Professional Documents
Culture Documents
Assessment
INTRODUCTION interact with a patient in any of a process. By 1972, the problems of The CEX
variety of settings including the assessing thousands of doctors evaluates the
T
he mini Clinical Evaluation hospital, outpatient clinic, and annually had become so great
A&E. The trainee conducts a that the oral examination was
trainee’s
Exercise or mini-CEX is a
method for simultaneously focused history and physical discontinued. In its place, the performance
assessing the clinical skills of examination and after the Board asked training programme with a real
trainees and offering them feed- encounter provides a diagnosis directors to assess the clinical patient
back on their performance. It is a and treatment plan. The faculty competence of candidates for
simple modification of the tradi- member scores the performance certification and recommended
tional bedside oral examination using a structured document and the use of a clinical evaluation
and because of that, it relies on then provides educational feed- exercise, or CEX, for trainees in
the use of real patients and the back. The encounters are intended their first postgraduate year.
judgments of skilled clinician to be relatively short, about 15
educators. This article describes minutes, and to occur as a routine The CEX was based on the
the mini-CEX, recounts how it was part of the training programme. bedside oral examination that was
developed, and then illustrates its Each trainee should be evaluated part of the certification process. A
use in the Modernising Medical on several different occasions by single faculty member evaluated
Careers (MMC) Foundation Pro- different faculty examiners. the trainee as he or she performed
gramme Assessment. a complete history and physical
Development of the mini-CEX examination on a pre-selected
BACKGROUND For the first four decades of its patient in the hospital. Trainees
existence, the American Board of were then expected to reach diag-
How the mini-CEX works Internal Medicine administered a nostic and therapeutic conclu-
In the mini-CEX, a single faculty traditional bedside oral examina- sions, present their findings, and
member observes the trainee tion as part of its certification produce a written report of the
patient. The faculty member then with real patients who exhibit ings, create a management
assessed the trainee’s performance the full range of conditions plan, and communicate this in
along several dimensions. The CEX seen in the clinical setting. both oral and written form.
took about two hours and by the
• The trainee is observed by a Despite its strengths, a grow-
early 1990s the vast majority of
skilled clinician-educator who ing research literature through
first year internal medicine train-
both assesses the performance the 1980s and 1990s showed that
ees in the United States were being
and provides educational the results of CEX were not likely
assessed by this method.
feedback. This enhances the to generalise very far beyond the
validity of the results and single encounter that was ob-
The CEX has at least three
ensures that the trainee served. This conclusion was based
important strengths.
receives the type of on numerous studies of the
• It evaluates the trainee’s per- constructive criticism that assessment of doctors.
formance with a real patient. should result in a reduction of
• The research showed that
In medical school, the Objec- errors and an improvement in
trainees’ performances with
tive Structured Clinical Exam- quality of care.
one patient were not a very
ination (OSCE) is often used
• The CEX presents trainees with good predictor of their per-
and it does an excellent job of
a complete and realistic clin- formances with other patients.
assessing clinical skills. As
ical challenge. They have to get Consequently, they needed to
trainees approach entry to
all of the relevant information be observed on different
practice, however, their edu-
from the patient, structure the occasions with different
cation and assessment needs
problem, synthesise their find- patients before drawing
to be based on performance
and how it should work. They are Assessors are also given writ- the method, its purpose, and its
given copies of the forms that ten guidance that contains a place in the overall Foundation
need to be completed and description of the mini-CEX and programme. The competences to
responsibility for having them how it works. They receive infor- be assessed are listed and des-
done in a timely fashion. mation about the development of cribed for the satisfactory trainee
CONCLUSION
FURTHER READING