ePOSTER  
Theme: Clinical Assessment and the OSCE
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Abstract Title Logo
Assessing the Validity of a Multidisciplinary mini clinical evaluation exercises (mini-CEX): a Comparison to a Multidisciplinary OSCE
Authors: Institutions: University of Ottawa
Academy for Innovation in Medical Education
Background

Although there are many tools used in the work-place to assess the clinical abilities of learners, the mini clinical evaluation exercises (mini-CEX) is commonly used and is worthy of further study to ensure its validity.

During a typical mini-CEX encounter, the trainee is observed performing a clinical task with a real patient in a real clinical situation, followed by feedback.  

The form assesses students on six competencies (medical interviewing, physical examination, humanistic qualities and professionalism, clinical judgment, counselling, and organization and efficiency) and on overall clinical competence using a nine-point scale, with a ratings span from 1-3 (unsatisfactory), 4-6 (satisfactory), and 7-9 (superior).

As with any assessment tool, it is important to study the ongoing validity and one aspect of validity is to correlate the mini-CEX to written examinations and clinical examinations to see to what degree they measure similar abilities. 

Although previous studies have shown correlations between the mini-CEX and other examinations (2, 3), there were methodological weaknesses noted: 

  • With few exceptions, studies were all completed during an internal medicine rotation.  
  • Mini-CEXs all completed during a medicine rotation, yet these were correlated to a multidisciplinary written exam and OSCE

 

The purpose of this study was to gather further validity evidence for the mini-CEX specifically related to relations to other variables and to address some of the weaknesses identified in previous research.  

Specifically, we correlated the ratings of mini-CEXs from multiple disciplines to:

  1. scores from multidisciplinary OSCEs
  2. scores from written exams
Summary of Work

 

Research Ethics Board approval received from The Ottawa Hospital. 

Retrospective study; mini-CEX forms completed for all third-year medical students rotating through clinical rotations from September 1, 2011- August 31, 2012 were collected. 

Data from five of eight clinical rotations were collected (Internal Medicine, Family Medicine, Pediatrics, Surgery, and Obstetrics and Gynecology).


Mean items

Average rating of all items (competencies) on the mini-CEX was calculated for each individual form and averaged across forms for each student.

Mean global rating (Mean GR)

Average of global rating (overall clinical competence) across forms for each student.


Each of these means were correlated to scores on 2 OSCEs and 5 written end-of-rotation clerkship exams.

Bonferroni correction was applied to the significance level to correct for multiple comparisons (p < .01).

 

 

Summary of Results
A total of 147 students were included in the study and 1262 mini-CEX forms were available for analysis.
 
The mean number of forms completed per student was 8.6 (range 5 - 12). 
 
The mean score for each items was quite similar, ranging from a score of 7.08 to 7.62 for an overall total mini-CEX score of 7.29. 
 
 
 
Conclusion

Student performance on the mini-CEX is significantly correlated to multi-disciplinary OSCEs, but not consistently with written exam scores. Given that the purpose of mini-CEXs and OSCEs (i.e., to assess clinical skills and communication) is different than written examinations (i.e., to assess knowledge), this finding was expected.  

This study provides further validity evidence for the use of the mini-CEX as a formative assessment tool for clinical skills.

References

  

  1. Kogan JR, Holmboe ES, Hauer KE. Tools for direct observation and assessment of clinical skills of medical trainees: a systematic review. JAMA 2009 Sep 23; 302(12):1316-26.
  2. Ney EM, Shea JA, Kogan JR. Predictive validity of the mini-Clinical Evaluation Exercise (mcex): do medical students' mCEX ratings correlate with future clinical exam performance? Acad Med. 2009 Oct;84(10 Suppl):S17-20.
  3. Kogan JR, Bellini LM, Shea JA. Feasibility, reliability, and validity of the mini-clinical evaluation exercise (mCEX) in a medicine core clerkship. Acad Med. 2003 Oct; 78(10 Suppl):S33-5

  

Acknowledgement
Thank you to Christine Seabrook for her help, to UGME for their support and to AIME for funding and support.
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Background
Summary of Work
Summary of Results
Conclusion
References
Acknowledgement
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