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Mini-CEX

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 10-20 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.

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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

Mini-CEX Evaluators

  • General faculty
  • Core faculty
  • Chief medical residents

Rating Scale

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:

  1. Determine if the performance was satisfactory, unsatisfactory or superior
  2. Determine which of the three possible ratings best reflects the observed trainee-patient encounter within the selected performance category:
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Examples of Clinical Skills Evaluated

  • 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 patients needs of comfort, modesty, confidentiality and information
  • Follows efficient, logical sequence
  • Balances screening/diagnostic steps for problem
  • Sensitive to a patient's modesty and comfort
  • Explains rationale for test/treatment, obtains a patient's consent
  • Educates/counsels regarding disease management
  • Discussion is prioritized, timely and concise
  • Selectively orders/performs appropriate diagnostic studies
  • Considers risks and benefits of prescribed treatment

Overall Clinical Competence (PCPS Patient Care and Procedural Skills (PCPS)
Gathers and synthesizes essential and accurate information to
  define each patient's clinical problem(s)
Develops and achieves comprehensive management plan for
  each patient
Manages patients with progressive responsibility and independence
Skill in performing procedures
Requests and provides consultative care
, MKMedical Knowledge (MK)
Clinical knowledge
Knowledge of diagnostic testing and procedures
, PBLIPractice-Based Learning and Improvement (PBLI)
Monitors practice with a goal for improvement
Learns and improves via performance audit
Learns and improves via feedback
Learns and improves at the point of care
, IPCSInterpersonal and Communication Skills (IPCS)
Communicates effectively with patients and caregivers
Communicates effectively in interprofessional teams (e.g.,
  peers, consultants, nursing, ancillary professionals and other
  support personnel)
Appropriate utilization and completion of health records
, PProfessionalism (P)
Has professional and respectful interactions with patients,
  caregivers and members of the interprofessional team
  (e.g., peers, consultants, nursing, ancillary professionals and
  support personnel)
Accepts responsibility and follows through on tasks
Responds to each patient’s unique characteristics and needs
Exhibits integrity and ethical behavior in professional conduct
, SBPSystem-Based Practice (SBP)
Works effectively within an interprofessional team
  (e.g., peers, consultants, nursing, ancillary professionals
  and other support personnel)
Recognizes system error and advocates for system improvement
Identifies forces that impact the cost of health care, and
  advocates for, and practices cost-effective care
Transitions patients effectively within and across health
  delivery systems
)

  • 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.

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The ACGME General Competencies

As part 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)

  • Gathers and synthesizes essential and accurate information to define each patient's clinical problem(s)
  • Develops and achieves comprehensive management plan for each patient
  • Manages patients with progressive responsibility and independence
  • Skill in performing procedures
  • Requests and provides consultative care

Medical Knowledge (MK)

  • Clinical knowledge
  • Knowledge of diagnostic testing and procedures

Practice-Based Learning and Improvement (PBLI)

  • Monitors practice with a goal for improvement
  • Learns and improves via performance audit
  • Learns and improves via feedback
  • Learns and improves at the point of care

Interpersonal and Communication Skills (IPCS)

  • Communicates effectively with patients and caregivers
  • Communicates effectively in interprofessional teams (e.g., peers, consultants, nursing, ancillary professionals and other support personnel)
  • Appropriate utilization and completion of health records

Professionalism (P)

  • Has professional and respectful interactions with patients, caregivers and members of the interprofessional team (e.g., peers, consultants, nursing, ancillary professionals and support personnel)
  • Accepts responsibility and follows through on tasks
  • Responds to each patient’s unique characteristics and needs
  • Exhibits integrity and ethical behavior in professional conduct

System-Based Practice (SBP)

  • Works effectively within an interprofessional team (e.g., peers, consultants, nursing, ancillary professionals and other support personnel)
  • Recognizes system error and advocates for system improvement
  • Identifies forces that impact the cost of health care, and advocates for, and practices cost-effective care
  • Transitions patients effectively within and across health delivery systems