The costs and utility of the Mini-CEX

Dear Sir

Brazil et al. (2012) have added another piece of the jigsaw that shows what might constitute cost and value in medical education. However, their approach in measuring costs and in evaluating the utility of the assessment intervention may be flawed.

When measuring costs in education, we must be rigorous, thorough and comprehensive (Walsh 2010). This means that estimates should not be made of costs, but rather all elements of costs should be carefully accounted for and added up until a final definitive sum is arrived at. It appears from the paper by Brazil et al. (2012) that the authors only accounted for the cost of the senior assessor time. This may account for the majority of the costs but are unlikely to account for all of them. This approach does not include the costs of the time of learners, the costs of the time of administration staff, the costs of consumables (e.g. printed forms), the costs of software and hardware (used to store results), and the costs of blueprinting and standard setting. In assessment programmes that are rolled out, these costs will add up and cannot be ignored.

Next there is the issue of assessment utility. Even though adding the mini-CEX did not affect summative assessment results, both learners and assessors did have positive perceptions about the mini-CEX, and also the “mini-CEX was more effective in identifying the individual domains in which the interns demonstrated deficiencies.” The question therefore is whether these outcomes are worth the sums spent on the assessment. This is not straightforward as the outcomes cannot be expressed in monetary terms. If educationalists, healthcare professionals and members of society place sufficient weight on these outcomes, then the cost will likely be justified. But if they do not, then the cost will not. Only by means of open public debate will be come to a conclusion on this.