Mini-clinical evaluation exercise in anaesthesia training

Abstract

BACKGROUND: The Mini-Clinical Evaluation Exercise (Mini-CEX) is a workplace-based assessment tool of potential value in anaesthesia to assess and improve clinical performance. Its reliability and positive educational impact have been reported in other specialities, but not, to date, in anaesthesia. In this study, we evaluated the psychometric characteristics, logistics of application, and impact on the quality of supervision of the Mini-CEX in anaesthesia training.

METHODS: A Mini-CEX encounter consisted of a single specialist anaesthetist observing a trainee over a defined period of time, completing an online Mini-CEX form with the trainee, and providing written and verbal feedback. We sought trainee and supervisor perspectives on its value and ease of use and used Generalizability Theory to estimate reliability.

RESULTS: We collected 331 assessments from 61 trainees and 58 assessors. Survey responses strongly supported the positive effect of the Mini-CEX on feedback, its relative feasibility, and acceptance as a potential assessment tool. In this cohort, we found variable assessor stringency and low trainee variation. However, a feasible sample of cases and assessors would produce sufficiently precise scores to decide that performance was satisfactory for each trainee with 95% confidence. To generate scores that could discriminate sufficiently between trainees to allow ranking, a much larger sample of cases would be needed.

CONCLUSIONS: The Mini-CEX in anaesthesia has strengths and weaknesses. Strengths include: its perceived very positive educational impact and its relative feasibility. Variable assessor stringency means that large numbers of assessors are required to produce reliable scores.