Initiating formative assessment of postgraduate students in obstetrics & gynecology.

ABSTRACT

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.