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Resumen La evaluación es un proceso sistemático que resulta en un juicio de valor para tomar decisiones. Los instrumentos empleados para obtener datos sobre el desempeño de los estudiantes requieren de un proceso sistemático y objetivo para su implementación. El mini-CEX es un instrumento de observación directa que ha sido empleado para la evaluación de la competencia clínica en los estudiantes de pre y posgrado desde su invención en 1955. Cuenta con diferentes evidencias de validez para su uso en distintos contextos educativos y clínicos. Permite realizar evaluaciones rápidas, acompañadas de realimentación y que proporcionan información relevante del desarrollo de la competencia clínica. El objetivo de este escrito es exponer la experiencia de la implementación del mini-CEX en el pregrado médico para la evaluación formativa de los estudiantes utilizando la simulación con pacientes estandarizados. Para lograr este objetivo se empleó la siguiente secuencia: búsqueda, planeación, integración y aplicación. Posterior a estos pasos se dan una serie de recomendaciones para la implementación del mini-CEX. Se concluye que la evaluación de la competencia clínica es importante para la mejora continua y permanente de los estudiantes de pre y posgrado. Es necesario sistematizar la evaluación ajustada siempre a objetivos y necesidades específicas de la evaluación.
Abstract Evaluation is a systematic process that results in a judgment to make decisions. The instruments used to obtain data on student performance require a systematic and objective process for their implementation. The mini-CEX is a direct observation tool that has been used for the evaluation of clinical competence in undergraduate and postgraduate students since its invention in 1955. It has different validity evidence for use in different educational and clinical contexts. It allows rapid evaluations, accompanied by feedback and providing relevant information on the development of clinical competence. The objective of this paper is to expose the experience of the implementation of the mini-CEX in the medical undergraduate for the formative evaluation of students using simulation with standardized patients. To achieve this goal, the following sequence was used: search, planning, integration, and application. After these steps we make some recommendations for the implementation of the mini-CEX. Its is concluded that the evaluation of clinical competence is important for the continuous and permanent improvement of undergraduate and graduate students. It is necessary to systematize the evaluation always adjusted to objectives and specific needs of the evaluation.
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Objective:To investigate the application of modified mini-clinical evaluation exercise (Mini-CEX) in the probationary teaching of dermatology and venereology for eight-year program students.Methods:From 2019 to 2020, a modified Mini-CEX was used to grade 58 eight-year program students at the Third Affiliated Hospital of Sun Yat-Sen University at the early, middle, and late stages of the probationary teaching of dermatology and venereology. The modifications included refining various evaluation indicators. Specifically, medical history collection involved dynamic changes in rashes, negative symptoms with differential diagnostic significance, past history/personal history/family history, and other important medical history; physical examination involved the specialized condition of rashes, systematic physical examination, and negative signs with differential diagnostic significance; humanistic care involved caring for patients, health education, and privacy protection; clinical judgment involved principles of diagnosis, differential diagnosis, and treatment; communication skills involved proficiency, prioritization, and body language; organizational effectiveness involved time allocation, patient compliance, and preparation work; overall performance involved calmness and fluency, neat writing, and preliminary clinical thinking. SPSS 20.0 was used to perform the t test. Results:Compared with the early stage of probation, the 58 eight-year program students improved their scores in clinical comprehensive ability evaluation and scores in each specific evaluation at the middle and late stages of probation ( P < 0.001). The dynamic changes in rashes and the specialized situation of rashes (identification and description of rashes) were specific to this discipline. Conclusion:The modified Mini-CEX is an objective, comprehensive, concise, and efficient assessment tool, which meets the needs of teaching reform and practice of dermatology and venereology.
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Objective:To study the application effect of scenario simulation teaching combined with mini-clinical evaluation exercise (Mini-CEX) in the standardized residency training of general surgery.Methods:The study included in 62 trainees who had standardized residency training in the Department of General Surgery of the Affiliated Hospital of Xuzhou Medical University From July 2019 to July 2020. The subjects were randomly divided into traditional teaching group (control group) and scenario simulation teaching combined with Mini-CEX teaching group (experimental group), with 31 students in each group. The scores of the entrance examination, Mini-CEX scores and the evaluation of teaching effect were compared between the two groups. SPSS 21.0 was used to perform t test on the test scores, Mini-CEX scores and teaching effective evaluation scores of the two groups. Results:①The theoretical scores of the experimental group [(82.48 ± 6.02) points] were significantly higher than those of the control group [(77.32±6.25) points], with significant differences ( t=3.31, P<0.01). The clinical practice scores of the experimental group [(88.96 ± 2.93) points] were significantly higher than those of the control group [(80.87±5.41) points], with significant differences ( t=7.33, P<0.01). ②Mini-CEX scores of the experimental group were higher than those of the control group ( P<0.01). ③Through the teaching questionnaire, the scores of the experimental group were higher than those of the control group ( P<0.01). Conclusion:Scenario simulation teaching combined with Mini-CEX has achieved good results in the standardized residency training of general surgery, which could be used as a new clinical teaching mode.
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Objective:To evaluate the application effect of mini-clinical exercise assessment (Mini-CEX) in clinical teaching of pediatrics of Chinese medicine, further optimize Mini-CEX scale with characteristics of pediatrics of Chinese medicine, and improve teachers' understanding of its connotation.Methods:A total of 50 pediatric clinical practice undergraduates were randomly divided into Mini-CEX group and control group, 25 in each group, with a total of 4 weeks of practice. The application effect of Mini-CEX was evaluated by clinical comprehensive ability assessment, and the students' evaluation on the introduction of Mini-CEX in clinical teaching was understood through questionnaire survey on the recognition, advantages and existing problems of various contents of Mini-CEX. SPSS 17.0 was used for t test and chi-square test. Results:Total scores and sub-item scores of clinical comprehensive ability examination in Mini-CEX group were higher than those in control group ( P < 0.05), and the satisfaction with teaching in Mini-CEX group was significantly higher than that in control group ( P < 0.05). Through the questionnaire, it was found that the students had a high degree of recognition for the items in the improved Mini-CEX scale, and thought it was more suitable for the internship study and effect evaluation of pediatrics of Chinese medicine, especially in the aspects of clinical communication skills and humanistic care. Conclusion:Mini-CEX has many advantages, such as improving the clinical comprehensive ability of undergraduates, teaching effect, flexible teaching methods, objective evaluation methods and focusing on the cultivation of doctor-patient communication skills, which is worthy of clinical promotion.
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Introducción: la evaluación kinesiológica contempla la realización de una rigurosa historia clínica y examen físico que orientan a establecer un diagnóstico, un pronóstico funcional, y es la base del plan de intervención. Esta competencia requiere de experiencia y razonamiento clínico para la toma de buenas decisiones terapéuticas. Los resultados históricos de las evaluaciones de aprendizajes del internado, concluyen que esta competencia tiene bajo nivel de desempeño, por lo que se deben mejorar las estrategias utilizadas para su aprendizaje durante el internado. El mini-CEX, es un instrumento de evaluación para el aprendizaje, que promueve la observación y feedback en el sitio de trabajo. Objetivo: diseñar e implementar un instrumento de evaluación para el aprendizaje de la evaluación kinesiológica durante el internado profesional de la Carrera de Kinesiología de la PUC. Método: estudio prospectivo, utilizando la me-todología de investigación acción, diseñado en 4 etapas. Resultados: se obtuvo un instrumento de evaluación para el aprendizaje, el mini-CEX, adaptado a las necesidades del internado profesional de kinesiología. El estudio piloto reportó buena aceptación entre estu-diantes y docentes. La percepción de los internos es que son más observados y que las destrezas asociadas a la evaluación kinesiológica mejoraron luego del estudio. Conclusiones: el instrumento reportó un tiempo de aplicación bajo (35 min.), lo que beneficiaría instancias de observación directa y feedback dentro de los internados. Es necesaria una aplicación a gran escala, que contribuya a determinar su validez y confiabilidad. Se requiere una capacitación formal a los docentes evaluadores y ajustar la escala.
Introduction: The physiotherapy clinical assessment competence includes the performance of a rigorous clinical history and physical examination that guides the establishment of a diagnosis and a functional prognosis, and is the basis of the intervention plan. This competence requires experience and clinical reasoning to make good therapeutic decisions. The historical global clerkship assessments conclude that this competency has a low level of performance, so the strategies used for its learning the clerkship must be improved. The mini-CEX is an assessment for learning, which promotes observation and feedback in the workplace. Objective: To design and im-plement an assessment for learning mini-CEX to the Physiotherapy PUC clerkship. Method: Prospective study, using an action research methodology, designed in 4 stages. Results: The main result was the mini-CEX, adapted to the Physiotherapy clerkship needs. The pilot study reported good acceptance among students and teachers. In addition, clerks' perception is that they feel more observed and that the skills associated with the physiotherapy assessment improved after its implementation.
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Prospective Studies , Kinesiology, Applied , Evaluation Study , Internship and Residency , Learning , Students , Observation , Diagnosis , Faculty , FeedbackABSTRACT
Abstract: 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.
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Background: Student's assessment is a systemic process of determining the extent to which the student has achieved the desired competency. Mini'Clinical Evaluation Exercise (Mini-CEX) is an assessment tool applicable in broad range of settings. Very little data is available in Indian settings about Mini-CEX in undergraduate. This study has been undertaken to understand its role in formative assessment.Methods: In this interventional study 47 students and 7 faculty of pediatrics participated. Students were assessed for two encounters of Mini-CEX. Assessment was as per Mini-CEX rating form followed by feedback.Results: Mean score range for different competency of data gathering were 1.76 to 2.5 during first mini-CEX and 4.38 to 5.14 during second Mini-CEX. Difference was significant (Cohen's d >0.8). More than 90% of students felt that Mini-CEX is better way to assess clinical skills and would like to be assessed by Mini-CEX. One to one interaction was most important advantage felt about Mini-CEX. Though nearly all faculties felt that Mini-CEX is a better way for assessment half of them disagree to continue using it in future due to time constraints.Conclusions: In this study we found Impact of Mini-CEX in formative assessment is significant to improve clinical competency at undergraduate level. Improvement in Mini-CEX scores in consecutive encounter signifies its role even as Teaching Learning tool. Need to consider issues about its feasibility for Undergraduate level in settings with limited staff strength.
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Objective@#To discuss the application effect of Nursing-Mini-Clinical Evaluation Exercise (Nursing-Mini-CEX) based on the theory of extended skill circle to construct and implemented the clinical practice teaching scheme.@*Methods@#Applied convenient sampling in a hospital in Dalian and taked 42 grade 2012 undergraduates as control group, which will be given Nursing-Mini-CEX teaching model. 47 students of grade 2013 undergraduates as observation group, given on the Nursing-Mini-CEX teaching model based on extended skill circle theory, At the end of the clinical practice, we used the Nursing-Mini-CEX tools and the Teaching ability of Clinical Teaching Teachers questionnaire and the satisfaction scale of Nursing students' practice to evaluate the effect of the Nursing-Mini-CEX teaching model based on extended skill circle theory.@*Results@#The score of control group in Special care, nursing examination, nursing diagnosis, humanistic care, organizational effectiveness and overall evaluation were (6.26±1.01) 、(6.40±1.00) 、(6.37±1.11) 、(6.77±1.03) 、(6.37±1.17) 、(7.06±1.11) 、(6.89±1.11) , The experimental group students′ performance was higher than the control group in the Special care, nursing examination, nursing diagnosis, humanistic care, organizational effectiveness and overall evaluation, The scores were(7.10±1.14), (6.90±0.81), (7.19±0.86), (7.12±0.97), (7.43±0.91), (7.43±0.91), (7.43±0.80), with significant differences (t=1.523~3.640, P˂0.05) . The scores of clinical teachers′ teaching ability were higher than that of the control group (80.27 ± 13.90) ,the score was (86.68 ± 12.21) , With significant differences (t=3.83,P˂0.05) ,and the satisfaction degree of the experimental group was higher than that of the control group, With significant differences (t=0.827,P˂0.05) .@*Conclusion@#Nursing-Mini-CEX teaching model based on extended skill circle theory made the clinical teaching more systematic and standardized. It can improve clinical teaching quality and the nursing students′ clinical ablity, and it is well worth to apply in clinical.
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Objective@#To observe the effectiveness of mini-clinical evaluation exercise (Mini-CEX) on the standardized training of residents in the department of nephrology.@*Methods@#Mini-CEX was used to evaluate the 80 residents who received clinical standardized training in the department of nephrology from March 2017 to March 2018 in our hospital. The assessment mainly contained seven aspects: medical history taking, physical examination, clinical diagnosis, therapeutic regimen, doctor-patient communication, humanistic care, and overall clinical ability. Meanwhile, a Mini-CEX questionnaire was conducted among 9 teachers and 80 residents, including their viewpiont and satisfaction degree on Mini-CEX. The SPSS 21.0 was used for statistical analysis and the independent sample t-test was used for comparison between the two groups.@*Results@#Through the Mini-CEX assessment, every aspect of clinical competence of residents at the end of this program was significantly higher than that at the early period, and the difference was statistically significant (P<0.05). The most obvious improvement in residents was their treatment plan, overall clinical ability and physical examination. About the assessment of therapeutic regimen, the average score at the end of the training was (7.525±1.062), which was better than before (5.175±1.035), and the difference was statistically significant (P=0.000). Besides, clinical diagnosis and humanistic care were significantly better than those at the beginning (P<0.05). About the assessment of clinical diagnosis, the average score after the training was (6.925±1.071), which was better than before (5.425±1.238), and the difference was statistically significant (P=0.000). According to results of Mini-CEX questionnaire, teachers thought that Mini-CEX was a better way of assessment (88.9%) and could promote self-learning (77.8%), while residents believed that Mini-CEX was close to clinical practice and the ward-or-practice-based assessment was relatively comprehensive, which could significantly improve clinical skills (85.0%) and comprehensive quality (87.5%), with a satisfaction degree of 92.5%.@*Conclusion@#Mini-CEX is applied in the standardized training of residents in the department of nephrology, which can effectively improve clinical comprehensive ability of residents and improve Self-learning of teachers.
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Objective To observe the effectiveness of mini-clinical evaluation exercise (Mini-CEX) on the standardized training of residents in the department of nephrology. Methods Mini-CEX was used to evaluate the 80 residents who received clinical standardized training in the department of nephrology from March 2017 to March 2018 in our hospital. The assessment mainly contained seven aspects: medical history taking, physical examination, clinical diagnosis, therapeutic regimen, doctor-patient communication, humanistic care, and overall clinical ability. Meanwhile, a Mini-CEX questionnaire was conducted among 9 teachers and 80 residents, including their viewpiont and satisfaction degree on Mini-CEX. The SPSS 21.0 was used for statistical analysis and the independent sample t-test was used for comparison between the two groups. Results Through the Mini-CEX assessment, every aspect of clinical competence of residents at the end of this program was significantly higher than that at the early period, and the difference was statistically significant (P<0.05). The most obvious improvement in residents was their treatment plan, overall clinical ability and physical examination. About the assessment of therapeutic regimen, the average score at the end of the training was (7.525 ±1.062), which was better than before (5.175 ±1.035), and the difference was statistically significant (P=0.000). Besides, clinical diagnosis and humanistic care were significantly better than those at the beginning (P<0.05). About the assessment of clinical diagnosis, the average score after the training was (6.925 ±1.071), which was better than before (5.425 ±1.238), and the difference was statistically significant (P=0.000). According to results of Mini-CEX questionnaire, teachers thought that Mini-CEX was a better way of assessment (88.9％) and could promote self-learning (77.8％), while residents believed that Mini-CEX was close to clinical practice and the ward-or-practice-based assessment was relatively comprehensive, which could significantly improve clinical skills (85.0％) and comprehensive quality (87.5％), with a satisfaction degree of 92.5％. Conclusion Mini-CEX is applied in the standardized training of residents in the department of nephrology, which can effectively improve clinical comprehensive ability of residents and improve Self-learning of teachers.
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Objective To discuss the application effect of Nursing-Mini-Clinical Evaluation Exercise (Nursing-Mini-CEX) based on the theory of extended skill circle to construct and implemented the clinical practice teaching scheme. Methods Applied convenient sampling in a hospital in Dalian and taked 42 grade 2012 undergraduates as control group, which will be given Nursing-Mini-CEX teaching model. 47 students of grade 2013 undergraduates as observation group, given on the Nursing-Mini-CEX teaching model based on extended skill circle theory, At the end of the clinical practice, we used the Nursing-Mini-CEX tools and the Teaching ability of Clinical Teaching Teachers questionnaire and the satisfaction scale of Nursing students' practice to evaluate the effect of the Nursing-Mini-CEX teaching model based on extended skill circle theory. Results The score of control group in Special care, nursing examination, nursing diagnosis, humanistic care, organizational effectiveness and overall evaluation were(6.26±1.01)、(6.40±1.00)、(6.37±1.11)、(6.77±1.03)、(6.37±1.17)、(7.06±1.11)、(6.89 ± 1.11), The experimental group students′performance was higher than the control group in the Special care, nursing examination, nursing diagnosis, humanistic care, organizational effectiveness and overall evaluation , The scores were(7.10±1.14), (6.90±0.81), (7.19±0.86), (7.12±0.97), (7.43±0.91), (7.43± 0.91), (7.43±0.80), with significant differences(t=1.523~3.640, P?0.05). The scores of clinical teachers′teaching ability were higher than that of the control group(80.27±13.90),the score was(86.68±12.21), With significant differences(t=3.83,P?0.05),and the satisfaction degree of the experimental group was higher than that of the control group, With significant differences(t=0.827,P?0.05). Conclusion Nursing-Mini-CEX teaching model based on extended skill circle theory made the clinical teaching more systematic and standardized. It can improve clinical teaching quality and the nursing students′ clinical ablity, and it is well worth to apply in clinical.
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Objective To explore the reliability and validity of mini-clinical evaluation exercise (Mini-CEX) in neurology education during student-teacher interactive procedures. Methods 84 eight-year interns of clinical medicine and 5 teachers were assessed by Mini-CEX after teaching rounds. We calculated Chronbach's α as index of reliability for all teachers and students. Additionally, the Spearman correlation coefficients between students' performance and score of Mini-CEX were assessed as validation. Results According to the Mini-CEX table, the Chronbach'sαfor all teachers' evaluation was 0.986, and 0.968 for all interns. Each item in Mini-CEX was positively related with final performance of students (correlation coefficients>0.75, P<0.05). Conclusion Mini-CEX was used to evaluate both teachers and students in clinical teaching of neurology, during which it was found that Mini-CEX had good reliability and validity, and was helpful to improve the quality of clinical teaching.
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Objective To evaluate the application effect of mini-clinical evaluation exercise (Mini-CEX) in the clinical teaching of orthopedics. Methods A total of 60 students who finished their orthopedics internship in Renji Hospital of Shanghai Jiao Tong University from January 2017 to July 2017 were in-volved and randomly divided into the experimental group and the control group with 30 students in each group. The experimental group received Mini-CEX while the control group received traditional lessons. Sur-veys and tests were conducted after the internship and the results were recorded. All statistical analyses were performed with the independent sample t test and Chi-square test using SPSS software (version 21.0). Results Except for communication skills, the medical counseling skills, physical examination skills, humanistic qualities, clinical diagnosis, organization and overall clinical competence were higher in the experimental group than in the control group and the difference was statistically significant (P<0.05). The improvements in clinical diagnosis ( χ2=6.674, P=0.036), professional knowledge and skills ( χ2=6.455, P= 0.040), clinical practice skills ( χ2=6.673, P=0.036) and satisfaction ( χ2=6.881, P=0.032) were greater in the experimental group than in the control group and the difference was statistically significant (P<0.05). No significant difference was observed in the inspiration of learning interest(χ2=4.025, P=0.134) and the improve-ments in language proficiency ( χ2=4.993, P=0.085), medical history acquisition ability ( χ2=1.564, P=0.458), humanistic qualities ( χ2=2.982, P=0.255) and teamwork ( χ2=2.651, P=0.266) between the two groups. Conclusion Mini-CEX not only achieves higher satisfaction but also helps students to improve their pro-fessional knowledge and skills, clinical diagnosis and clinical practice skills. Besides, Mini-CEX in the clinical teaching of orthopedics can effectively improve the quality of teaching and the satisfaction of students, thus providing a new teaching mode worthy of popularization.
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Objective The study explored the feasibility of PBL teaching approach and mini-CEX scores evaluation method in hematology probation teaching practice. Methods 54 medical students of eight-year program were selected in the study and they were in hematology department of Sun Yat-sen Memorial Hospital for clinical probation. The study compared PBL teaching approach with traditional training method, and used mini-CEX to evaluate the students' clinical competence. Results The performance of PBL teaching group is better than traditional teaching group in the aspect of inquiry skill, clinical diagnosis, therapy plan and humanistic care (P<0.05). There is no significant difference of basic knowledge, physical examination skill and clinical operational skills between these two groups. More than 85％of the students in PBL group are satisfied with the teacher in the aspect of participation, feedback, guidance, correction and assistance. Conclusion Through this teaching practice, the study provides new methods for improving the teaching of pre-internal clinical practice in hematology department.
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Objective To investigate the feasibility and effect of scene simulation combined with multiple-station mini-CEX evaluation used for the teaching of standardized training of emergency medicine. Methods Sixty standard-trained doctors were randomly(random number) divided into two groups. Thirty standard-trained doctors in team A were taught using the traditional teaching modality of emergency medicine, and the rest in team B were trained using the method of scene simulation combined with multiple-station mini-CEX evaluation. At the end of standardized training, comparisons of the examination results of mini-CEX evaluation and the satisfaction of standard-trained doctors with the teaching mode were done between two groups. Results The scores of team B on medical interviewing skills, clinical judgment, counseling skills, proper presentation/efficiency and overall clinical competence were significantly higher than those of team A[(7.26±0.36),(7.63±0.39),(7.22±0.34),(7.26±0.45), (7.75±0.24) vs. (6.81±0.42),(7.24±0.39),(6.90±0.44),(6.97±0.50),(7.21±0.32)],while there were no significant differences in scores on physical examination skills and humanistic qualities/professionalism between two teams [(7.60±0.36),(7.92±0.35) vs. (7.42±0.30),(7.98±0.32)]. The satisfaction with the mini-CEX evaluation of both teachers and standard-trained doctors in team B were significantly higher than those in team A [(7.40±0.30), (7.46±0.28) vs. (7.06±0.38), (6.91±0.38)]. The satisfaction of standard-trained doctors in team B with the teaching mode and teaching effect were significantly higher than those in team A[(8.17±0.78),(8.59±0.66) (6.67±0.73), (6.80±0.72)]. Conclusions The scene simulation combined with multiple-station mini-CEX evaluation used for the teaching of standardized training of emergency medicine may improve some of the clinical skills of standard-trained doctors, and thus this teaching reform was feasible.
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By using SWOT method, we analyze the strengthen, weakness, existing opportunity and challenging of applying Mini-CEX which is named Mini Clinical Evaluation Exercise in theOrgan-system-based curriculum modelclinical nursing teaching, and propose related development strategy of Mini-CEX.
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El Mini Clinical Evaluation Exercise (Mini-CEX) es una herramienta formativa de evaluación aplicada durante la observación directa del desempeño en la clínica. Nuestro objetivo fue evaluar la confiabilidad y factibilidad del Mini-CEX utilizando descriptores pediátricos en dos programas de residencia de pediatría. El diseño fue de tipo observacional y corte transversal. Se consensuaron descriptores de la consulta pediátrica para cada una de las dimensiones del Mini-CEX. Los operadores fueron capacitados en el uso de esta herramienta por medio de descriptores, así como en las estrategias informativas. Finalmente, se realizaron 2 evaluaciones independientes y simultáneas por cada observación de desempeño. Análisis: a) Puntaje global y por dimensión del Mini-CEX, b) Concordancia de puntajes entre operadores (promedios de diferencias e IC95%); c) Frecuencias de descriptores no evaluables y d) Duración y satisfacción en su uso. Se realizaron 80 observaciones en 40 consultas pediátricas. Puntaje global 7.5 ± 0.9 (6.4 ± 2 a 8.3 ± 1.1 según dimensión), sin diferencias significativas entre instituciones. Se observó alta concordancia entre observadores (Media, diferencia 0.1 a 0.3; IC 95% -0.8 a 0.3). La frecuencia de descriptores no evaluables fue 5 a 28 (9% a 51%) y no se asoció con el lugar de aplicación. El tiempo promedio de implementación fue 20 minutos. El uso resultó altamente satisfactorio para docentes y residentes. Se implementó el Mini-CEX luego de consensuar descriptores de la consulta pediátrica. La experiencia conjunta fue satisfactoria y a la vez confirmó el valor de la evaluación y entrega de sus resultados: la devolución formativa.
The Mini Clinical Evaluation Exercise (Mini-CEX) is an assessment tool, which emphasizes the educational value and is based on direct performance observation. The objective was to evaluate the reliability and feasibility of Mini-CEX using pediatric descriptors during its implementation in two pediatric residency programs. The design was observational, exploratory and feasibility in the use of this evaluation tool. Based on the original format, descriptors related to the pediatric consult for each Mini-CEX dimension´s were agreed. Operators were trained in the use of this tool by means of descriptors as well as in debriefing strategies. Finally, there were two simultaneous and independent evaluations for each observation. Analysis: a) Mini-CEX global and dimension score; b) Concordance between operators scores (mean differences and 95% CI); c) Non evaluable descriptors frequency; d) Duration and satisfaction in use. There were 80 observations in 40 pediatric consults. Overall score 7.5 ± 0.9 (6.4 ± 2 to 8.3 ± 1.1 depending on dimension), with no significant differences between the two institutions. There was high agreement between observers (Mean, difference between 0.1 and 0.3, 95% CI -0.8 to 0.3). The frequency of non evaluable descriptors ranged 5-28 (9% to 51%) and it was not associated with the implementation stage. The average implementation time was 20 minutes, and satisfaction in use was high among both operators and residents. Mini-CEX tool using pediatric descriptors showed high reliability. The joint experience was satisfactory and simultaneously confirmed the value of debriefing.
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Humans , Outpatient Clinics, Hospital , Pediatrics/education , Quality Indicators, Health Care/statistics & numerical data , Educational Measurement/methods , Internship and Residency/methods , Subject Headings , Time Factors , Observer Variation , Feasibility Studies , Reproducibility of Results , Clinical Competence/statistics & numerical data , Work Performance/educationABSTRACT
Background and Objectives: Postgraduate (PG) students, in India have a vast clinical exposure & see a diversity of cases, yet lack confidence during practical assessments. There is an observed gap between their performance in exams and performance in actual workplace.Some aspects of their clinical skills are never observed or assessed. MCI guidelines emphasize that the Postgraduate training be competency based & formative assessment be done.The mini-CEX involves direct observation of student’s skills in authentic setting with immediate feedback and has been used in a variety of clinical settings, and levels of training with documented validity and reliability. As we are in the implementation stage of formative assessment, we initiated with mini-CEX as a tool of performance assessment, to evaluate its feasibility, and acceptability in our setup. Methodology: After an orientation workshop on mini-CEX, PG students of obstetrics were given ‘schedule plan’ of 1 mini-CEX per month, each to be taken by a different faculty and address a different clinical problem. The faculty observed while resident performed a focused history taking and physical examination over 15-20 minutes. The resident presented a diagnosis & treatment plan. Faculty member rated the resident using the mini-CEX evaluation form and provided educational feedback. After 6 months, the perceptions of the faculty and the students were noted. Results: 22 residents took part in the study. 83% of scheduled mini-CEX took place. The mean time taken for observation and feedback was 18.56 and 7.25 minutes respectively. The residents and faculty perceived need for such assessments, and improvement in clinical skills. The residents reported increased communication skills, thought organization and confidence levels. Residents first apprehensive, were later comfortable being observed during their clinical encounters and welcomed the one to one interaction with faculty. Initial difficulties the faculty faced, improved with provision of rating scale and structuring feedback. Observation of performance in authentic clinical settings, case diversity, flexibility of time and multiple encounters with different assessors contributed to the utility of mini-CEX. The faculty & residents reiterated their willingness to continue with mini-CEX as one of the tools for formative assessments of clinical skills.
ABSTRACT
Background and Objectives: Mini-CEX method of assessment is widely accepted method which includes structured assessment of an observed clinical encounter, provides feedback to the student on skills essential to the provision of good clinical care, and improves the competencies expected & the confidence level of the student. There has been limited or negligible research in this area in the field of Faculty of Ayurved. Methodology: 45 students from 2nd BAMS students were included in the study. The standard nine point scale format was adopted for rating the students. Each student was assessed twice on real patients, with low or moderate complexity level. The cases were not repeated for the successive encounter. Each student was rated for the competencies; the time required for observation & providing feedback, the evaluators’ & trainees’ satisfaction using mini-CEX were noted. Feedback was obtained from the trainees after completing the entire task. Results: Total 81 encounters with 44 students against a planned figure of 90 were recorded giving a completion rate of 90%. The mean observation time was 22 minutes & feedback time was 08 minutes. The scores in medical interviewing, physical examination, communication & professional qualities, counselling skills, clinical judgement, organisation efficiency & overall clinical performance (p< 0.0001, paired t-test) show statistically significant change in the successive encounter. The satisfaction level of the students and the assessors achieved high score with the mean of 7.7/8.1 and 8.3/8.1 respectively. Feedback analysis from the faculty & trainees is as follows: Average 40% trainees were felt anxious being observed. The method helped the students to: be more attentive & regular in clinical postings, achieve the confidence level, improve interpersonal skills, & to analyse strengths and weak areas of the students. Conclusions: The mini-CEX is an effective tool of assessment in second B.A.M.S. students in Rognidan to improve the expected competencies in case presentation skills with confidence.
ABSTRACT
Introducción. La observación directa de los alumnos por parte de distintos docentes en forma periódica, en diversos escenarios y en tiempo real, tiene gran valor en el proceso de formación. Objetivos. Evaluar la factibilidad en la implementación de una versión del Ejercicio de Examen Clínico Reducido adaptada a Pediatría, describir las evaluaciones realizadas según el ámbito de observación, la complejidad del paciente, el foco del encuentro y la situación pediátrica, y conocer la satisfacción de docentes y alumnos con respecto a esta herramienta. Método. Participaron en forma voluntaria todos los docentes y alumnos de la carrera. Las observaciones tenían carácter formativo. Las competencias evaluadas fueron: habilidades para la conducción de la entrevista, para el examen físico, para el asesoramiento, profesionalismo, criterio clínico, efciencia y competencia clínica global. Se defnió la factibilidad del estudio como la posibilidad de realizar cuatro observaciones en al menos 70% de los participantes y que se llevaran a cabo observaciones en todas las áreas de rotación. Resultados. Se realizaron 388 observaciones. Participaron 54 alumnos y 50 docentes. Se realizaron 7,18 observaciones por participante, en el ámbito ambulatorio en el 57% y con baja complejidad en el 60% de los casos. El 85% de los participantes fueron observados mientras conducían una consulta de supervisión en salud. La califcación por competencia específca fue uniforme. El foco del encuentro presentó variaciones según el ámbito de observación. Docentes y alumnos se mostraron satisfechos. Conclusión. El instrumento pudo aplicarse con la frecuencia preestablecida, en los ámbitos programados y fue bien aceptado.
Aims. Faced with the increased challenge of assessing competences in young doctors, the purpose of the study was to evaluate the implementation of a pediatric version of the Mini-Cex in pediatric trainees as well as the level of satisfaction of teachers and students with the new assessment tool. Methods and results. From July 2007 to August 2009, 54 pediatric trainees were periodically monitored in a variety of clinical settings by 50 teachers. The competences evaluated included medical interviewing, physical examination and counseling skills, humanistic qualities/ professionalism, clinical judgment, organization and overall clinical competence. The feasibility of this study was defned as an average 4 observations per participant, and observations in all clinical rotations. During the study, 388 observations were carried over 54 students (average of 7.18 observations per student); 57% took place in ambulatory settings, 60% were of low complexity and 85% involved healthy children programmed consultations. The ratings for specifc competences had little variation; the focus related to the setting. Conclusions. Used in a variety of settings, with different patient problems, the method was well accepted by both students and teachers.