THE MINI-CEX (CLINICAL-EVALUATION EXERCISE) - A PRELIMINARY INVESTIGATION
THE MINI-CEX (CLINICAL-EVALUATION EXERCISE) - A PRELIMINARY INVESTIGATION
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DOI：
10.7326/0003-4819-123-10-199511150-00008
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发表时间：
1995-11-15
影响因子：
39.2
通讯作者：
KIMBALL, HR
中科院分区：
文献类型：
--
作者：
NORCINI, JJ;BLANK, LL;KIMBALL, HR
目的：收集住院医师临床技能评估工具Mini-CEX的初步数据。设计：由教职员工使用Mini-CEX对住院医师进行评估。设置：宾夕法尼亚州5个内科培训项目。参与者：388次Mini-CEX见面会，涉及88名住院医师和97名评估者。测量：迷你CEX见面会包括一名教职员工观察住院医师，该住院医师在任何一种环境下进行重点病史和体检。在向住院医生询问诊断和治疗计划后，教职员工对住院医生进行评分并提供教育反馈。会面的时间很短(约20分钟)，并作为培训的常规部分，以便每个住院医师都能在不同的教职人员多次场合进行评估。结果：会面发生在住院和门诊环境中，并且比预期的时间长(中位持续时间，25分钟)。居民看到了新患者或后续患者，他们集体出现了广泛的临床问题。中位数评估者对两名居民进行了评估，总体上对迷你CEX格式感到满意；居民对该格式更满意。Mini-CEX的重复性高于传统CEX，其测量特征与标准化患者、标准化口试等其他测试形式相似。结论：Mini-CEX比传统CEX评估住院医师的临床情况范围更广，具有更好的重复性，为住院医师提供了更多由多名教职员工和多名患者观察和反馈的机会。另一方面，迷你CEX可能更难管理，因为必须为每个居民安排多次会面。独家使用迷你CEX还可以防止居民在进行完整的病史和体检时被观察。然而，鉴于迷你CEX的良好结果和测量特点，美国内科医学委员会鼓励将该方法与传统CEX结合使用或作为传统CEX的替代品。
Objective: To gather preliminary data on the mini-CEX (clinical evaluation exercise), a device for assessing the clinical skills of residents.Design: Evaluation of residents by faculty members using the mini-CEX.Setting: 5 internal medicine training programs in Pennsylvania.Participants: 388 mini-CEX encounters involving 88 residents and 97 evaluators.Measurements: A mini-CEX encounter consists of a single faculty member observing a resident while that resident conducts a focused history and physical examination in any of several settings. After asking the resident for a diagnosis and treatment plan, the faculty member rates the resident and provides educational feedback. The encounters are intended to be short (about 20 minutes) and to occur as a routine part of training so that each resident can be evaluated on several occasions by different faculty members.Results: The encounters occurred in both inpatient and ambulatory settings and were longer than anticipated (median duration, 25 minutes). Residents saw either new or follow-up patients who collectively presented with a broad range of clinical problems. The median evaluator assessed two residents and was generally satisfied with the mini-CEX format; residents were even more satisfied with the format. The reproducibility of the mini-CEX is higher than that of the traditional CEX, and its measurement characteristics are similar to those of other test formats, such as standardized patients and standardized oral examinations.Conclusions: The mini-CEX assesses residents in a much broader range of clinical situations than the traditional CEX, has better reproducibility, and offers residents greater opportunity for observation and feedback by more than one faculty member and with more than one patient. On the other hand, the mini-CEX may be more difficult to administer because multiple encounters must be scheduled for each resident. Exclusive use of the mini-CEX also prevents residents from being observed while doing a complete history and physical examination. Given the promising results and measurement characteristics of the mini-CEX, however, the American Board of Internal Medicine encourages the use of this method in conjunction with or as an alternative to the traditional CEX.