Early experience with Mini-CEX in otorhinolaryngology residency: feasibility, feedback quality, and perceived educational impact

To describe the implementation of the Mini-Clinical Evaluation Exercise (Mini-CEX) in an Otorhinolaryngology residency program and to analyze assessment outcomes, feedback, and residents' and preceptors' perceptions during the first 21 months.

This retrospective observational study with a cross-sectional quantitative survey and brief open-ended responses comprised a retrospective review of Mini-CEX forms completed between January 2022 and October 2023 in the Otorhinolaryngology outpatient clinics of Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da USP (HCFMRP/USP). Assessments were summarized by subspecialty, complexity, training year, and preceptor experience (≤ 10 vs. >10 years). Participants answered a 27-item online questionnaire on Mini-CEX knowledge and perceptions, plus three open-ended questions.

Forty Mini-CEX encounters were completed for 22 residents by 17 preceptors. Most assessments occurred in otology (52.5%), whereas laryngology was the least represented subspecialty (2.8%). Cases were predominantly of moderate or high complexity (>60%). 46% of assessments were rated as "above expectations", with no significant differences among assessed domains (p = 0.19). Less experienced preceptors were selected more often and assigned lower scores than more experienced preceptors (p < 0.0001); non-faculty preceptors assigned lower scores than faculty members (p = 0.0032). First-year residents scored lower than second- and third-year residents (p = 0.0014). Although 90% received feedback, only 2.5% of feedback entries met completeness criteria, regardless of preceptor experience (p = 0.72). The survey response rate was 90%. Correct responses averaged 87% for knowledge items, while agreement for impact items was 58%; preceptors reported a higher impact than residents (p = 0.006).

Mini-CEX implementation in an Otorhinolaryngology residency program was feasible and captured the expected progression by training year; however, it revealed insufficient feedback documentation and potential rating leniency. To enhance its educational impact, rater training, protected time for assessment, standardized feedback, and broader subspecialty sampling are recommended.

IV.