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Why consider the Mini-CEX? Year 4 OSCE 2011 Overall Results

Using the Mini-Clinical Evaluation Exercise (Mini-CEX) as an assessment tool for medical students April 29, 2011. Why consider the Mini-CEX? Year 4 OSCE 2011 Overall Results. Number sitting OSCE 248 Number passing 245 (98.8%). Competency Domains. What is mini-CEX?.

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Why consider the Mini-CEX? Year 4 OSCE 2011 Overall Results

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  1. Using the Mini-Clinical Evaluation Exercise (Mini-CEX) as an assessment tool for medical studentsApril 29, 2011

  2. Why consider the Mini-CEX?Year 4 OSCE 2011 Overall Results • Number sitting OSCE 248 • Number passing 245 (98.8%)

  3. Competency Domains

  4. What is mini-CEX? Structured 10 min observation of a student performing specified tasks during routine practice Feedback session (10 min) Completion of a standardized one-page rating form

  5. Mini-CEX: Types of tasks Focused history Physical examination Counselling advise patient regarding management options provide appropriate education make recommendations that address patient’s concerns Clinical reasoning skills diagnostic and therapeutic skills Case presentation

  6. History-taking Form

  7. Guidelines for marking

  8. Reliability of the Mini-CEX Average Composite Ratings

  9. Implementing a Mini-CEXAssessment Process

  10. Implementing a Mini-CEX Orientation Familiarize yourself with the mini-CEX rating form and definition of the components of the student’s performance you will be rating Schedule the mini-CEX 1-2 / week Allow 20 minutes for each assessment Obtain patient permission

  11. Implementing a Mini-CEX Select the patient encounters to be observed Year 3 “must see” list of medical conditions new or existing medical problem acute vs. chronic illness different age groups and both genders different clinical settings (e.g. office, hospital) if possible Ask the student to perform the task without prompting about the possible diagnosis perform an abdominal examination Not: examine the patient for possible appendicitis

  12. Assessment Process Avoid interrupting the student during the patient encounter no questions, comments or suggestions if you want to follow-up findings with patients, do this after the student is finished Conduct immediate feedback (10 minutes) Complete rating form Discuss rating or comments with student

  13. Mini-CEX: Feedback Immediate Specific Limited to key issues Honest Fair Descriptive, not judgmental, e.g. “you did not examineX” NOT “you were way off base”

  14. Mini-CEX: Feedback Two-way process (inter-active) Start by asking the student some questions how they felt they did with the patient what findings they found what they think is the most likely diagnosis why they ordered a particular investigation or suggested a particular treatment Answers can stimulate specific feedback and also guide ratings of performance

  15. Feedback challenge • Easy when the student does well • More difficult when the performance is poor • do not hesitate to point out area of weakness • multiple assessments with multiple examiners (reliability) • sampling performance across the spectrum of clinical situations (validity)

  16. Mini-CEX: FeedbackClosing the loop Provide a recommendation interviewing/ examination/ counselling skills/ management/ presentation Develop a specific action plan allows student to act on the recommendation

  17. Example of use of Mini-CEX ER • A man presents with abdominal pain • The student performs a focused abdominal examination (10 minutes) • The preceptor notices that the student did not examine the inguinal areas adequately • Feedback is given • the preceptor demonstrates the correct technique • recommends a review of hernias in clinical skills textbook • suggests plan to practise exam technique

  18. Summary: Key features of the Mini-CEX Direct assessment of actual patient care Allows assessment of performance good evidence supporting mini-CEX’s validity and reliability cumulatively can infer student’s competence Can be incorporated into daily activities efficient use of resources Allows immediate and substantive feedback

  19. Assessor’s training Paper-based orientation Familiarize with the process, specific observation task and ratings form All assessors who participated received this form of training Workshop* - video-based training Videos exemplifying three levels of performance Rated at the end on the form by all participants *(Modeled after ABIM/NBME ‘Direct observation of Competence Training Program’, Holmboe et al., 2004)

  20. Effects of training Assessors of the post-graduate trainees Raters not trained in workshop were more lenient: 3.17 vs. 2.31 6.17 vs. 4.85 8.29 vs. 7.38 Both the scenario and training-group effects were significant

  21. Reliability Generalizability-theory approach to reliability Allows for estimating the variance-components attributable to the different factors of the measurement situation Calculating G-coefficient (reliability coefficient) Modeling the effect of changes in these factors (e.g., number of items needed to achieve certain level of precision) Number of mini-CEXs needed was the main factor followed through all studies (in one case, the effect of blueprinting was also explored)

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