Mini-Clinical Evaluation Exercise as a Formative Assessment Tool in Undergraduate Medical Training: A Study of Student and Faculty Acceptability

Abstract

Background: Mini-CEX evaluation exercise is a workplace-based assessment method which evaluates a medical student’s clinical acumen, behaviour and professionalism. Every aspect of a clinical encounter is evaluated at mini-CEX. It involves history taking & interviewing skills, physical & clinical examination skills, clinical judgement, counselling skills and overall professionalism. The process includes a short observed clinical interaction by a medical student with a live patient & the whole process is observed by an accessor at bedside who after the encounter is over provides structured feedback to the student. The feedback form is a rating chart where the accessor marks the trainee’s performance across the pre-defined competencies using a standardized & structured rating scale. The immediate feedback by the accessor provides scope for further learning & skill improvement.

Aims: To assess the acceptability of the Mini-Clinical Evaluation Exercise (mini-CEX) as a formative assessment tool among final MBBS students and faculty members

Methods: A cross-sectional observational study was conducted in six months duration in the department of medicine to study the acceptability of mini-CEX amongst students of final MBBS and faculties of medicine department after obtaining permission from IEC. 25 medical students were selected by systemic random sampling. Following sensitization and informed consent each student underwent a mini-CEX encounter assessed by a trained faculty using a nine-point standardized mini-CEX rating scale. Clinical skills, clinical acumen, communication skills, clinical judgement and overall professionalism were evaluated during the 20 mints encounter followed by immediate feedback and the rating chart being handed over to the student. Acceptability of this encounter was assessed by using five-point Likert scale based on structured & validated questionnaires covering multiple domains for acceptability. Data were analysed using descriptive statistics & Chi-square test.

Results: Acceptability of mini-CEX among students was assessed across four domains: satisfaction level, educational impact, assessment utility and psychological perception. The mean sentiment scores for these domains were 3.56±1.19, 4.08±0.97, 3.82±1.32 & 3.32±1.57, respectively. These findings indicate students have positive perception of mini-CEX regarding its educational value and its utility as an assessment tool. Psychological impact remained neutral likely reflecting the direct observation component of the process. Statistical analysis revealed a significant association with immediate feedback in mini-CEX (P< 0.05) & it’s linked with improved students’ performance with greater awareness of individual’s strength & weakness. Faculty perception scores across the same domains were 3.60±0.28, 3.20±0.51, 3.29±0.67 & 3.00±1.58, showing broadly similar trends, though faculty perception regarding its utility as educational tool and assessment method appeared more reserved. The overall acceptability score was 3.70±1.19 among students & 3.27± 0.76 among faculty, indicating a positive perception in both two groups.

Conclusion: Mini- CEX is a feasible and well accepted tool for formative assessment in clinical settings with particular strength in providing immediate feedback, which ensures students’ learning & improves performance. Its integration in learning module will improve clinical competence however adequate faculty training must be implemented beforehand.