Mini-clinical evaluation exercise Mini-CEX

1. Mini-clinical evaluation exercise Mini-CEX بسم الله الرحمن الرحیم Assessment of Overall Clinical Skills لیلا پاداش دانشگاه علوم پزشکی گلستان عضو هیات علمی و مسئول دفتر رشد و بالندگی اساتیددانشگاه

2. What is a mini-CEX ? A workplace-based assessment a short episode of real student-patientinteraction within the workplace observed and judged by the supervising clinician (observer) followed by feedback

3. Why do mini-CEX ? Workplace-based assessment drives experiential learning?

4. 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 requiresdirectobservation

5. 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%

6. 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

7. Miller’s Pyramid Mini.cex Faculty Observation DOES Faculty Observation SHOWS HOW OSCE PMP.KFP KNOWS HOW KNOWS MCQ.SAQ

8. how to do miniCEX ? too simple

9. Triangulation DESK Patient Resident(trainee) Attending(observer)

10. 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.

11. 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

12. 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.

14. FEEDBACK The feedback session is the most important part of the mini-cex& it should occureimmediately 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.

15. To be most effective, feedback needs to be interactive strengths and weaknesses. → (agreement & signature)

16. 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.

17. 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, … )

18. 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.

19. How many encounters must be observed to provide a reliable mean rating?

20. Mini-CEX: Reliability • Reliability Coefficients • > 0.80 with 6 observations • > 0.90 with 12 observation • > 0.95 with 24 observations

21. 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

22. 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