on the practicality and impact on learning of these formats. This study was conducted to explore Indonesian students’ and specialists’ appreciation of the implementation of the Mini-Clinical Evaluation Exercise (Mini-CEX) in Indonesian clerkships. Methods This study was conducted at the Universitas Gadjah Mada, Indonesia. Participants were 52 students and 21 specialists in neurology and 78 students and 50 specialists in internal medicine. They were asked to complete a 19-item questionnaire that covered the characteristics of the mini-CEX such as its practicality, and the impact on learning and professional development. We used a Mann-Whitney U test to analyse the data. Results In total, 124 students (46 from neurology and 78 from internal medicine) and 38 specialists (13 from neurology and 25 from internal medicine) participated in this study. Students and specialists were positive about the practicality of the mini-CEX and the impact of this assessment format on learning and on professional development. The Mann-Whitney U test showed that there were no significant differences between students’ and specialists’ opinions on the mini-CEX, except for 2 items: specialists’ appreciation of direct observation (mean rank = 93.16) was statistically significantly higher than students’ appreciation of it (mean rank = 77.93; z = 2.065; p p Conclusion Students and specialists were positive about the mini-CEX in Indonesian clerkships, although it was developed and validated in another culture. We found only small differences between their appreciations, which could be explained by the patterns of specialist-student interaction in Indonesian culture as large power distance and low individualism country.

Objective: To evaluate the quality of the observed mini-CEX scores by estimating reliability coefficients and standard errors. Study Design: Quasi-experimental, co relational study. Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi from Sep 2016 to Oct 2017. Material and Methods: This Quasi-experimental, correlational study was conducted with the OBGYN residents through non probability convenience sampling at Pak Emirates Military Hospital with sample size of 40. Twenty residents underwent Mini CEX (in addition to the existing teaching) while 20 had training through existing traditional teaching methods (lectures, SGDs, OPD, ward rounds, journal clubs, CPCs). Before commencing the study both faculty and Resident trainees were introduced to Mini-CEX. The faculty (CPSP accredited supervisors), were given face to face training in conducting and rating Mini-CEX by a workshop. Each of the 20 trainees took four Mini-CEX sessions over a period of one year. The clinical skills were rated on a standard adapted Mini-CEX proforma. The trainees were given immediate feedback. Action plan was made and documented on the proformas. Results: The Trainees were assessed for improvement in clinical skills over the period of 12 months; and a trend of increased performance was obsessed amongst the trainees with each subsequent evaluation, supporting the construct validity of the instruments. Conclusions: The study showed that the mini-CEX is a potentially powerful tool to provide high-quality, interactive feedback that could contribute to improvement in trainees’ clinical skills.

Objective: To assess feasibility, acceptability and effectiveness of launching mini-CEX as a Work Place Based Assessment tool in Obs/Gynae post-graduate residency program. Study Design: Mixed method approach. Place and Duration of Study: Obs/Gynae dept of Islamic International Medical College Rawalpindi Pakistan, from Aug 2016 to Feb 2017. Patients and Methods: Twenty one post graduate residents from first to final year MCPS/FCPS and available faculty members (10) were invited to participate. Non-probability convenience sampling was used. We adopted an amended mini-CEX tool. The residents were assessed in history taking, physical examination, clinical judgment, communication skills and professionalism. Copies of the mini-CEX forms were collected and analyzed. Results of the first and last Mini CEX scores were compared to determine the efficiency of mini-CEX. These results were analyzed using SPSS version 21. Perceptions of faculty and PG residents are expressed as average scale frequencies ± 2 standard deviation. To assess the feasibility; time taken for each encounter was noted. Mean time was calculated. The total time taken for mini-CEX encounters during the study period was extrapolated over a year. For further assessing the feasibility; considerable practical difficulties were identified. Results:Almost all the residents (18/21) and faculty members (8/10) were satisfied with the mini-CEX as a learning tool. More than 75% of the residents showed gradual improvement in scores from the first to the fourth mini-CEX. The average duration of mini-CEX was 19.51 minutes. Average time taken for the feedback was 13.08 minutes. Seventeen residents were contented with feedback of each session of mini-CEX. Majority of comments indicated that feedback was the strongest characteristic of mini-CEX. Most participants (17 residents; 8 faculty members) never or occasionally experienced trouble organizing the mini-CEX. About 27% residents felt anxious being observed. Conclusions:This study concluded that Mini-CEX is highly acceptable and feasible educational tool. Its effectiveness was established by statistically significant improvement in results of post graduate residents over a period of time. It was also useful in helping faculty to assess and to give formative feedback to residents on their clinical performance in real workplace based environment.

Background Direct observation of medical students with actual patients is important for the assessment of clinical skills including interviewing and counseling skills. This article describes medical students’ experience of mini-clinical evaluation exercise (mini-CEX) during their clerkship in consultation psychiatry. Materials and methods In our center during inpatient consultation psychiatry clerkship, all rotating students are expected to complete one mini-CEX assessment as part of their clinical training. We conducted retrospective analysis of mini-CEX ratings completed from 2013 to 2016. All evaluations took place at inpatient medical setting in patients admitted with medical conditions and psychiatric comorbidities. Results A total of 113 evaluations were reviewed. The time examiner observed the interaction of a student with the patient was 14.24 minutes (mean), and the time spent in providing feedback to the student was 9.71 minutes. Complexity of problem was rated as low in 0.88% (n=1), moderate in 50.44% (n=57), and high in 48.67% (n=55). Highest ratings were for professionalism, similar to previous reports. Total score calculated by examiner showed no difference by the complexity of the patient; however, we observed a trend in higher counseling score for the high complexity group. Conclusion Mini-CEX assessment during busy clerkship is feasible with good outcomes. Direct observation of medical trainees with actual patients is important for the assessment of performance-based clinical skills. Hospital psychiatry rotation covering various medical and surgical units offers a great opportunity for exposure in patient communication., Video abstract

Item does not contain fulltext Whenever multiple observers provide ratings, even of the same performance, inter-rater variation is prevalent. The resulting 'idiosyncratic rater variance' is considered to be unusable error of measurement in psychometric models and is a threat to the defensibility of our assessments. Prior studies of inter-rater variation in clinical assessments have used open response formats to gather raters' comments and justifications. This design choice allows participants to use idiosyncratic response styles that could result in a distorted representation of the underlying rater cognition and skew subsequent analyses. In this study we explored rater variability using the structured response format of Q methodology. Physician raters viewed video-recorded clinical performances and provided Mini Clinical Evaluation Exercise (Mini-CEX) assessment ratings through a web-based system. They then shared their assessment impressions by sorting statements that described the most salient aspects of the clinical performance onto a forced quasi-normal distribution ranging from "most consistent with my impression" to "most contrary to my impression". Analysis of the resulting Q-sorts revealed distinct points of view for each performance shared by multiple physicians. The points of view corresponded with the ratings physicians assigned to the performance. Each point of view emphasized different aspects of the performance with either rapport-building and/or medical expertise skills being most salient. It was rare for the points of view to diverge based on disagreements regarding the interpretation of a specific aspect of the performance. As a result, physicians' divergent points of view on a given clinical performance cannot be easily reconciled into a single coherent assessment judgment that is impacted by measurement error. If inter-rater variability does not wholly reflect error of measurement, it is problematic for our current measurement models and poses challenges for how we are to adequately analyze performance assessment ratings.

In the midst of clinical environment unpredictability, feedback helps students to make the most out of clinical learning opportunities. Mini clinical evaluation exercise (Mini-CEX) is considered to be appropriate for providing feedback to students. This study aims to explore the feedback process within the Mini-CEX at a large Australian medical school. Between year 2011-2012, 23 Mini-CEX sessions, involved 18 final year medical students, were observed, followed by 15-minutes structured interviews. 7 experienced clinical teachers were also interviewed. A questionnaire administered to 274 final year medical students to seek their views on feedback provided in the Mini-CEX. Most feedback has complied with the characteristics of constructive feedback, however the amount of feedback decreased as the quality level of feedback increased. These findings matched students’ perceptions recorded on the questionnaire. The themes derived from the interviews showed that for feedback to be useful, each of feedback process components (feedback provider, types of feedback, feedback recipient and action plans following feedback) need to be attended to. Both tutors and students need to focus on the process of incorporating feedback to inform students’ learning, not only on the feedback characteristics. One of the means to achieve this is by providing reflective feedback where students are considered as active recipients. Keywords: feedback, Mini-CEX, clinical, assessment, learning. Proses Umpan Balik pada Mini Clinical Evaluation Exercise (Mini-CEX): Studi Eksplorasi Abstrak Di tengah ketidakpastian lingkungan klinis, umpan balik membantu mahasiswa memaknai kesempatan belajar di tatanan klinis. Mini clinical evaluation exercise (Mini-CEX) cocok untuk memberikan umpan balik kepada mahasiswa. Studi ini bertujuan untuk mengeksplorasi proses umpan balik pada Mini-CEX di sebuah fakultas kedokteran besar di Australia. Antara tahun 2011-2012, 23 sesi Mini-CEX, melibatkan 18 mahasiswa kedokteran tahap akhir, diobservasi dan dilanjutkan wawancara terstruktur selama 15 menit. 7 dosen klinik berpengalaman juga diwawancara. Kuesioner diberikan kepada 274 mahasiswa kedokteran tahap akhir untuk mengetahui pandangan mereka terhadap umpan balik yang diberikan dalam Mini-CEX. Sebagian besar umpan balik telah memenuhi karakteristik umpan balik konstruktif, namun jumlah umpan balik menurun seiring dengan meningkatnya level kualitas umpan balik. Hal tersebut juga ditemukan dalam persepsi mahasiswa yang tercatat sebagai hasil kuesioner. Tema yang diidentifikasi dari wawancara memperlihatkan bahwa agar umpan balik bermanfaat, setiap komponen dari proses umpan balik (pemberi umpan balik, tipe umpan balik, penerima umpan balik, rencana aksi setelah umpan balik) perlu diperhatikan. Baik dosen maupun mahasiswa harus fokus pada proses untuk memastikan bahwa umpan balik dimanfaatkan dalam pembelajaran, tidak hanya pada karakteristik umpan balik semata. Salah satu cara untuk mencapai hal tersebut adalah dengan memberikan umpan balik reflektif yaitu mahasiswa diperlakukan sebagai penerima aktif. Kata kunci: umpan balik, Mini-CEX, klinik, asesmen, pembelajaran.&nbsp

Introduction: The goal of this work is to validate tools to assess clinical competences of undergraduate medical students in the workplace. One of the most well-known scales is the Mini-Clinical Evaluation Exercise (Mini-CEX). This scale has been vastly studied, however, its validity is very variable amongst studies and it has never been validated to the EU-Portuguese language and context. Subjects and methods: The translation process of the Mini-CEX was conducted by 2 bilingual individuals and overseen by four physicians specialized in medical education. We performed methods of both qualitative (translation, assessment of the translation, back translation) and quantitative nature (internal consistency, construct and content validity analysis). The scale was applied to 3rd year medical students in a simulated assessment environment with a final sample size of 818 assessments. Results: The results show that the Portuguese version of the Mini-CEX is a valid scale and fit its purpose for the assessment of clinical competencies. The Cronbach's alpha coefficient (0.927), confirmed the internal consistency of the scale. Additionally, the validity analysis also proved to be satisfactory, with confirmatory results for all domains of the analysis. Conclusions: This work intends to provide a scale, translated, adapted and validated to Portuguese that is focused on clinical competencies. Given the confirmatory results of the scale's validity, supporting its feasibility and applicability, we believe this tool is ready to be implemented as a complement to clinical skills assessment.

Introduction: Acquisition of clinical skills is the main aim of the compulsory clinical rotations during internship. It is left to chance that students acquire clinical skills as there is no formal assessment to ensure that skill learning has actually taken place. The best method for assessing clinical competence is Work Place Based Assessment (WPBA). Mini-clinical Evaluation Exercise (mini-CEX) and Directly Observed Procedural Skills (DOPS) are among some of the tools used for assessment of clinical competence. These tools can also be used to incorporate feedback to the students and at the same time it can be used as an excellent teaching-learning opportunity. Aim: To assess the feasibility and use of Mini-clinical evaluation exercise and directly observed procedural skills as assessment tools for assessing clinical competence of interns. Materials and Methods: This Prospective interventional study was conducted in Department of Ophthalmology of Punjab Institute of Medical Sciences, Jalandhar, Punjab, India from June 2016-June 2017. The clinical competence of interns was assessed using mini-CEX and DOPS. One Hundred interns undertook four Mini-clinical evaluation exercises each by different assessors and at least one DOPS for refraction was conducted per intern. If result was unsatisfactory, then further DOPS was undertaken till performance was satisfactory. The grading was done on the checklist (key points required) and evaluation done in points as pre-decided by assessors on a scale of 1-9 (1-3 unsatisfactory, 4-6 satisfactory and 7 to 9 superior). Satisfaction with the process of assessment by miniCEX was also graded on a 9 point scale. Overall performance of interns for the procedure of refraction was graded on a 9 point scale in DOPS. A feedback questionnaire about the conduct and acceptability of assessment tools was taken from the interns and assessors at the end of their posting using a prevalidated questionnaire. All the results were computed using SPSS software (version 22.0). Average scores of all the interns in each subcompetency of mini-CEX and DOPS were recorded. The progression of the scores was observed from first miniCEX and the fourth mini-CEX. Comparison of scores was done between mini-CEX 1 vs. mini-CEX 4 using ANOVA Post-hoc Tukey’s Test. Results: A total of 100 interns undertook 400 Mini-clinical evaluation exercise (four Mini-clinical evaluation exercise each intern) and 160 DOPS (at least one DOPS each). For Miniclinical evaluation exercise (total including 1, 2, 3 and 4) the grading was satisfactory in 76.25% (305) and unsatisfactory in 23.75 % (95). For DOPS (total=160), 62.5% (100) were graded as satisfactory and 37.5% (60) of the DOPS were graded unsatisfactory. A mean score of 8.0 was given by interns and 7.7 by faculty for their satisfaction with assessment by miniCEX. Overall performance in DOPS was graded as 6.2. Conclusion: Mini-clinical evaluation exercise and directly observed procedural skills are useful assessment tools for assessing competence in interns and further improving clinical skills. It is feasible to use these assessment methods in ophthalmology clinical setting. These assessment methods act as an effective tool for giving feedback.

ObjectivesThe formative aspect of the mini-clinical evaluation exercise (mini-CEX) in postgraduate medical workplace-based assessment is intended to afford opportunities for active learning. Yet, there is little understanding of the perceived relationship between the mini-CEX and how trainees self-regulate their learning. Our objective was to explore trainees’ perceptions of their mini-CEX experiences from a learning perspective, using Zimmerman’s self-regulated learning theoretical framework as an interpretive lens.DesignQualitative, using semi-structured interviews conducted in 2017. The interviews were analysed thematically.SettingGeriatric medicine training.ParticipantsPurposive sampling was employed to recruit geriatric medicine trainees in Melbourne, Australia. Twelve advanced trainees participated in the interviews.ResultsFour themes were found with a cyclical inter-relationship between three of these themes: namely, goal setting, task translation and perceived outcome. These themes reflect the phases of the self-regulated learning framework. Each phase was influenced by the fourth theme, supervisor co-regulation. Goal setting had motivational properties that had significant impact on the later phases of the cycle. A ‘tick box’ goal aligned with an opportunistic approach and poorer perceived educational outcomes. Participants reported that external feedback following assessment was critical for their self-evaluation, affective responses and perceived outcomes.ConclusionsTrainees perceived the performance of a mini-CEX as a complex, inter-related cyclical process, influenced at all stages by the supervisor. Based on our trainee perspectives of the mini-CEX, we conclude that supervisor engagement is essential to support trainees to individually regulate their learning in the clinical environment.

Objective This study was aimed to explore students’ learning response toward feedback during mini-CEX encounter. Methods This study used a phenomenological approach to identify the students’ experiences toward feedback during mini-CEX encounter. Data was collected using Focus Group Discussion (FGD) for all students who were in their final week of clerkship in the internal medicine rotation. There were 4 FGD groups (6 students for each group). All FGD were audio-taped and transcribed verbatim. The FGD transcripts were analyzed thematically and managed using Atlas-ti (version 7.0). Results Feedback content and the way of providing feedback on mini-CEX stimulated students’ internal process, including self-reflection, emotional response, and motivation. These internal processes encouraged the students to take action or do a follow-up on the feedback to improve their learning process. In addition, there was also an external factor, namely consequences, which also influenced the students’ reaction to the follow-up on feedback. In the end, this action caused several learning effects that resulted in the students’ increased self-efficacy, attitude, knowledge and clinical skill. Conclusions Feedback content and the way of providing feedback on mini-CEX stimulates the students’ internal processes to do a follow-up on feedback. However, another external factor also affects the students’ decision on the follow-up actions. The follow-ups result in various learning effects on the students. Feedback given along with summative assessment enhances learning effects on students, as well. It is suggested that supervisors of clinical education are prepared to comprehend every factor influencing feedback on mini CEX to improve the students’ learning response.

Objectives The Mini-Clinical Evaluation Exercise (mini-CEX) is one of the most commonly used clinical assessment tools to provide learner feedback to drive learning. High quality constructive feedback promotes development and improves clinical competency. However, the effectiveness of feedback has not been objectively evaluated from the learners' and assessors' points of view, especially in Asia, where the nature of the student–tutor relationship is relatively hierarchical. This study seeks to compare the strengths, limitations, and feedback of the mini-CEX between assessors and students. Materials and Methods A cross-sectional study was conducted among 275 senior medical undergraduates at the National University of Singapore and 121 clinical tutors from seven restructured hospitals in Singapore. Data was collected via a self-administered questionnaire. Univariate analysis was used to determine the prevalence of responses, as well as differences between tutors and students. Results The mini-CEX provided immediate feedback and timely correction of mistakes. However, effective administration was limited by inter-tutor variability and lack of time. Students reported being receptive to feedback, but tutors disagreed and felt that students were resistant to negative feedback. Additionally, students felt that their performance was compared unfairly against more senior students, although the tutors felt otherwise. Conclusion The mini-CEX is an effective assessment tool, but is limited by barriers to administration and evaluation. Differing opinions and expectations between tutors and students could provide an interesting focal point for future studies.

Objectives: Workplace-based assessments are based on the principle of providing feedback to medical students on clinical performance in authentic settings. In practice, however, the assessment often overshadows the feedback. The aim of this study was to determine what problems faculty perceived when performing workplace-based assessments and what solutions they suggested to overcome these difficulties. Methods: Discussion meetings were conducted with education coordinators and faculty (n=55) from 11 peripheral hospitals concerning the difficulties encountered when conducting workplace-based assessments. We analysed the reports from these discussion meetings using an integrated approach guided by our research questions to code the data. Two researchers analysed the data independently and resolved differences of opinion through consensus. Results: The problems perceived by faculty in workplacebased assessments (difficulties) and suggestions for improvement formed the overarching themes. Problems included the short duration of clerkships, students choosing the assessment moments, the use of grades for the miniClinical Evaluation Exercise, the difficulty in combining teacher and assessor roles and the difficulty in giving fail judgements. Suggestions for improvement included longer clerkship duration, faculty choosing the assessment moments, using a pass/fail system for the mini-Clinical Evaluation Exercise and forward feeding of performance from earlier clerkships following a fail judgement. Conclusions: Our study indicates that faculty perceive difficulties when conducting workplace-based assessments. These assessments need periodical review to understand the difficulties faculty experience using them; they also require periodical feedback to ensure their proper and effective use.

Fil: Alves de Lima, Alberto. Universidad Nacional del Nordeste. Facultad de Medicina; Argentina. Fil: Di Bernardo, Juan José. Universidad Nacional del Nordeste. Facultad de Medicina; Argentina. Los sistemas de evaluación en los programas de educación médica de grado enfatizan el desarrollo y la adquisición de conocimientos, habilidades y competencias. El concepto de competencia clínica puede ser observado desde distintos ángulos; así Kane M. la definió como el grado en que un individuo puede usar sus conocimientos, habilidades y el criterio asociado a su profesión para llevar adelante eficientemente en diferentes escenarios los problemas de su práctica. 1 Desde la etapa de alumno de medicina en formación de grado hasta volverse un médico experto se requiere compromiso con la práctica, mantener la reflexión en y sobre su práctica acompañada de una estimulante retroalimentación (RA) por parte de sus docentes evaluadores. 2, 3 Esto implica construir un andamiaje en el que el alumno debe ser capaz de plantearse problemas, elaborar hipótesis, evaluar diagnósticos, tratamientos y justificar las técnicas de estudios seleccionadas. La Asociación Americana de Medicina Interna en la década de 1990 (American Board of Internal Medicine; ABIM) desarrolló inicialmente el ejercicio de evaluación clínica con caso largo. Como una mejora en el año 1995 se desarrolló el ejercicio de evaluación clínica reducido (EECR, mini-CEX) demostrando su validez y confiabilidad y posteriormente comenzó a aplicarse en la educación médica de grado. 4, 5 En nuestro país existe experiencia publicada en la que se reporta la satisfacción de alumnos y residentes con la herramienta de evaluación, pero se discute su impacto educativo en establecer una diferencia sobre resultados del aprendizaje en las distintas instituciones de formación. 6-8 La nueva curricula (desde el año 2000) de la Facultad de Medicina de la Universidad Nacional del Nordeste (U.N.NE; Ciudad de Corrientes, Argentina), está basada en un modelo de desarrollo de competencias que promueve la exposición clínica temprana del alumno. En la etapa de formación clínica de los alumnos, desde tercero a quinto año se comenzaron a utilizar nuevas estrategias de evaluación con observación basadas en el lugar de trabajo que fomentan el desarrollo de habilidades clínicas. A nivel institucional y departamental en nuestra Facultad de Medicina se reconoció la necesidad de alinear los constructos de evaluación formativa detectados con los objetivos de aprendizajes de habilidades procedimentales formulados para los alumnos en período clínico, lo que condujo a la implementación del mini-CEX. La asignatura Medicina II seleccionó para su programa la herramienta de evaluación mini-CEX como nueva forma de evaluación formativa complementaria por sus propiedades psicométricas considerando que permitirá objetivar y evidenciar el rendimiento clínico de los alumnos. La elección del mini-CEX se basó, además, en su practicidad para evaluar habilidades en la interacción médico - paciente - alumno en diferentes escenarios clínicos y con la realización de retroalimentación constructiva inmediata. Esta herramienta de evaluación formativa innovadora se introdujo en la cátedra en el año 2013 como parte complementaria del sistema de evaluación de la cátedra sexta correspondiente al área de dictado de Clínica Médica de la Asignatura Medicina II, de la Facultad de Medicina de la U.N.NE. El mini-CEX con pacientes reales consiste en encuentros bajo la forma de un ejercicio clínico reducido, breve, focalizado de cada alumno con diferentes pacientes en ambiente clínico real y con observación directa (OD) por un evaluador quien luego de calificar el rendimiento observado (contra un criterio estándard) en un formulario estructurado realiza una RA constructiva con un plan de acción con el fin de mejorar su rendimiento clínico. Es una herramienta de evaluación formativa que se desarrolla en ambiente clínico auténtico utilizando un formulario estructurado que evalúa seis habilidades y una impresión global para el desarrollo de la competencia clínica. Ahora, en la Facultad de Medicina y en nuestra asignatura Medicina II (U.N.NE.) no existen antecedentes de datos publicados acerca de la aplicación de una herramienta de evaluación formativa basada en la observación directa como el mini-CEX. Hasta el momento se desconocen los resultados que tendría la aplicación práctica del mini-CEX en la población de alumnos del período clínico correspondientes al cuarto año de la carrera de medicina de la U.N.NE. Por otra parte, a nivel nacional son escasos los reportes de su aplicabilidad en el grado en la evaluación de diferentes dominios de competencia clínica. Fil: Gómez, José Ramón Oscar. Universidad Nacional del Nordeste. Facultad de Medicina; Argentina.

Background One of the most frequently used assessment tools that measure the trainees’ performance in workplace is the mini-Clinical Evaluation Exercise (mini-CEX), in which an expert observes and rates the actual performance of trainees. Several primary studies have evaluated the effectiveness of mini-CEX by assessing its educational and psychometric properties. The objective of this BEME review is to explore, analyze, and synthesize the evidence considering the utility of the mini-CEX for assessing undergraduate and postgraduate medical trainees. Methods Studies reporting on mini-CEX performed in undergraduate and postgraduate medical education and providing some empirical data for mini-CEX in relation to one or more of the validity, reliability, educational impact, acceptability, and cost of mini-CEX will be included in the review. No restrictions on study design or publication date or language will be handled. To ensure comprehensiveness of our search, we will use different approaches and methods. In addition to electronic search in bibliographic databases, we will conduct forward and backward searching. We will also contact leading authors in the field of mini-CEX and will search for the gray literature. Data extractions will be done independently by two coders based on a form. If there is any discordance, a third author will resolve it. The quality assessment will be also done independently by two team members, based on critical appraisal checklists. In attempting to answer our original research questions, we will use meta-analysis or meta-synthesis. Discussion The findings of this study can be transferred to the medical education stakeholders such as administrators of medical schools, residency program directors, and faculty members. We also hope that publication of this review will encourage stakeholders who have already adopted the mini-CEX to evaluate and report its different characteristics. Lastly, we expect that we can identify gap of knowledge in this field and suggest areas for future research.

This article was migrated. The article was marked as recommended. Introduction: Direct observation assessments that provide both formative feedback and data for summative decisions can be difficult to achieve. The mini-clinical evaluation exercise (mini-CEX) is a widely used tool of direct observation that provides opportunities for feedback. We introduced a direct observation system with frequent mini-CEXs to increase clerkship student learning opportunities and to improve competency-based summative decisions. However, students may express resistance to assessments for learning with any summative impact as they may perceive the assessments as purely a series of summative evaluations. Aims: We explored how frequent low-stakes mini-CEXs affect clerkship students' perception of learning and to understand student perceptions of these assessments supporting their end-of-rotation summative clinical performance evaluations. Methods: This qualitative study used a purposive sampling strategy of focus groups with students who completed multiple mini-CEXs during their four-week neurology clerkship at one of three sites. All eleven students chose to participate. Eight students completed eight mini-CEXs, two students completed seven, and one student completed four. Investigator triangulation was used with interpretation comparisons that included independent content analysis. The emerging themes were discussed and final theme consensus was reached. Results: Three major themes arose: perceived effects of frequent mini-CEXs for clerkship student learning by facilitating multiple opportunities for guided practice under low assessment anxiety; the importance of consistent, effective faculty feedback and engagement to maximize mini-CEXs for learning; and support for summative impact of frequent, mainly formative, low stakes mini-CEXs. Conclusions: Students perceived that frequent mini-CEXs are mainly formative assessments for learning while having summative impact. However, variable perceived faculty affinity and engagement with the mini-CEX are important considerations to maximize the assessments for learning. These findings support a shift towards workplace-based assessment programs for learning that promote frequent direct observation and feedback, while also improving the trustworthiness of summative decisions.

Background: Various feedback characteristics have been suggested to positively influence student learning. It is not clear how these feedback characteristics contribute to students' perceived learning value of feedback in cultures classified low on the cultural dimension of individualism and high on power distance. This study was conducted to validate the influence of five feedback characteristics on students' perceived learning value of feedback in an Indonesian clerkship context.Methods: We asked clerks in Neurology (n = 169) and Internal Medicine (n = 132) to assess on a 5-point Likert scale the learning value of the feedback they received. We asked them to record whether the feedback provider (1) informed the student what went well, (2) mentioned which aspects of performance needed improvement, (3) compared the student's performance to a standard, (4) further explained or demonstrated the correct performance, and (5) prepared an action plan with the student to improve performance. Data were analyzed using multilevel regression.Results: A total of 250 students participated in this study, 131 from Internal Medicine (response rate 99%) and 119 from Neurology (response rate 70%). Of these participants, 225 respondents (44% males, 56% females) completed the form and reported 889 feedback moments. Students perceived feedback as more valuable when the feedback provider mentioned their weaknesses (beta = 0.153, p Conclusions: In Indonesia, we could validate four out of the five characteristics for effective feedback. We argue that our findings relate to culture, in particular to the levels of individualism and power distance. The recognized characteristics of what constitutes effective feedback should be validated across cultures.

Background: Despite an increasing emphasis on workplace-based assessment (WPBA) during medical training, the existing assessment system largely relies on summative assessment while formative assessment is less valued. Various tools have been described for WPBA, mini-clinical evaluation exercise (mini-CEX) being one of them. Mini-CEX is well accepted in Western countries, however, reports of its use in India are scarce. We conducted this study to assess acceptability and feasibility of mini-CEX as a formative assessment tool for WPBA of surgical postgraduate students in an Indian setting. Methods: Faculty members and 2nd year surgical residents were sensitized toward mini-CEX and requisite numbers of exercises were conducted. The difficulties during conduction of these exercises were identified, recorded, and appropriate measures were taken to address them. At the conclusion, the opinion of residents and faculty members regarding their experience with mini-CEX was taken using a questionnaire. The results were analyzed using simple statistical tools. Results: Nine faculty members out of 11 approached participated in the study (81.8%). All 16 2nd year postgraduate surgical residents participated (100%). Sixty mini-CEX were conducted over 7 months. Each resident underwent 3–5 encounters. The mean time taken by the assessor for observation was 12.3 min (8–30 min) while the mean feedback time was 4.2 min (3–10 min). The faculty reported good overall satisfaction with mini-CEX and found it acceptable as a formative assessment tool. Three faculty members (33.3%) reported mini-CEX as more time-consuming while 2 (22.2%) found it difficult to carry the exercises often. All residents accepted mini-CEX and most of them reported good to high satisfaction with the exercises conducted. Conclusions: Mini-CEX is well accepted by residents and faculty as a formative assessment tool. It is feasible to utilize mini-CEX for WPBA of postgraduate students of surgery.

Mini-clinical evaluation exercise in UK medical education has grown in recent years. We conducted Mini-CEX as a clinical evaluation method to assess its’ feasibility and students’ acceptance in undergraduate trainees. They were assessed by valid and reliable rating scale.Then, their satisfaction and experiences were assessed. Trainees’ satisfaction of mini-CEX was 76.8±12.5 (of 100). They mentioned that this method could improve their motivation, but it was time-consuming. The results implicate that undergraduate students were satisfied with mini-CEX outcome. But they worried about its’ long process. We recommend shortening its’ process by dividing it into some parts in order to use mini-CEX as a lifelong learning.

The assessment of undergraduate medical students in the clinical setting has become a key priority for medical educators. Facilitating the successful translation of undergraduate theoretical knowledge into safe and appropriate postgraduate clinical practice represents a challenge in medical education [1]. Poor clinical performance of newly qualified doctors has been highlighted as a major issue relating to patient safety [2]. Performance based assessment in the undergraduate setting may assist in addressing this issue by assessing ‘doing’ rather than ‘knowing’. The mini clinical evaluation exercise (Mini-CEX) is a formative assessment used to assess the performance of medical students in a clinical context. It incorporates assessment by, and feedback from, an assessor, based on the direct observation of a student–patient consultation [3]. Conducted in a series of stages, the Mini-CEX allows focused assessment of key competencies (see Box 1) [3].

Introducción: Hasta el momento, la evaluación en las carreras de licenciatura en cinesiología contempla contenidos conceptuales, además de que el estudiante desarrolle en el proceso de enseñanza-aprendizaje contenidos procedimentales y actitudinales. Las competencias necesarias para el ejercicio de la cinesiología afectan los dominios procedimentales y actitudinales, más allá de los conceptuales, lo que pone de manifiesto la insuficiencia de las evaluaciones tradicionales. Por tal motivo se analizó la aplicación y las aportaciones de un instrumento de evaluación holística, el mini-CEX. Sujetos y métodos: Se aplicó una planilla del mini-CEX adaptada a 125 estudiantes de cuarto y quinto año de la carrera de licenciatura en cinesiología que cursan asignaturas específicas de práctica profesional. Resultados: Participaron 125 estudiantes en 20 evaluaciones (cinco en cada asignatura), con una media de 1,3 a 4,6, que fue mejorando en cada evaluación. El tiempo de cada una fue de 20 minutos. Conclusión: El instrumento constituye un aportación a la evaluación de competencias en estudiantes de cinesiología. Introduction: So far, the evaluation Degree Careers in Kinesiology, provide conceptual, regardless students develop in the teaching-learning process in the field, procedural and attitudinal. The skills required for the exercise of kinesiology undertake procedural and attitudinal domains, beyond the conceptual, which highlights the inadequacy of traditional assessments. Therefore the applicability and reliability of an instrument of holistic assessment, the mini-CEX analyzed. Subjects and methods: A form of mini-CEX 125 adapted to fourth and fifth year of the Bachelor in Kinesiology specific subjects enrolled in professional practice applies. Results: 125 students participated in 20 evaluations (five in each subject) with an average of 1.3 to 4.6, which was improving with every evaluation. Each time was 20 minutes. Conclusion: It is concluded that the reliability and feasibility study indicated when applied kinesiology students.

Antecedentes: la lectura de los trabajos de Miller y Montesinos, entre otros, nos alentó a iniciar cambios en nuestra unidad académica, definir mejor las competencias clínicas y adecuar la enseñanza y evaluación. Objetivos: comunicar una experiencia docente de evaluación formativa compartida permanente. Material y métodos: analizamos nuestra experiencia con: 1) una lista de verificación de las 5 competencias del Mini-CEX para Evaluación Formativa Compartida Permanente con devolución, 2) un programa elemental de Lectura crítica de trabajos científicos, 3) un ejercicio clínico presentado por alumnos, 4) teóricos grabados con voz en el Entorno Educativo a disposición permanente de alumnos, 5) un e-book gratuito 3a edición 2016 y 6) simulación de prácticas sencillas en el Hospital de Simulación Clínica (HoSiC). Finalmente, hicimos una encuesta informatizada de satisfacción a los alumnos que cursaron en 2016 con Google Forms® como referencia aproximada del impacto. Resultados: obtuvimos 46 respuestas de 67. Los alumnos consideraron como buenos o muy buenos: 1) trabajos prácticos 69%, 2) teóricos grabados 90%, 3) el e-book 90%, 4) Ejercicios clínicos 100%, 5) Lectura crítica 85%, 6) Teóricos breves 58% y 7) Curso completo 90%. La encuesta específica para Simulación mostró que: a) el 67% nunca había hecho esas prácticas, b) el 100% la consideró muy buena y c) el 65% de los alumnos mejoró el tiempo y la calidad de ejecución de la práctica al repetirla. Conclusiones: si bien las encuestas hablan poco del proceso de enseñanza-aprendizaje, la satisfacción se correlaciona en forma directa con la motivación, que es esencial a la hora de aprender y de enseñar., Background: the reading of the works of Miller and Montesinos among others, encouraged us to initiate changes in our academic unit. Better definition of clinical skills, and adequate teaching and assessment. Objectives: to communicate a teaching experience of continuous shared formative evaluation. Materials and methods: we analyze our experience with: 1) a checklist of the 5 competencies of the MiniCEX for Permanent Formative Shared Assessment with feedback, 2) an elementary program of Critical Reading of Scientific Works, 3) a clinical exercise presented by students, 4) conferences recorded with voice in the Educational Environment available for students, 5) a free Ebook 3rd edition 2016, and 6) simulation of simple practices in Clinical Simulation Hospital (HoSiC). Finally, we did a computerized survey of satisfaction to the students that took in 2016 with Google Forms® as approximate reference of the impact. Results: we obtained 46 responses of 67, students considered as good or very good: 1) Practical Works 69%, 2) Theoretical Engravings 90%, 3) The Ebook 90%, 4) Clinical Exercises 100%, 5) Critical Reading 85 %, 6) Theorists Brief 58% and 7) Complete Course 90%. The specific survey for Simulation showed that: a) 67% had never done these practices, b) 100% considered it Very Good and c) 65% of the students improved the time and quality of execution of the practice when repeating it. Conclusions: although the surveys speak little about the Teaching-Learning process; Satisfaction correlates directly with motivation, which is essential when it comes to learning and teaching., Facultad de Ciencias Médicas

Introducción: Hasta el momento, la evaluación en las carreras de licenciatura en cinesiología contempla contenidos conceptuales, además de que el estudiante desarrolle en el proceso de enseñanza-aprendizaje contenidos procedimentales y actitudinales. Las competencias necesarias para el ejercicio de la cinesiología afectan los dominios procedimentales y actitudinales, más allá de los conceptuales, lo que pone de manifiesto la insuficiencia de las evaluaciones tradicionales. Por tal motivo se analizó la aplicación y las aportaciones de un instrumento de evaluación holística, el mini-CEX. Sujetos y métodos: Se aplicó una planilla del mini-CEX adaptada a 125 estudiantes de cuarto y quinto año de la carrera de licenciatura en cinesiología que cursan asignaturas específicas de práctica profesional. Resultados: Participaron 125 estudiantes en 20 evaluaciones (cinco en cada asignatura), con una media de 1,3 a 4,6, que fue mejorando en cada evaluación. El tiempo de cada una fue de 20 minutos. Conclusión: El instrumento constituye un aportación a la evaluación de competencias en estudiantes de cinesiología.

Objetivo. Determinar el impacto de la evaluación basada en el desempeño de los residentes utilizando el modelo de Kirkpatrick. Sujetos y métodos. Estudio descriptivo tipo encuesta a 93 residentes (72 de primer año y 21 de segundo año) y 34 tutores del Programa de Segunda Especialización de la Universidad Privada Antenor Orrego. Se consideró una actitud positiva cuando los encuestados calificaron un ítem con una media igual o superior a 4 en una escala Likert de cinco puntos para los niveles de Kirkpatrick 1 a 3, y el nivel 4 se midió evaluando las tasas de mortalidad neta e infecciones intrahospitalarias en cinco hospitales académicos de Trujillo, Perú, entre los años 2012-2014. Resultados. La discusión de casos clínicos e incidentes críticos y la retroalimentación del portafolio virtual tuvieron un impacto positivo en los residentes en los niveles 1 a 3 de Kirkpatrick. Los tutores consideraron que las pruebas de progreso, portafolio, ejercicio de evaluación miniclínico (mini-CEX) y observación directa de actividades procedimentales (DOPS) tuvieron un efecto positivo en el desempeño de los residentes en los niveles 1 a 3 de Kirkpatrick. La evaluación tuvo impacto positivo en el nivel 4. Conclusiones. Se debe enfatizar la discusión de casos clínicos e incidentes críticos y retroalimentación del portafolio virtual y, en general, la evaluación basada en el desempeño de los residentes tendría impacto en el nivel 4 de Kirkpatrick al mejorar la mortalidad neta e infecciones intrahospitalarias en hospitales académicos. Aim. To investigate the impact of formative and reflective assessment on performance of residents according the Kirk-patrick's model. Subjects and methods. Cross-sectional study in which a survey was to sent to 93 residents (first year, 72; second year, 21) and 34 mentors of the Program of Second Specialization at the Antenor Orrego Private University. Each item was rated on a Likert scale of five points, and was considered relevant when respondents rated an item with an equal or higher average score of 4 (which indicated a positive attitude) and level 4 was evaluated considering net mortality and intrahospitalary rates in five academic hospitals in Trujillo, Peru, among 2012 and 2014. Results. The components of the corresponding portfolio to reflective and critical incidents and discussion of clinical cases obtained educational impact on levels 1, 2 and 3 in residents. Clinical mentors felt that progress tests, portfolios, Mini-Clinical Evaluation Exercise (Mini-CEX) and Direct Observation of Procedural Skill (DOPS) had a positive effect on the performance of residents in levels 1, 2 and 3 of Kirkpatrick. The assessment system had impact on the level 4 of Kirkpatrick. Conclusions. It should encourage case-based discussion, reflective critical incidents and feedback components of virtual portfolio in order to improve the performance of residents and performance-based evaluation would have a positive impact in the level 4 of Kirkpatrick in reducing the rates of net mortality and nosocomial infections in academic hospitals.

Due to the multi-dimensional characteristics of professionalism, no single assessment modality has shown to reliably assess professionalism. This review aims to describe some of the popular assessment tools that are being used to assess professionalism with a view to formulate a framework of assessment of professionalism in medicine. In December 2015, the online research databases of MEDLINE, the Educational Resources Information Center (ERIC), Elton Bryson Stephens Company (EBSCO), SCOPUS, OVID and PsychINFO were searched for full-text English language articles published during 2000 to 2015. MeSH terms “professionalism” AND “duty” AND “assessment” OR “professionalism behavioural” AND “professionalism– cognitive” were used. The research articles that assessed professionalism across medical fields along with other areas of competencies were included. A final list of 35 articles were selected for this review. Several assessment tools are available for assessing professionalism that includes, but not limited to, mini clinical evaluation exercise, standardised direct observation of procedural skills, professionalism mini-evaluation exercise, multi-source feedback and 360 degree evaluation, and case based discussions. Because professionalism is a complex construct, it is less likely that a single assessment strategy will adequately measure it. Since every single assessment tool has its own weaknesses, triangulation involving multiple tools can compensate the shortcomings associated with any single approach. Assessment of professionalism necessitates a combination of modalities at individual, interpersonal, societal, and institutional levels and should be accompanied by feedback and motivational reflection that will, in turn, lead to behaviour and identity formation. The assessment of professionalism in medicine should meet the criteria of validity, reliability, feasibility and acceptability. Educators are urged to enhance the depth and quality of assessment instruments in the existing medical curricula for ensuring validity and reliability of assessment tools for professionalism.

Item does not contain fulltext We reviewed the literature on instruments for work-based assessment in single clinical encounters, such as the mini-clinical evaluation exercise (mini-CEX), and examined differences between these instruments in characteristics and feasibility, reliability, validity and educational effect. A PubMed search of the literature published before 8 January 2009 yielded 39 articles dealing with 18 different assessment instruments. One researcher extracted data on the characteristics of the instruments and two researchers extracted data on feasibility, reliability, validity and educational effect. Instruments are predominantly formative. Feasibility is generally deemed good and assessor training occurs sparsely but is considered crucial for successful implementation. Acceptable reliability can be achieved with 10 encounters. The validity of many instruments is not investigated, but the validity of the mini-CEX and the 'clinical evaluation exercise' is supported by strong and significant correlations with other valid assessment instruments. The evidence from the few studies on educational effects is not very convincing. The reports on clinical assessment instruments for single work-based encounters are generally positive, but supporting evidence is sparse. Feasibility of instruments seems to be good and reliability requires a minimum of 10 encounters, but no clear conclusions emerge on other aspects. Studies on assessor and learner training and studies examining effects beyond 'happiness data' are badly needed.

La devolución constructiva o feedback es definida como el acto de dar información a un estudiante o a un residente describiendo su desempeño en una situación clínica observada. Las claves que requiere la devolución para mejorar el desempeño son: la observación de un evento, una apreciación por parte del docente de ese desempeño siempre de acuerdo a un patrón o estándar previamente establecido, y una recomendación para mejorar. El mayor impacto se obtiene cuando el estudiante o residente compara la devolución del docente con su propio desempeño. La disonancia entre el desempeño deseado y el realizado, es un potente generador de motivación y de aprendizaje profundo. La mayoría de los docentes lo consideran fundamental pero en general lo hacen en forma breve y no específica. Los estudiantes de medicina y los residentes quieren y necesitan devoluciones constructivas y las asocian claramente a enseñanza de alta calidad. Aunque las valoran es raro que las soliciten. Es fundamental aprovechar la devolución en toda su magnitud dando recomendaciones, provocando reacciones y auto reflexión y también definiendo un apropiado plan de acción. Es una herramienta que lleva tiempo y esfuerzo aplicarla pero es de gran valor para el crecimiento y el desarrollo académico de estudiantes y residentes.Constructive feedback is defined as the act of giving information to a student or resident through the description of their performance in an observed clinical situation. The following keys are required during feedback in order to get student´s performance improvement: the observation of an event, the instructor´s comment on said performance, by following always a pre-established pattern or standard, and advice on improvement. Major impact takes place when a student or a resident compares the teacher´s feedback to its own performance. The dissonance between desired and actual performance constitutes a strong motivation and deep-learning generator. Most of the teachers find it essential, but in general they carry it out in a short and non specific way. Medical students and residents are willing to get and need constructive feedback and they clearly associate it to high-quality learning. However, even though they appreciate it, they seldom request it. It is essential to take maximum advantage of feedback by giving recommendations, producing reactions and self-analysis and also by defining an appropriate action plan. It takes time and effort to apply this tool, but it is of great value for the growth and academic development of students and residents.

espanolEn los ultimos anos se recomienda el uso de instrumentos que evaluen la adquisicion de habilidades clinicas en el contexto de la practica clinica. Entre los instrumentos mas recomendados se encuentra el Mini Clinical Evaluation Exercise (mini-CEX), desarrollado inicialmente para la evaluacion de medicos residentes, y que ha demostrado una buena fiabilidad y validez. Aunque se ha utilizado en estudiantes de medicina, no se dispone de un analisis completo de la experiencia acumulada. Para la presente revision se realizo en septiembre de 2014 la busqueda de los articulos indizados en Medline, Embase, Biosis Previews y Current Contents. Se seleccionaron aquellos articulos que incluian los terminos ‘mini clinical evaluation exercise’, ‘mini-CEX’ o ‘mcex’. Tras la eliminacion de los duplicados se obtuvo un total de 168 articulos. Se revisaron los que se referian al uso del mini-CEX en estudiantes de medicina (n = 34) y se analizaron a fondo aquellos que contenian datos empiricos (n = 21). Los estudios llevados a cabo en estudiantes de medicina confi rman que el mini-CEX es un instrumento util y factible para evaluar las habilidades clinicas de los estudiantes de medicina y que posee propiedades psicometricas adecuadas en terminos de validez y fi abilidad. Asimismo, es bien aceptado por estudiantes y tutores y puede ser usado tanto con fi nalidades formativas como sumativas. La importancia de dar un feedback adecuado y la concordancia de las puntuaciones de los tutores son los puntos mas criticos en la implementacion del mini-CEX en estudiantes de grado. EnglishIn recent years the use of work-based assessments has been increasingly recommended to evaluate clinical skills, as they allow for the evaluation of performance in the context of clinical practice. Among these tools, one of the most recommended is the Mini Clinical Evaluation Exercise (mini-CEX). This method was developed to be used in physicians-in-training and has good reliability and validity properties. Even when mini-CEX has also been used in medical students, a review of its value in undergraduates is lacking. This review is mainly based on a search of the articles indexed in Medline, Embase, Biosis Previews or Current Contents databases in September 2014. References were selected for articles which included the following terms: ‘mini clinical evaluation exercise’, ‘mini-CEX’ or ‘mcex’. Duplicates between databases were eliminated; as a result, a total of 168 articles were retrieved. Articles that dealt with the use of mini-CEX in medical students were reviewed (n = 34) and those that included empirical data were further analysed (n = 21). These studies confirm that this tool is useful and feasible to assess medical students and has adequate psychometric properties in different domains of validity and reliability. It is also well-accepted by students and tutors and may be used both in formative and summative evaluations. The present review shows that mini-CEX is also a good tool to assess clinical skills of medical students. The importance of giving adequate feedback and the alignment in the scores of tutors are the most critical points to be considered in the implementation of mini-CEX in undergraduate students.

En los últimos años se recomienda el uso de instrumentos que evalúen la adquisición de habilidades clínicas en el contexto de la práctica clínica. Entre los instrumentos más recomendados se encuentra el Mini Clinical Evaluation Exercise (mini-CEX), desarrollado inicialmente para la evaluación de médicos residentes, y que ha demostrado una buena fiabilidad y validez. Aunque se ha utilizado en estudiantes de medicina, no se dispone de un análisis completo de la experiencia acumulada. Para la presente revisión se realizó en septiembre de 2014 la búsqueda de los artículos indizados en Medline, Embase, Biosis Previews y Current Contents. Se seleccionaron aquellos artículos que incluían los términos 'mini clinical evaluation exercise', 'mini-CEX' o 'mcex'. Tras la eliminación de los duplicados se obtuvo un total de 168 artículos. Se revisaron los que se referían al uso del mini-CEX en estudiantes de medicina (n = 34) y se analizaron a fondo aquellos que contenían datos empíricos (n = 21). Los estudios llevados a cabo en estudiantes de medicina confirman que el mini-CEX es un instrumento útil y factible para evaluar las habilidades clínicas de los estudiantes de medicina y que posee propiedades psicométricas adecuadas en términos de validez y fiabilidad. Asimismo, es bien aceptado por estudiantes y tutores y puede ser usado tanto con finalidades formativas como sumativas. La importancia de dar un feedback adecuado y la concordancia de las puntuaciones de los tutores son los puntos más críticos en la implementación del mini-CEX en estudiantes de grado. In recent years the use of work-based assessments has been increasingly recommended to evaluate clinical skills, as they allow for the evaluation of performance in the context of clinical practice. Among these tools, one of the most recommended is the Mini Clinical Evaluation Exercise (mini-CEX). This method was developed to be used in physicians-in-training and has good reliability and validity properties. Even when mini-CEX has also been used in medical students, a review of its value in undergraduates is lacking. This review is mainly based on a search of the articles indexed in Medline, Embase, Biosis Previews or Current Contents databases in September 2014. References were selected for articles which included the following terms: 'mini clinical evaluation exercise', 'mini-CEX' or 'mcex'. Duplicates between databases were eliminated; as a result, a total of 168 articles were retrieved. Articles that dealt with the use of mini-CEX in medical students were reviewed (n = 34) and those that included empirical data were further analysed (n = 21). These studies confirm that this tool is useful and feasible to assess medical students and has adequate psychometric properties in different domains of validity and reliability. It is also well-accepted by students and tutors and may be used both in formative and summative evaluations. The present review shows that mini-CEX is also a good tool to assess clinical skills of medical students. The importance of giving adequate feedback and the alignment in the scores of tutors are the most critical points to be considered in the implementation of mini-CEX in undergraduate students.

Introducción. La evaluación de la competencia clínica constituye un importante elemento de la formación médica. En el presente artículo se presentan los resultados de un estudio piloto para evaluar la factibilidad del empleo del Mini-Clinical Evaluation Exercise (mini-CEX) en estudiantes de grado de medicina. Sujetos y métodos. Se utilizó el mini-CEX en estudiantes de tercer, cuarto y quinto cursos de la Facultad de Medicina de la Universitat de Barcelona durante las prácticas clínicas de semiología y propedéutica, neumología/cirugía torácica y nefrología/urología en el curso académico 2013-2014. Los estudiantes completaron al menos una evaluación y participaron diversos profesores de los departamentos correspondientes. Resultados. Participaron 13 tutores y 27 estudiantes, con un total de 64 observaciones y una media de 2,4 observaciones por estudiante. El tiempo medio empleado en cada una de ellas fue de 14 min (rango: 4-60 min) y en el período de feed-back, de 8,4 min (rango: 3-30 min). La satisfacción media de los estudiantes (9,2; rango: 6-10) fue superior a la de los tutores (8,8; rango: 7-10). Conclusiones. El estudio demostró la factibilidad del empleo del mini-CEX en estudiantes de medicina en cuanto al tiempo empleado para realizarlo y en la satisfacción de los participantes. Introduction. The evaluation of clinical skills is an important part of the medical training. The present article describes the results of a pilot study that was carried out to analyze the feasibility of the implementation of the Mini-Clinical Evaluation Exercise (mini-CEX) in medical students. Subjects and methods. Mini-CEX was used in students from third, fourth and fifth year of Medical School of the University of Barcelona during their clerkship in Internal Medicine, Pneumology/Thoracic surgery, Nephrology/Urology in the academic year 2013-2014. Students completed at least one encounter and several tutors from different departments participated in the study. Results. Thirteen tutors and 27 students participated, with 64 encounters and a mean of 2.4 encounters by student. The mean time of the encounters was 8.4 min (range: 4-60 min) and of the feedback period of 8.4 min (range: 3-30 min). The mean score of students' satisfaction (9.2; range: 6-10) was higher than of the tutors (8.8; range: 7-10). Conclusions. The study showed the feasibility of mini-CEX in medical students regarding the time needed to perform it and the satisfaction of tutors and students with the experience.

Background The mini-CEX is a valid and reliable method to assess the clinical competencies of trainees. Its data could be useful for educators to redesign curriculum as a process of quality improvement. The aim of this study was to evaluate a mini-CEX assessment program in our internal medicine residency training. We investigated the impact of mini-CEX workshops as a faculty development program on the acquisition of cognitive knowledge and the difference of practice behaviors among faculty members used the mini-CEX to assess residents’ performance at work. Methods We designed an observational, two-phase study. In the faculty development program, we started a mini-CEX workshop for trainers in 2010, and the short-term outcome of the program was evaluated by comparing the pretest and posttest results to demonstrate the improvement in cognitive knowledge on mini-CEX. From September 2010 to August 2011, we implemented a monthly mini-CEX assessment program in our internal medicine residency training. The data of these mini-CEX assessment forms were collected and analyzed. Results In the group of 49 mini-CEX workshop attendees, there was a statistically significant improvement in cognitive knowledge by comparing the pretest and posttest results (67.35 ± 15.25 versus 81.22 ± 10.34, p

Fragestellung: Die Allgemeinheit erwartet von jedem Arzt (ganz egal welcher späteren Fachrichtung zugehörig) am Ende seiner praktischen Ausbildung, dass er/sie die häufigsten und allgemein relevanten Krankheitsbilder erkennen kann. Dazu gehört insbesondere die praktische [for full text, please go to the a.m. URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2012)

Reliability estimations of workplace-based assessments with the mini-CEX are typically based on real-life data. Estimations are based on the assumption of local independence: the object of the measurement should not be influenced by the measurement itself and samples should be completely independent. This is difficult to achieve. Furthermore, the variance caused by the case/patient or by assessor is completely confounded. We have no idea how much each of these factors contribute to the noise in the measurement. The aim of this study was to use a controlled setup that overcomes these difficulties and to estimate the reproducibility of the mini-CEX. Three encounters were videotaped from 21 residents. The patients were the same for all residents. Each encounter was assessed by 3 assessors who assessed all encounters for all residents. This delivered a fully crossed (all random) two-facet generalizability design. A quarter of the total variance was associated with universe score variance (28%). The largest source of variance was the general error term (34%) followed by the main effect of assessors (18%). Generalizability coefficients indicated that an approximate sample of 9 encounters was needed assuming a single different assessor per encounter and assuming different cases per encounter (the usual situation in real practice), 4 encounters when 2 raters were used and 3 encounters when 3 raters are used. Unexplained general error and the leniency/stringency of assessors are the major causes for unreliability in mini-CEX. To optimize reliability rater training might have an effect.

Item does not contain fulltext Reliability estimations of workplace-based assessments with the mini-CEX are typically based on real-life data. Estimations are based on the assumption of local independence: the object of the measurement should not be influenced by the measurement itself and samples should be completely independent. This is difficult to achieve. Furthermore, the variance caused by the case/patient or by assessor is completely confounded. We have no idea how much each of these factors contribute to the noise in the measurement. The aim of this study was to use a controlled setup that overcomes these difficulties and to estimate the reproducibility of the mini-CEX. Three encounters were videotaped from 21 residents. The patients were the same for all residents. Each encounter was assessed by 3 assessors who assessed all encounters for all residents. This delivered a fully crossed (all random) two-facet generalizability design. A quarter of the total variance was associated with universe score variance (28%). The largest source of variance was the general error term (34%) followed by the main effect of assessors (18%). Generalizability coefficients indicated that an approximate sample of 9 encounters was needed assuming a single different assessor per encounter and assuming different cases per encounter (the usual situation in real practice), 4 encounters when 2 raters were used and 3 encounters when 3 raters are used. Unexplained general error and the leniency/stringency of assessors are the major causes for unreliability in mini-CEX. To optimize reliability rater training might have an effect.

During in-training assessment students are frequently assessed over a longer period of time and therefore it can be expected that their performance will improve. We studied whether there really is a measurable performance improvement when students are assessed over an extended period of time and how this improvement affects the reliability of the overall judgement. In-training assessment results were obtained from 104 students on rotation at our university hospital or at one of the six affiliated hospitals. Generalisability theory was used in combination with multilevel analysis to obtain reliability coefficients and to estimate the number of assessments needed for reliable overall judgement, both including and excluding performance improvement. Students' clinical performance ratings improved significantly from a mean of 7.6 at the start to a mean of 7.8 at the end of their clerkship. When taking performance improvement into account, reliability coefficients were higher. The number of assessments needed to achieve a reliability of 0.80 or higher decreased from 17 to 11. Therefore, when studying reliability of in-training assessment, performance improvement should be considered.

Objective Based on the CanMEDS framework and the European Training Charter for Clinical Radiology a new radiology curriculum was designed in the Netherlands. Both the development process and the resulting new curriculum are presented in this paper. Methods The new curriculum was developed according to four systematic design principles: discursiveness, hierarchical decomposition, systematic variation and satisficing (satisficing is different from satisfying; in this context, satisficing means searching for an acceptable solution instead of searching for an optimal solution). Results The new curriculum is organ based with integration of radiological diagnostic techniques, comprises a uniform national common trunk followed by a 2-year subspecialisation, is competency outcome based with appropriate assessment tools and techniques, and is based on regional collaboration among radiology departments. Discussion The application of the systematic design principles proved successful in producing a new curriculum approved by all authorities. The principles led to a structured, yet flexible, development process in which creative solutions could be generated and adopters (programme directors, supervisors and residents) were highly involved. Further research is needed to empirically test the components of the new curriculum.

espanolObjetivo. Determinar el impacto de la evaluacion basada en el desempeno de los residentes utilizando el modelo de Kirk-patrick. Sujetos y metodos. Estudio descriptivo tipo encuesta a 93 residentes (72 de primer ano y 21 de segundo ano) y 34 tutores del Programa de Segunda Especializacion de la Universidad Privada Antenor Orrego. Se considero una actitud positiva cuando los encuestados calificaron un item con una media igual o superior a 4 en una escala Likert de cinco puntos para los niveles de Kirkpatrick 1 a 3, y el nivel 4 se midio evaluando las tasas de mortalidad neta e infecciones intrahospitalarias en cinco hospitales academicos de Trujillo, Peru, entre los anos 2012-2014. Resultados. La discusion de casos clinicos e incidentes criticos y la retroalimentacion del portafolio virtual tuvieron un impacto positivo en los residentes en los niveles 1 a 3 de Kirkpatrick. Los tutores consideraron que las pruebas de progreso, portafolio, ejercicio de evaluacion miniclinico (mini-CEX) y observacion directa de actividades procedimentales (DOPS) tuvieron un efecto positivo en el desempeno de los residentes en los niveles 1 a 3 de Kirkpatrick. La evaluacion tuvo impacto positivo en el nivel 4. Conclusiones. Se debe enfatizar la discusion de casos clinicos e incidentes criticos y retroalimentacion del portafolio virtual y, en general, la evaluacion basada en el desempeno de los residentes tendria impacto en el nivel 4 de Kirkpatrick al mejorar la mortalidad neta e infecciones intrahospitalarias en hospitales academicos. EnglishAim. To investigate the impact of formative and reflective assessment on performance of residents according the Kirk-patrick’s model. Subjects and methods. Cross-sectional study in which a survey was to sent to 93 residents (first year, 72; second year, 21) and 34 mentors of the Program of Second Specialization at the Antenor Orrego Private University. Each item was rated on a Likert scale of five points, and was considered relevant when respondents rated an item with an equal or higher average score of 4 (which indicated a positive attitude) and level 4 was evaluated considering net mortality and intrahospitalary rates in five academic hospitals in Trujillo, Peru, among 2012 and 2014. Results. The components of the corresponding portfolio to reflective and critical incidents and discussion of clinical cases obtained educational impact on levels 1, 2 and 3 in residents. Clinical mentors felt that progress tests, portfolios, Mini-Clinical Evaluation Exercise (Mini-CEX) and Direct Observation of Procedural Skill (DOPS) had a positive effect on the performance of residents in levels 1, 2 and 3 of Kirkpatrick. The assessment system had impact on the level 4 of Kirkpatrick. Conclusions. It should encourage case-based discussion, reflective critical incidents and feedback components of virtual portfolio in order to improve the performance of residents and performance-based evaluation would have a positive impact in the level 4 of Kirkpatrick in reducing the rates of net mortality and nosocomial infections in academic hospitals.