Mini Clinical Examination

(Mini-CEX)
Workshops on Clinical Teaching and
Assessment
Clerkship program
Medical School of Universitas Padjadjaran

Background
Direct 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

 ABIM developed and validated the clinical

exercise (CEX) as a method of assessing
students history taking and physical
examination skills

 The Mini-CEX assessment method is intended

to promote and facilitate the direct observation
of history taking, physical examination and
counseling skills

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

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

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

 Settings :

- inpatients ward

- outpatients clinic
- emergency dept
Evaluators :
Supervising physicians
Chief residents
Senior residents
Communications :

- convey written and verbal expectations for

mini-CEXs to evaluators and evaluatees

Mini CEX in emergency setting

Competencies demonstrated during

Mini-CEX
1.
2.
3.
4.
5.
6.
7.
8.

Medical interviewing skills

Physical examination skills
Humanistic qualities/ professionalism
Clinical judgment
Counseling skills
Organization/efficiency
Overall clinical competencies
Clinical reasoning skills

1. Medical interviewing skills :

- facilitates patients telling of story

- effectively uses questions/directions
to obtain accurate, adequate information
needed
- respond appropriately to affect ,nonverbal cues

2. Physical examination skills :

- follows efficient logical sequence
- balances screening/diagnostic steps
for problem
- informs patients
- sensitive to patients comfort,
modesty

3. Humanistic qualities / professionalism

- show respect, compassion, empathy,

establishes trust
- attends to patients needs of
comfort, modesty, confidentially

4. Clinical judgment :

- selectively orders/performs
appropriate diagnostic studies
- considers risks, benefits

5. Counseling skills :
- explains rationale for test/treatment
- obtains patients consent
- educates/counsels regarding
management

6. Organization/efficiency :
- prioritizes
- is timely
- succinct

7. Overall clinical competence :

- demonstrates judgment
- synthesis
- caring
- effectiveness
- efficiency

Mini-CEX forms

University of California introduced mini-CEX

into the core internal medicine clerkship in
1999
Each 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

 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)

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