Primarily utilized to monitor learning progress during patient encounters, the Mini Clinical Evaluation Exercise (Mini-CEX) is a formative assessment method that simultaneously assesses clinical skills and offers feedback to the learner. It has been extensively evaluated in the context of internal medicine and found to be a reliable assessment tool of workplace performance for medical housestaff. A 2009 systematic review by Kogan et al in JAMA found that medical student programs have extensively utilized this assessment tool for various skills domains. This may partially be in response to the Liaison Committee on Medical Education (LCME) standard which requires that medical education programs include ongoing assessment activities that ensure that medical students have acquired, and can demonstrate on direct observation, the core clinical skills, behaviors, and attitudes that have been specified in the program's educational objectives.

This month’s Editor’s Choice highlights three mini-CEXs in our product library. They are the Health Care Proxy (HCP) Mini-CEX and Mini-Cog Mini-CEX from Albert Einstein College of Medicine and the MMSE CEX from UCSF. Commonalities include the delineation of the specific tasks the learner should perform, summary assessments of competency in both performing the task and the relevant ACGME competency, sections for comments, satisfaction questions for both student and faculty, and faculty guides. Although each is designated as appropriate for learners from medical students to fellows, only the MMSE Mini-CEX gives suggestions for the level at which these tasks should be mastered by each.

The HCP Mini-CEX (click here) developed by Drs. Amy Ehrlich and Hannah Lipman assesses 5 specific steps important in setting the stage and discussing HCPs with patients. Examiners are asked to judge whether the learner has completed each step. The Mini-Cog Mini-CEX (click here) by Drs. Ehrlich and Kim Freeman similarly assesses 12 steps when conducting the Mini-Cog, however it does not require the student to interpret the test results. Both tools ask the examiner to judge overall competency in Interpersonal and Communication skills using a 9 point scale. This scale is similar to that used in ABIM evaluations, however the scale’s anchors differ- with a score of 2 considered passable (compared with 4 on the ABIM).

The MMSE Mini-CEX (click here) by Dr. C. Bree Johnston from UCSF assesses both the performance and the scoring of each of 11 items. Interpretation of the score, humanistic qualities, counseling performance, and a summary score are evaluated using the ABIM 9-point scale with 4 as the lowest satisfactory rating. Examiners are also asked to note things that were done particularly well. The faculty guide is comprehensive, providing examples of what is considered incorrect for certain items.

In this day where we are being asked to document not just that learners were exposed to, but that they actually achieved competency in specific areas, it is important that we have a shared mental model of what that competency looks like. These 3 Mini-CEXs provide examples of this that you may wish to use ‘off-the-shelf’ or modify for your learners. They allow you to provide feedback based on direct observation, improving your skills in observation and increasing the likelihood that all learners will learn the same key points in how to perform these tasks.

So try out these Mini-CEXs today! They are available for free in POGOe.org! (You can find all of them under the following link or by searching for "mini-CEX")