Mini-CEX: Direct Observation of Students – Tools & Techniques
The mini-CEX and you!
Simon Field
MD CCFP(EM) FCFP M.Ed
Assistant Dean, Clerkship
Dalhousie Undergraduate Medical Education
Dec 13, 2013
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Disclosure
The presenter has no real or perceived conflicts of interests
Objectives
After this session participants will:
Have defined the concept of and reviewed evidence for the mini Clinical Examination
Exercise (CEX)
Have reviewed the rationale for initiation of mini-CEX within the Skilled Clinician program at Dalhousie
Have understanding of the methodology and scoring for direct observation of clinical encounters
What is a mini-CEX?
Brief
Observed
Focused
Formative
Accompanied by feedback
Variety of settings
What is the evidence?
Widely used in US, UK, Australia/NZ, Canada
Spectrum from students to postgrad to CPD
Involves clinical performance on real patients plus feedback and reflection
“The mini-CEX assesses residents in a much broader range of clinical situations … has better reproducibility…offers residents greater opportunity for observation and feedback by more than one faculty member and with more than one patient “
Norcini et al. Ann Int Med: Nov 1995 123(10)
Why mini-CEX at Dalhousie?
Pre-clinical training uses simulated patients
(SPs) extensively
Minimal use of real patients
Main clinical assessment tools are ITERs
“Failure to fail”
Minimal observation of performance
Students respond well to feedback
How does it fit in?
Skilled Clinician Program
“Clinical Skills” in Med 1 and 2
Expansion into Med 3
Final portfolio in Med 4
How does it work at Dalhousie?
Broad range of evaluators – interprofessional, trainees
10-15 minutes observation
Focused on pre-determined domain
Standardized form completed
Feedback given (approx 5 minutes)
How does it work at Dalhousie?
(continued)
Complete one per 3-week rotation
Add to student portfolio
Complete 15 over the course of 3 rd year
Student selects “best 5”
Portfolio reviewed by UGME to ensure completion
Intent is to witness progression in skills development
What isn’t it…
NOT an ITER!
NOT summative
NOT a “convenience” item
What are the Domains to be assessed?
Select One Domain of:
History taking
Physical examination
Communication skills
Patient Counseling
Clinical Reasoning
Assess Every Time:
Professionalism
Organization/efficiency
Overall competence
How to do it…
Discuss the exercise prior to observing the encounter
Give meaningful feedback that the student can use in the future
Use specific examples
Obtain clarification from the learner and encourage reflection
Scoring the mini-CEX
Scoring (cont)
Resources http://facdev.medicine.dal.ca/techenhance.php
Questions?
SimonField@Dal.ca
