Didactic value of the clinical evaluation exercise. Missed opportunities

The clinical evaluation exercise (CEX), a direct observation of trainees' clinical skills, is a common method of house officer evaluation. During our studies of its reliability, the extent of the CEX's didactic value surfaced. This brief report describes the amount of information passed from the evaluator to the house officer in 73 CEXs. On average, evaluators made eight teaching points in postexamination sessions. However, there were as many points recorded on the CEX forms that evaluators never mentioned. In a subset of CEXs carried out with two observers present, agreement in the teaching points presented to the house officer within the pairs witnessing the same examination was 18%. Positive feedback constituted 9% to 12% of the points presented. Our observations suggest that the more systematic feedback mechanisms may enhance the didactic value of the CEX.