Chinese doctors’ views on workplace-based assessment: trainee and supervisor perspectives of the mini-CEX

Figures & data

Table 1. Participant demographics

	Questionnaire		Interviews
	Trainees	Supervisors	Trainees	Supervisors
Total number	43	48	11	11
Gender (male)	23	30	5	6
Median Age	25 years	42 years	26 years	38 years
Specialty
Radiation oncology	18	17	4	3
Surgery	13	15	3	3
Internal medicine	4	8	2	2
Anaesthesiology	7	4	1	2
Gynaecology	1	2	0	0
Radiology	0	1	1	0
Ultrasound	0	1	0	1
Career grade
Foundation	43	0	11	0
Specialist registrar	0	26	0	6
Consultant	0	17	0	5
Chief consultant	0	5	0	0

Table 2. Participants’ experience of the mini-CEX

Number of previous encounters	Questionnaire		Interviews
	Trainees	Supervisors	Trainees	Supervisors
≤2	35	26	3	3
3–6	3	10	5	6
7–9	4	8	3	1
≥10	1	4	0	1
Total	43	48	11	11

Table 3. Trainee and supervisor perspectives of the mini-CEX

Questions	Trainees (N = 43)					Supervisors (N = 48)
	Strongly disagree	Disagree	Neutral	Agree	Strongly agree	Strongly disagree	Disagree	Neutral	Agree	Strongly agree
1. I have a precise understanding of the purpose of the mini-CEX.	0	2	15	20	6	1	7	15	17	6
2. Supervisors initiate the mini-CEX.	0	1	8	21	13	1	6	14	17	6
3. There is sufficient time for each encounter.	1	3	9	21	9	1	6	18	17	6
4. Each encounter is directly observed.	1	4	10	20	8	1	3	12	22	10
5. Feedback is provided after each encounter.	1	3	9	21	9	1	3	11	24	9
6. Feedback is real-time.	1	4	10	20	8	1	6	5	21	15
7. Feedback is content specific.	0	1	7	22	13	1	2	9	26	10
8. Feedback points out weaknesses in performance.	0	1	10	18	14	1	2	12	23	10
9. The mini-CEX helps in prompting reflection.	0	3	7	20	13	1	3	14	21	8
10. Score actually reflects the quality of performance.	1	4	10	20	8	1	3	16	24	9
11. The mini-CEX is useful in identifying under-performance.	0	2	8	22	11	1	4	9	27	7
12. The mini-CEX informs learning progression.	0	4	7	25	7	1	3	11	24	9
13. The mini-CEX helps to improve overall clinical competence.	0	4	7	25	7	0	2	19	22	5
14. The supervisor/trainee shows commitment during mini-CEX encounters.	1	3	10	19	10	1	2	12	21	12
15. In general, mini-CEX gets a buy-in from me.	0	4	9	15	15	0	4	11	19	14

Table 4. Themes identified from the trainee and supervisor interviews

Themes	Examples
1. Perceptions of the mini-CEX
Interpretation of the purpose
Diagnostic tool for learning	‘exemplifying learning strength and weakness’; ‘reflect progress while indicating setbacks’; ‘they watched how you did things and gave feedback, so it is real’
Summary of training in a specific period of time	‘a change in every stage of training’; ‘exemplifies what and how you had learned’; ‘get a real picture of learning’;
Administrative regulation	‘a requirement for both parties’; ‘they [supervisors] are obliged to observe our change in capability now’; ‘now it becomes compulsory and written in paper, they [supervisors] must do that’
A teaching and learning event	‘a standardised learning and teaching activity’; ‘a flexible and authentic learning’; ‘a routine teaching activity’
Concerns about reliability of scoring
Subjective rating	‘lacking a standard for score could undermine the accuracy’; ‘standard varies from trainer’; ‘each tutor holds an individual standard’
Inflated score	‘I don’t intend to hurt someone and that really influences overall score’; ‘they would not fail a trainee by saying the performance is extremely poor’; ‘you want to encourage them, so the overall score could inflate a little’
Calls for training	‘relevant training is definitely necessary’; ‘I guess not all [supervisors] are familiar with the content’; ‘not clear what a standardised encounter is’
C. Delivery of the mini-CEX
Supervisor initiated event	‘supervisor will take care of it [mini-CEX]’; ‘it is my [supervisor’s] responsibility to commence the assessment’; ‘usually they [supervisors] will make plans for that’
Timing of assessment	‘approaching the end of departmental training’; ‘in the middle of rotation’; ‘when I [supervisor] can spare myself from clinical work’
iii. Challenges of allocating time	‘required both of us to try hard to come up with enough time for one encounter’; ‘pressures of service provision make it easier to do it retrospectively’; ‘they [supervisors] are extremely busy’
D. Observation
i. Generating feedback	‘you have to observe to generate feedback’; ‘they [supervisor] watched you doing the job and then fed back’; ‘produce useful tips in feedback’
ii. Effect of corrections on clinical practice	‘you can tell if they [trainees] correct errors in routine work’; ‘I can see [correction] during next performance’
iii. Creates a sense of learning	‘you felt learning when they [supervisors] are watching you’; ‘now you get more attention while they [supervisors] must watch you do things’
E. Feedback
i. Likelihood of provision	‘I get feedback every encounter’; ‘no guarantee you get feedback after each encounter’
ii. Real-time	‘instantly’; ‘immediately’; ‘as soon as it [mini-CEX] is finished’
iii. Honest feedback	‘you must be honest’; ‘it [feedback] is focused on my underperformance’; ‘they [trainees] know that they are here for learning’
iv. Narrative and detail	‘[supervisor] pinpoints some leading language that I used in medical interview’; ‘very detailed and comprehensive’; ‘comments on physical examination or procedures are more specific and explicit’
v. Verification and correction	‘I get corrected right away’; ‘it is normal for them to correct you’; ‘highly appreciate direct feedback’
vi. Overall aim to encourage	‘a slightly larger proportion of positive content [in feedback]’; ‘the main tone of feedback remains positive … they [trainees] need to be encouraged’; ‘balance between positive and constructive’
Educational impact of mini-CEX
Framework for assessing and teaching	‘there is a framework for process or instruction’; ‘broadened my [supervisor’s] interpretation of teaching’; ‘a framework to help us understanding learning task and learning content’
Guidance for learning	‘a learning habit that promotes systematic and coherent thinking’; ‘comprehensive illustration of learning tasks and learning content’; ‘flexible and authentic learning: a tool for learning and teaching’
Provoking reflection for learning and teaching	‘check what could be amended and needs for special coaching’; ‘leads them [trainees] to think what patients really value’; ‘leads me to tailor my coaching approach to offer best support’
Co-operation/sharing responsibility	‘they [trainees] are willing to co-operate’; ‘I am willing to share portions of responsibility in patient treatment with trainees showing good competencies and enthusiasm’; ‘helpful to share treatment responsibility … tutors are more willing to teach, we collaborate better’
A sense of achievement or self-improvement	‘you change in every stage of training’; ‘I can see progress in skills because I made a great effort to advance’; ‘I am now confident to illustrate explicitly and consider [assessment] more comprehensively’
Aligning training with daily work	‘the most tangible improvement … I can link them to routine work’; ‘compare advice [from supervisor] with practice’; ‘case selected [for assessment] in line with curriculum, usually those common cases with a typical syndrome’
3. Acceptability of mini-CEX
Positive	‘they [trainees] were very engaged in doing it [mini-CEX]’; ‘[Supervisors] are keen to carry out an assessment’; ‘essential for training and I would embrace it’
Negative	‘little practical meaning in busy clinical setting and looks like an administrative regulation’; ‘[the supervisor] took the assessment as a tick-box task’; ‘little value in practice’
Neutral	‘unclear assessing standard’; ‘may not fit every discipline’; ‘I literally think it is good only if it is infrequent, as it takes a lot of time’