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GME Evaluation Task Force Recommendation

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July 1, 2008

PATIENT CARE




PATIENT CARE SKILLS (MINI-CEX)
Recommended Assessment Tool

The Mini-Clinical Evaluation Exercise (Mini-CEX) was developed and studied extensively by the American Board of Internal Medicine. It is a focused assessment on specific aspects of a patient interaction. As such it can assess principles of patient care foremost and secondarily it asks for ratings of professionalism and interpersonal and communication skills as these are important components of every patient interaction.

Reliability and Validity

For use at the semi-annual review meeting a minimum of 6 forms/year would provide satisfactory reliability with 12 being optimal. The reliability and validity is based on the research done with the Mini-CEX. The program must monitor that the forms are being completed correctly including signatures to ensure that they are measuring with the same psychometric rigor as was done in the research studies.

Administration
  • Timing: 6 (up to 12) assessments per year
  • Who Performs: Skill assessments should be done through observation of the actual performance. It is possible that a faculty member could assess through video review of the performance, but the assessment reflects the skill of the resident on the performance date. The entire clinical encounter does not need to be observed – a shorter duration of observation may be more efficient.
  • Format: A checklist is the most appropriate format for evaluating specific procedural or communication skills (see section on focused assessment of observed skills). Because the Mini-CEX is developed for generic use across different encounter types, it uses scales to assess important elements in any encounter (e.g., history-taking, the physical examination, humanistic qualities and clinical reasoning).
  • Scoring Criteria and Training: The Mini-CEX research has been done on the 9 point scale for assessment. While other research may suggest that fewer points will give the same decisions, it is recommended with maintaining the 9 point scale as designed. The form includes a glossary describing the skills being assessed but no criteria are provided for unsatisfactory vs. satisfactory vs. superior performance. Attending faculty review the form and it is considered self-explanatory. This is not ideal, but most expedient.
  • Documentation: At minimum, twice annually as part of semi-annual review meetings.

  • Uses of the Data
  • Formative Feedback: Concurrent, written same-day feedback is recommended. The Mini-CEX is an observational form and must be completed in real time. It sets the expectation that resident and faculty member will discuss the observation and sign the form. More details may be found in an article by Holmboe (1).
  • Summative Decisions: Programs should inform residents that the criteria for judging progress will be the performance on the Mini-CEX averaged across all observations. The program should indicate a standard that would generate action such as any single Mini-CEX with an "unsatisfactory" rating. These decisions criteria should be made explicit to the residents.
  • Remediation Threshold: Programs should communicate what performance on the Mini-CEX would require remediation. However, the faculty must be willing to support such a process or they may be likely to inflate performance so as to not be burdened with remediation. Most programs would consider an average of 5 or below on the Mini-CEX while supposedly indicating satisfactory performance worthy of a development plan for the resident.
  • Program Effectiveness: The Mini-CEX is so intertwined with the fundamentals of patient care that the data are to assess resident performance and generate plans as needed. They are less likely to be useful for program effectiveness. References1. Holmboe ES, Yepes M, Williams F, Huot SJ. Feedback and the Mini Clinical Evaluation Exercise. J Gen Intern Med 2004; 19(5 Pt 2): 558–561.

    Patient Care Mini-CEX Skills Form
    Patient Care Skills (Mini-CEX)
    Core Measure for UCSF GME

     

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