The University of Southampton
University of Southampton Institutional Repository

Implementing the undergraduate mini-CEX: a tailored approach at Southampton University

Hill, Faith, Kendall, Kathleen, Galbraith, Kevin and Crossley, Jim (2009) Implementing the undergraduate mini-CEX: a tailored approach at Southampton University Medical Education, 43, (4), pp. 326-334. (doi:10.1111/j.1365-2923.2008.03275.x). (PMID:19335574).

Record type: Article


OBJECTIVES: The mini-clinical evaluation exercise (mini-CEX) is widely used in the UK to assess clinical competence, but there is little evidence regarding its implementation in the undergraduate setting. This study aimed to estimate the validity and reliability of the undergraduate mini-CEX and discuss the challenges involved in its implementation.

METHODS: A total of 3499 mini-CEX forms were completed. Validity was assessed by estimating associations between mini-CEX score and a number of external variables, examining the internal structure of the instrument, checking competency domain response rates and profiles against expectations, and by qualitative evaluation of stakeholder interviews. Reliability was evaluated by overall reliability coefficient (R), estimation of the standard error of measurement (SEM), and from stakeholders' perceptions. Variance component analysis examined the contribution of relevant factors to students' scores.

RESULTS: Validity was threatened by various confounding variables, including: examiner status; case complexity; attachment specialty; patient gender, and case focus. Factor analysis suggested that competency domains reflect a single latent variable. Maximum reliability can be achieved by aggregating scores over 15 encounters (R = 0.73; 95% confidence interval [CI] +/- 0.28 based on a 6-point assessment scale). Examiner stringency contributed 29% of score variation and student attachment aptitude 13%. Stakeholder interviews revealed staff development needs but the majority perceived the mini-CEX as more reliable and valid than the previous long case.

CONCLUSIONS: The mini-CEX has good overall utility for assessing aspects of the clinical encounter in an undergraduate setting. Strengths include fidelity, wide sampling, perceived validity, and formative observation and feedback. Reliability is limited by variable examiner stringency, and validity by confounding variables, but these should be viewed within the context of overall assessment strategies.

Full text not available from this repository.

More information

Published date: April 2009


Local EPrints ID: 67232
ISSN: 0308-0110
PURE UUID: cb1a24e3-cf71-4c05-b5e5-f84e4431500f

Catalogue record

Date deposited: 07 Aug 2009
Last modified: 19 Jul 2017 00:20

Export record



Author: Faith Hill
Author: Kevin Galbraith
Author: Jim Crossley

University divisions

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton:

ePrints Soton supports OAI 2.0 with a base URL of

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.