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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.

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

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.

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.

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.

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.

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

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.