The utility of mini-Clinical Evaluation Exercise in undergraduate and postgraduate medical education: A BEME review: BEME Guide No. 59

Abstract

Background: This BEME review aims at exploring, analyzing, and synthesizing the evidence considering the utility of the mini-CEX for assessing undergraduate and postgraduate medical trainees, specifically as it relates to reliability, validity, educational impact, acceptability, and cost.

Methods: This registered BEME review applied a systematic search strategy in seven databases to identify studies on validity, reliability, educational impact, acceptability, or cost of the mini-CEX. Data extraction and quality assessment were carried out by two authors. Discrepancies were resolved by a third reviewer. Descriptive synthesis was mainly used to address the review questions. A meta-analysis was performed for Cronbach’s alpha.

Results: Fifty-eight papers were included. Only two studies evaluated all five utility criteria. Forty-seven (81%) of the included studies met seven or more of the quality criteria. Cronbach’s alpha ranged from 0.58 to 0.97 (weighted mean = 0.90). Reported G coefficients, Standard error of measurement, and confidence interval were diverse and varied based on the number of encounters and the nested or crossed design of the study. The calculated number of encounters needed for a desirable G coefficient also varied greatly. Content coverage was reported satisfactory in several studies. Mini-CEX discriminated between various levels of competency. Factor analyses revealed a single dimension. The six competencies showed high levels of correlation with statistical significance with the overall competence. Moderate to high correlations between mini-CEX scores and other clinical exams were reported. The mini-CEX improved students’ performance in other examinations. By providing a framework for structured observation and feedback, the mini-CEX exerts a favorable educational impact. Included studies revealed that feedback was provided in most encounters but its quality was questionable. The completion rates were generally above 50%. Feasibility and high satisfaction were reported.

Conclusion: The mini-CEX has reasonable validity, reliability, and educational impact. Acceptability and feasibility should be interpreted given the required number of encounters.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Acknowledgments

The authors would like to thank the Alabama BICC (BEME International Collaborating Center) and the BREC (BEME Review Editorial Committee) for their comments and feedback on the study protocol and manuscript.

Disclosure statement

The authors declare that they have no competing interests. All authors confirmed the final version and given approval for the manuscript to be published. SMH, MJ, SN, MS, and RM are members of BEME International Collaboration Center at Tehran University of Medical Sciences (TUMS BICC).

Additional information

Funding

This study has been funded and supported by Tehran University of Medical Sciences.

Notes on contributors

Sara Mortaz Hejri

Sara Mortaz Hejri, MD, PhD, AFAMEE, Assistant Professor, Department of Medical Education, Health Professions Education Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Mohammad Jalili

Mohammad Jalili, MD, Professor, Department of Emergency Medicine, Department of Medical Education, Tehran, Iran.

Rasoul Masoomi

Rasoul Masoomi, PhD candidate in Medical Education, Department of Medical Education, Tehran University of Medical Sciences, Tehran, Iran.

Mandana Shirazi

Mandana Shirazi, PhD, Associate Professor, Education Development Center, Department of Medical Education, Tehran University of Medical Sciences, Tehran, Iran; Affiliated Associate Professor of Department of Clinical Science and Education at SOS Hospital, Karolina Institute, Stockholm, Sweden.

Saharnaz Nedjat

Saharnaz Nedjat, MD, PhD, Professor, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

John Norcini

John Norcini, PhD, President Emeritus of Foundation for Advancement of International Medical Education and Research (FAIMER), Philadelphia, Pennsylvania, USA.