Implementing the undergraduate mini-CEX: a tailored approach at Southampton University
Implementing the undergraduate mini-CEX: a tailored approach at Southampton University
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.
326-334
Hill, Faith
4a93e3c7-75bd-46b5-bef9-a93f64590d8d
Kendall, Kathleen
7c1c7abc-513b-4da5-b99d-268cd1d8bc58
Galbraith, Kevin
df577969-60e6-4356-8bd3-03875868912d
Crossley, Jim
287d43f8-049b-4257-9215-37b25b11fcd7
April 2009
Hill, Faith
4a93e3c7-75bd-46b5-bef9-a93f64590d8d
Kendall, Kathleen
7c1c7abc-513b-4da5-b99d-268cd1d8bc58
Galbraith, Kevin
df577969-60e6-4356-8bd3-03875868912d
Crossley, Jim
287d43f8-049b-4257-9215-37b25b11fcd7
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), .
(doi:10.1111/j.1365-2923.2008.03275.x).
(PMID:19335574)
Abstract
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.
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Published date: April 2009
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Local EPrints ID: 67232
URI: http://eprints.soton.ac.uk/id/eprint/67232
ISSN: 0308-0110
PURE UUID: cb1a24e3-cf71-4c05-b5e5-f84e4431500f
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Date deposited: 07 Aug 2009
Last modified: 13 Mar 2024 18:46
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Author:
Kevin Galbraith
Author:
Jim Crossley
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