Mini-clinical evaluation
exercise
Mini-CEX
Assessment of Overall Clinical Skills
What is a mini-CEX ?
A workplace-based assessment
 a short episode of real student-patient
interaction within the workplace

observed and judged by the supervising
clinician (observer)

followed by feedback
Why do mini-CEX ?
Workplace-based assessment drives
experiential learning?
Are Clinical Skills Important?
Clinical skills are essential for patient care
Clinical skills :
Medical interviewing
Physical examination
Clinical judgment
Communication skills
Evaluation of clinical skills requires direct observation
diagnosis and medical interview

Hampton (BMJ, 1975):

Medical interview: 82%
– Physical exam: 9%
– Laboratory: 9%

Kirch (Medicine, 1996)
– Medical interview (+Ph/Ex): 70%
– Imaging: 35%
Importance of
complete Clinical Skills
To decrease diagnostic errors
– Inaccurate/ incomplete medical interview is one
important reason of diagnostic errors.
Wrong information leads to wrong decisions
To increase patient satisfaction
– Higher with better communication skills
To improve patient self-care
– Better adherence and outcomes associated
with better physician communication skills
Miller’s Pyramid
Mini.cex
DOES
Faculty Observation
Faculty Observation
SHOWS
HOW
KNOWS HOW
KNOWS
OSCE
PMP.KFP
MCQ.SAQ
how to do miniCEX ?
too simple
Triangulation
DESK
Patient
Resident(trainee)
Attending(observer)

In the mini-CEX, a single faculty
Member(observer) observes the trainee`s interact
with a patient in any of a variety of settings
including the hospital, outpatient clinic, and E.D
 In fact, the mini CEX can assess a range of core
competencies that a trainee uses during day to
day encounters with patients.
Encounters should …
 take place In the normal working environment .

take place In different working environment.
 cover different cases and different specialty areas.
 be observed by different skilled observers.
During the encounters …
 Observer must assess trainee`s clinical skills & fill
the feedback form.
 Observer must note some extra information such as
complexity of patient`s problem

One encounter takes 20 min & has 2 steps
Exam : 15_20 min
Feedback : ~5 min
The trainee conducts a focused history and physical
examination and then provides a diagnosis and
treatment plan.
The faculty member(observer) scores the
performance using a structured document and
then provides educational feedback.
FEEDBACK

The feedback session is the most important part
of the mini-cex & it should occure immediately
after the encounter.
 The observer should discuss both the positive &
negative aspects of encounter with the trainee.
 The observer should also discuss a plan to
improve any areas of weakness.
To
be most effective, feedback
needs to be interactive
strengths and weaknesses.
→ (agreement & signature)
Mini_CEX program

Trainees have to complete at least one
encounter for every 3 months (4 encounters in
a year) in order to be eligible for central exam
at the end of the year.
 The trainee should meet an educational
supervisor during the program . During this
meetings they can map out a learning plan for
next period, according to trainee`s rotations &
his/her past encounters.

The trainee is responsible for instigating each
mini- CEX encounter.

Each assessment should focus on a limited
number of competencies & different
encounters should include a range of cases
with each focusing on specific aspects of the
clinical skills. (e.g. history taking, PH/EX, … )

Each observer may have his/her own way to run the
encounters with the trainees. One accepted format is :

To choose the last patient of a day ( e.g : the last
outpatient in the clinic or the last patient on the ward
round)
→To be less disruptive to the flow of the clinical
workload.
 →To allow for feedback to occur straight after the
encounter.

How many encounters must be observed to provide
a reliable mean rating?
Changes in reliability as a function of the
number of observed encounters
1
0.9
0.8
0.7
0.6
0.5
1
4
6
8
10
12
14
16
18
Mini-CEX: Reliability
 Reliability Coefficients
 > 0.80 with 6 observations
 > 0.90 with 12 observation
 > 0.95 with 24 observations
Mini-Clinical Examination (Mini-CEX)
The evidence will be rated and recorded
in the Portfolio.
Immediate feedback will be provided by
the observer rating the student.
A learning plan will be developed, based
on the strengths and developmental
needs observed
Summary
 Basic
clinical skills are important:
so is the need to observe them!
 Observation is a complex skill that
requires training and practice
 Direct observation by educators will
remain a critical component of both
evaluation and feedback