Mini-clinical evaluation exercise Mini-CEX
description
Transcript of Mini-clinical evaluation exercise Mini-CEX
![Page 1: Mini-clinical evaluation exercise Mini-CEX](https://reader030.fdocuments.net/reader030/viewer/2022012307/56812bd8550346895d904722/html5/thumbnails/1.jpg)
Mini-clinical evaluation exerciseMini-clinical evaluation exercise
Mini-CEXMini-CEX
Ass
ess
men
t of
Overa
ll C
linic
al S
kills
Ass
ess
men
t of
Overa
ll C
linic
al S
kills
بسم الله الرحمن الرحیمبسم الله الرحمن الرحیم
لیال پاداشلیال پاداش
دانشگاه علوم پزشکی گلستاندانشگاه علوم پزشکی گلستانعضو هیات علمی و مسئول دفتر رشد و بالندگی
اساتیددانشگاه
![Page 2: Mini-clinical evaluation exercise Mini-CEX](https://reader030.fdocuments.net/reader030/viewer/2022012307/56812bd8550346895d904722/html5/thumbnails/2.jpg)
What is a mini-CEXWhat is a mini-CEX? ?
A workplace-based assessmentA workplace-based assessment
a short episode of a short episode of real student-patientreal student-patient
interaction within the workplaceinteraction within the workplace
observed and judged by the supervising observed and judged by the supervising
clinician (clinician (observerobserver))
followed by followed by feedbackfeedback
![Page 3: Mini-clinical evaluation exercise Mini-CEX](https://reader030.fdocuments.net/reader030/viewer/2022012307/56812bd8550346895d904722/html5/thumbnails/3.jpg)
Why do mini-CEX Why do mini-CEX ? ?
Workplace-based assessment drives
experiential learning?
![Page 4: Mini-clinical evaluation exercise Mini-CEX](https://reader030.fdocuments.net/reader030/viewer/2022012307/56812bd8550346895d904722/html5/thumbnails/4.jpg)
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
![Page 5: Mini-clinical evaluation exercise Mini-CEX](https://reader030.fdocuments.net/reader030/viewer/2022012307/56812bd8550346895d904722/html5/thumbnails/5.jpg)
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%
![Page 6: Mini-clinical evaluation exercise Mini-CEX](https://reader030.fdocuments.net/reader030/viewer/2022012307/56812bd8550346895d904722/html5/thumbnails/6.jpg)
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
ToTo increase patient satisfaction– Higher with better communication skills
To To improve patient self-care– Better adherence and outcomes
associated with better physician communication skills
![Page 7: Mini-clinical evaluation exercise Mini-CEX](https://reader030.fdocuments.net/reader030/viewer/2022012307/56812bd8550346895d904722/html5/thumbnails/7.jpg)
Miller’s Pyramid
KNOWS
KNOWS HOW
SHOWS
HOW
DOES
MCQ.SAQ
PMP.KFP
OSCE
Mini.cex
Faculty ObservationFaculty Observation
![Page 8: Mini-clinical evaluation exercise Mini-CEX](https://reader030.fdocuments.net/reader030/viewer/2022012307/56812bd8550346895d904722/html5/thumbnails/8.jpg)
how to do miniCEX?
too simple too simple
![Page 9: Mini-clinical evaluation exercise Mini-CEX](https://reader030.fdocuments.net/reader030/viewer/2022012307/56812bd8550346895d904722/html5/thumbnails/9.jpg)
Triangulation
DESK
Resident(trainee)
Patient
Attending(observer)
![Page 10: Mini-clinical evaluation exercise Mini-CEX](https://reader030.fdocuments.net/reader030/viewer/2022012307/56812bd8550346895d904722/html5/thumbnails/10.jpg)
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.
![Page 11: Mini-clinical evaluation exercise Mini-CEX](https://reader030.fdocuments.net/reader030/viewer/2022012307/56812bd8550346895d904722/html5/thumbnails/11.jpg)
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
![Page 12: Mini-clinical evaluation exercise Mini-CEX](https://reader030.fdocuments.net/reader030/viewer/2022012307/56812bd8550346895d904722/html5/thumbnails/12.jpg)
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.
![Page 13: Mini-clinical evaluation exercise Mini-CEX](https://reader030.fdocuments.net/reader030/viewer/2022012307/56812bd8550346895d904722/html5/thumbnails/13.jpg)
![Page 14: Mini-clinical evaluation exercise Mini-CEX](https://reader030.fdocuments.net/reader030/viewer/2022012307/56812bd8550346895d904722/html5/thumbnails/14.jpg)
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.
![Page 15: Mini-clinical evaluation exercise Mini-CEX](https://reader030.fdocuments.net/reader030/viewer/2022012307/56812bd8550346895d904722/html5/thumbnails/15.jpg)
To be most effective, feedback needs to be interactive
strengths and weaknesses.→ (agreement & signature)
![Page 16: Mini-clinical evaluation exercise Mini-CEX](https://reader030.fdocuments.net/reader030/viewer/2022012307/56812bd8550346895d904722/html5/thumbnails/16.jpg)
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.
![Page 17: Mini-clinical evaluation exercise Mini-CEX](https://reader030.fdocuments.net/reader030/viewer/2022012307/56812bd8550346895d904722/html5/thumbnails/17.jpg)
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, … )
![Page 18: Mini-clinical evaluation exercise Mini-CEX](https://reader030.fdocuments.net/reader030/viewer/2022012307/56812bd8550346895d904722/html5/thumbnails/18.jpg)
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.
![Page 19: Mini-clinical evaluation exercise Mini-CEX](https://reader030.fdocuments.net/reader030/viewer/2022012307/56812bd8550346895d904722/html5/thumbnails/19.jpg)
How many encounters must be observed to provide a reliable mean rating?
Changes in reliability as a function of the number of observed encounters
0.5
0.6
0.7
0.8
0.9
1
1 4 6 8 10 12 14 16 18
![Page 20: Mini-clinical evaluation exercise Mini-CEX](https://reader030.fdocuments.net/reader030/viewer/2022012307/56812bd8550346895d904722/html5/thumbnails/20.jpg)
Mini-CEX: Reliability
Reliability Coefficients > 0.80 with 6 observations > 0.90 with 12 observation > 0.95 with 24 observations
![Page 21: Mini-clinical evaluation exercise Mini-CEX](https://reader030.fdocuments.net/reader030/viewer/2022012307/56812bd8550346895d904722/html5/thumbnails/21.jpg)
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
Mini-Clinical Examination (Mini-CEX)
![Page 22: Mini-clinical evaluation exercise Mini-CEX](https://reader030.fdocuments.net/reader030/viewer/2022012307/56812bd8550346895d904722/html5/thumbnails/22.jpg)
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