Implementation of a Mini-CEX Requirement Across All Third-Year Clerkships

Area of Science:

• Medical Education
• Clinical Skills Assessment
• Competency-Based Education

Background:

• Direct observation and feedback are crucial for medical student development but are often infrequent.
• The mini clinical evaluation exercise (mini-CEX) is a tool designed to enhance direct observation and feedback.
• Previous use of mini-CEX in internal medicine clerkships showed higher observation rates compared to other specialties.

Purpose of the Study:

• To assess the impact of a universal mini-CEX requirement on third-year medical students' reported direct observation by faculty.
• To evaluate the effect of the mini-CEX requirement on objectively measured clinical skills.
• To determine the feasibility of implementing a standardized mini-CEX across all clerkships.

Main Methods:

• A mini-CEX requirement was implemented across all third-year clerkships.
• Student self-reported direct observation was measured via end-of-clerkship surveys and AAMC Graduation Questionnaire (GQ) items.
• Clinical skills were assessed using a summative Objective Structured Clinical Examination (OSCE).
• Pre- and post-intervention data were analyzed using chi-square and Fisher's exact tests.

Main Results:

• High adherence to the mini-CEX requirement was observed, with 92% of forms completed and 78% including specific feedback.
• Significant increases in student-reported direct observation of physical examinations and history taking were noted across all clerkships.
• Failures in the summative OSCE decreased significantly from 12% pre-intervention to 2% post-intervention (p = .0046).

Conclusions:

• Implementing a mini-CEX requirement across all third-year clerkships is feasible.
• The mini-CEX requirement is associated with increased direct faculty observation of students.
• The initiative led to improved clinical skills assessment, evidenced by reduced OSCE failure rates.