A Pilot Study of Modified Mini-Clinical Evaluation Exercises (Mini-CEX) in Rotation Students in the Department of Endocrinology

Figures & data

Table 1 The Modified Mini-CEX Form for Assessment of Trainees Who Interviewed Diabetes Mellitus (DM) Patients

Domains of Mini-CEX	Contents	Score
Medical interview skills	1. Introduce yourself and other staff to the patient in a way that makes them feel comfortable	1
	2. Respect the patient, ascertain the patient’s primary health problems, communicate in plain language, and encourage the patient to ask questions	1
	3. Appropriate questions and counseling to elicit adequate information, summarize the major complaint and the history of the current disease	1
	4. Have an appropriate response to the patient’s body language, (For example, if the patient complains about an unpleasant or painful spot in his body, the trainee should immediately do a physical examination (PE) and then proceed with the medical interview)	1
	5. Create a family tree for the patient, including each relative (the age starts to suffer from diabetes, health, major illness, and cause of death)	1
	6. In patients suspected of having type 1 diabetes or latent autoimmune diabetes in adults (LADA), obtain a medical history to rule out thyroid disease or other autoimmune diseases and perform a PE for the thyroid. Inquire about any autoimmune disease symptoms, such as joint pain or stiffness	1
	7. Macrovascular problems such as myocardial infarction, chest discomfort, orthopnea; stroke, and Transient Ischemic Arrack (TIA) are also possible	1
	8. Microvascular complications: blurred vision, foamy urine, etc.	1
	9. Diabetic neuropathy’s history includes changes in superficial and deep feeling, including numbness and discomfort in the lower limbs, as well as skin color	1
Physical examination skills	1. Protect the patient’s privacy	1
	2. Inform the patient about the aim of the PE	1
	3. Humanistic care, such as pre-warming the stethoscope head with the palm, etc.	1
	4. Handle the patient’s discomfort with care during palpation	1
	5. Utilize the GCS (Glasgow coma scale) to assess the patient’s mental state	1
	6. The PE performed for the cardiovascular system	1
	7. The PE performed for the neurological system	1
	8. The PE performed for the respiration system	1
	9. The PE was performed for diabetic neuropathy, 10g nylon wire inspection required	1
Clinical judgment	1. Could outline the primary complaint, the current illness’s history, previous medical history, and family history	1
	2. Could make a concise description of the physical examination	1
	3. Could describe the differential diagnostic possibilities	1
	4. Possess the ability to examine the complications of type 2 diabetes	1
	5. The ability to interpret laboratory data and special PE for macrovascular problems (eg, cardiovascular and cerebrovascular disorders)	1
	6. The ability to interpret laboratory data and specialized examinations for microvascular disorders (eg, renal and retinal disorders)	1
	7. The ability to interpret laboratory data and specialized examinations for diabetic peripheral neuropathy	1
	8. Preliminary diagnosis of latent autoimmune diabetes in adults (LADA), type 1 and type 2 diabetes.	1
	9. Clinical judgment regarding the outcome	1
Medical management skills	1. Adequate medical orders for nursing care, diet modification, and blood glucose monitoring.	1
	2. Appropriate medical orders for vital sign monitoring, oxygenation/respiratory care as determined by the GCS	1
	3. Appropriate oral medications for the treatment of type 2 diabetes	1
	4. Appropriate insulin dosage for treatment of hyperglycemia in type 2 diabetes, if necessary	1
	5. If necessary, appropriate medical orders for a rehydration regiment	1
	6. If necessary, the appropriate physician orders antibiotics	1
	7. If necessary, appropriate medical orders for laboratory tests	1
	8. If necessary, appropriate medical orders for the special assessment. CTA, MRA, and MRI are a few examples	1
	9. Determine whether additional consultations with other departments are necessary for the patient	1
Overall clinical competence	1. Above all, the mention is unsatisfying.	1–3
	2. Above all, the mention is satisfactory.	4–6
	3. Above all, excellent in the mention	7–9

Figure 1 Increased scores on the mini-CEX in 5 domains including medical interview skills (A), physical examination skills (B), clinical judgment (C), clinical management skills (D), and overall clinical competence (E) as well as an increase in total scores (F) among rotating medical students before and after type 2 diabetes-specific training. N=79, ****P<0.0001.

Table 2 The Correlation Between Changes in Age, Patients’ Gender, the Interval Between Examinations, Clinical Skills Scores, Observation Time, Feedback Time, and Change in Disease Severity in Relation to Increases in Total Scores

Variables	Increase in Total Score
	r	p
Age disparity among patients (years)	−0.025	0.826
Gender disparity among patients	0.206	0.069
Disease severity disparity	0.071	0.536
The interval between examinations (days)	0.035	0.761
Consultation type disparity (first/ repeated)	0.068	0.554
Medical interview scores change	0.840***	<0.001
Physical examinations score change	0.688***	<0.001
Clinical judgment score change	0.789***	<0.001
Medical management score change	0.660***	<0.001
Overall clinical competence score change	0.355***	0.001
Observation time disparity (min)	0.009	0.940
Feedback time (first exam) (min)	0.391***	<0.001
Feedback time (second exam) (min)	0.160	0.159

Note: ***: P<0.001.

Table 3 Multiple Linear Regression Analysis of Factors Influencing the Increase in the Total Score Before and After Training

Variables	Increment of Total Score R^2=0.153 F=14.400 P<0.001
	B	SE	β	t	p
Constants	−1.745	0.471		−3.708	<0.001
Feedback time (first)	0.080	0.021	0.391	3.795	<0.001

Abbreviations: B, unstandardized coefficient; SE, standard error; β, standardized coefficient.