The ABIM Mini-Clinical Evaluation Exercise (Mini-CEX) is intended to facilitate formative assessment of core clinical skills. It can be used by faculty as a routine, seamless evaluation of trainees in any setting.
The Mini-CEX is a 10 to 20 minute direct observation assessment or “snapshot” of a trainee-patient interaction. Faculty are encouraged to perform at least one per clinical rotation. To be most useful, faculty should provide timely and specific feedback to the trainee after each assessment of a trainee-patient encounter.
Mini-CEX booklets can be ordered directly from ABIM free of charge. ABIM recommends ordering one booklet, per trainee, per academic year. The Mini-CEX (pdf) can be distributed for demonstration during faculty workshops, staff meetings, orientation and training sessions.
Guidelines for Implementing the ABIM Mini-CEX Settings to Conduct Mini-CEXs
- Out-patient clinic
- In-patient services (CCU/ICU, general medical floor)
- Emergency department
Clinical Skills Evaluated
- Medical interviewing
- Physical examinations
- Informed decision-making/counseling
- Clinical judgment/reasoning
- General faculty
- Core faculty
- Chief medical residents
The Mini-CEX utilizes a nine-point rating scale:
- 1 through 3 is unsatisfactory
- 4 through 6 is satisfactory*
- 7 through 9 is superior
*A rating of 4, while classified as satisfactory, is defined as “marginal” and conveys the need to improve performance through program recommended remediation. Faculty using this assessment tool are expected to develop a common understanding of the criteria for each of these ratings through program-wide faculty development activities.
The recommended two-step approach for using a nine-point scale:
- Determine if the performance was satisfactory, unsatisfactory or superior
- Determine which of the three possible ratings best reflects the observed trainee-patient encounter within the selected performance category
Examples of Clinical Skills Evaluated
Medical Interviewing (PCPS, MK, IPCS)
- Facilitates accurate collection of a patient's history
- Effectively uses questions/directions to obtain accurate information needed
- Responds appropriately to non-verbal cues
- Shows respect, compassion, empathy and establishes trust
- Attends to a patient's needs of comfort, modesty, confidentiality and information
Physical Examination (PCPS, MK)
- Follows efficient, logical sequence
- Balances screening/diagnostic steps for problem
- Sensitive to a patient’s modesty and comfort
Informed Decision-Making/Counseling Skills (PCPS, MK, IPCS)
- Explains rationale for test/treatment, obtains a patient's consent
- Educates/counsels regarding disease management
- Discussion is prioritized, timely and concise
Clinical Judgment/Reasoning (PCPS, MK, PBLI, SBP)
- Selectively orders/performs appropriate diagnostic studies
- Considers risks and benefits of prescribed treatment
Overall Clinical Competence (PCPS, MK, PBLI, IPCS, P, SBP)
- Demonstrates judgment, synthesis, caring, effectiveness and efficiency in patient care
ABIM recognizes that not all the ACGME general competencies can be easily assessed and evaluated by observing clinical skills. The listed examples are intended to demonstrate how the ABIM Mini-CEX could facilitate competency-based assessment and evaluation.
The ACGME General Competencies
As the first major activity of the ACGME Outcome Project, the ACGME identified six general competencies for residents. Identifying the competencies was stimulated by increased attention to how adequately physicians are prepared to practice medicine in the changing health care delivery system.
Patient Care and Procedural Skills (PCPS)
Trainees must be able to provide patient care, including the safe and effective use of procedures, that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health.
Medical Knowledge (MK)
Trainees must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care.
Practice-Based Learning and Improvement (PBLI)
Trainees must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and lifelong learning.
Interpersonal and Communication Skills (IPCS)
Trainees must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families and health professionals.
Trainees must demonstrate a commitment to carrying out professional responsibilities and adherence to ethical standards.
System-Based Practice (SBP)
Trainees must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.