mini clinical examination (mini-cex)
DESCRIPTION
Mini Clinical Examination (Mini-CEX)TRANSCRIPT
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Mini Clinical Examination (Mini-CEX)Workshops on Clinical Teaching and AssessmentClerkship programMedical School of Universitas Padjadjaran
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BackgroundDirect observation of residents clinical skill by faculty is essential to ensure that students have achieved a satisfactory level of competence to practice independently
Medical students are rarely observed by attending physicians performing history & physical examination in realistic clinical encounters
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ABIM developed and validated the clinical exercise (CEX) as a method of assessing students history taking and physical examination skills
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The Mini-CEX assessment method is intended to promote and facilitate the direct observation of history taking, physical examination and counseling skills
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What is the mini-CEX?Mini-CEXs focus on the core skills that medical students demonstrate in patient encounters
Mini-CEX was designed as short, easy form to use in focused first-time or follow-up encounters in any clinical setting
It is used with medical students to augment the feedback they receive from their attending regarding their clinical skills
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Why are Mini-CEXs valued?Mini-CEXs are designed to enhance assessment, promote education and provide an effective evaluation tool
The advantages the opportunity for medical students to be : - observed interacting with a broad range of patients in a variety settings- evaluated by number of different faculty members
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What is needed ?A snapshot clinical performance, optimally taking between 15-20 minutes
To provide valid, reliable measures of performance, interaction is needed with - a range different patients - in a variety setting
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Settings : - inpatients ward- outpatients clinic- emergency deptEvaluators :Supervising physiciansChief residentsSenior residentsCommunications :- convey written and verbal expectations for mini-CEXs to evaluators and evaluatees
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Mini CEX in emergency setting
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Competencies demonstrated during Mini-CEXMedical interviewing skillsPhysical examination skillsHumanistic qualities/ professionalismClinical judgmentCounseling skillsOrganization/efficiencyOverall clinical competenciesClinical reasoning skills
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Medical interviewing skills :- facilitates patients telling of story- effectively uses questions/directions to obtain accurate, adequate information needed- respond appropriately to affect ,non- verbal cues
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Physical examination skills :- follows efficient logical sequence- balances screening/diagnostic steps for problem- informs patients- sensitive to patients comfort, modesty
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Humanistic qualities / professionalism - show respect, compassion, empathy, establishes trust- attends to patients needs of comfort, modesty, confidentially
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Clinical judgment : - selectively orders/performs appropriate diagnostic studies- considers risks, benefits
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Counseling skills : - explains rationale for test/treatment- obtains patients consent- educates/counsels regarding management
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Organization/efficiency : - prioritizes- is timely- succinct
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Overall clinical competence : - demonstrates judgment- synthesis- caring- effectiveness- efficiency
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Mini-CEX forms
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University of California introduced mini-CEX into the core internal medicine clerkship in 1999Each student is instructed to complete the mini-CEX during the first half of clerkship, spending 15-20 minutes on the encounter and 15 minutes on feedback
After the clinical encounter, the student immediately presents an assessment and plan, and the attending gives feedback
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The attending evaluates the students history and physical examination, clinical judgment, humanism, and overall clinical competence as a student, using the standardized mini-CEX form
The form uses a standardized nine-point scale : - 1-3 (unsatisfactory)- 4 (marginal)- 4-6 (satisfactory) - 7-9 (superior)
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Conclusion :The benefits of the mini-CEX :
- skills are evaluated in a short time- the students will receive a feedback - could be used for observing the student at the bedside, hear the students assessment - low cost
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