Utility and validity of Mini-CEX in a graduate entry medical program

Abstract

Introduction/background: Assessment of clinical skills is seen as an essential component of any clinical program. Observed structured clinical examinations (OSCE) have done much to standardise this process and have been widely adopted. However, this type of clinical assessment often does not involve ‘real’ patients, occurs in a somewhat artificial examination setting and may not truly reflect a students performance ‘on the wards’. The Mini-clinical evaluation exercise (Mini-CEX) has been developed as a practical clinical assessment tool that can be used in a variety of settings. Its reliability characteristics in post-graduate and undergraduate settings have been demonstrated but its validity in terms of comparability to currently standard methods of assessment (OSCE) has not been studied in an undergraduate setting. The Griffith Medical Program is a 4 year post-graduate course, in which the final 2 years are mainly based around clinical placements, including 9 rotations through various discipline areas. We have utilised the Mini-CEX assessment process in these rotations with students being required to complete 2 Mini-CEX assessments in 8 out of the 9 rotations (not in General Practice). This provides 16 separate ‘snap shots’ of a student’s performance across the two years. Students also undertake an 18 station OSCE towards the end of the course. Purpose: To study the validity of Mini-CEX assessments used in the clinical years of the Griffith Medical Program through comparison with the same students’ result in the final OSCE. Results: The Mini-CEX has proven to have reasonable validity when compared with OSCE performance. Discussion: We encountered a range of issues in implementing this method of assessment. In general, the process is understood by clinicians and students alike. However, there are issues around the use of a primarily formative tool as part of summative assessment. There are concerns amongst students relating to the variability of both the process and the applicable standards of the Mini-CEX. We have undertaken an extensive educational program regarding Mini-CEX but coverage has been variable. Conclusions: Mini-CEX is a useful and valid tool for assessing student clinical performance and implementation is both feasible and practical in an undergraduate setting.