MedEdPublish (Jun 2020)
Tutor-demonstrated feedback in the mini-clinical evaluation exercise
Abstract
Introduction: The mini-clinical evaluation exercise (mini-CEX) allows for assessment and subsequent feedback across a range of individual clinical cases, although much of what is assessed is left implicit. After the performance by a trainee, further observation of appropriate clinical performance by the tutor provides a strong standard of reference for effective learning. Methods: In each mini-CEX encounter one final year resident clinically assessed an unfamiliar patient in the presence of peers and a tutor. The tutor then demonstrated the appropriate clinical behaviour. Twelve peers rated the performance of the resident before and after the tutor-demonstrated feedback (TDF). The encounters with the first cases by each of the participants were completed one by one and the cycles of encounters with the next cases by each resident were similarly continued. Results: All 13 participants completed six mini-CEX encounters over one year with an overall response rate of 95% for peer-assessment ratings (PARs). There was a total of 1772 PAR forms each with seven parameters and 1772 peer-satisfaction rating (PSR). Reliability coefficients of PARs ranged from .77 to .93. The PARs decreased significantly in each of the six cases after TDF (p<0.001). Peers rated the performance more negatively after the TDF than before the TDF. The mean PSRs, however, increased significantly in each of the six cases after the TDF (p<0.05). The mean observation time of participants' performance decreased from 26 minutes in the initial two cases to 14.5 in the last two (p<0.001). Conclusion: The feasibility and the positive educational impact of the TDF were shown in our exploratory study. The novel concept of TDF in the mini-CEX as supervised learning events and formative assessment deserves further investigation.
