Weller J M, Jones A, Merry A F, Jolly B, Saunders D
Centre for Medical and Health Sciences Education, University of Auckland, Private Bag 92019, Auckland, New Zealand.
Br J Anaesth. 2009 Oct;103(4):524-30. doi: 10.1093/bja/aep211. Epub 2009 Aug 17.
The mini-Clinical Evaluation Exercise (mini-CEX) is a workplace-based assessment which may be useful in anaesthesia training. However, its value depends on how supervisors use it with their trainees. This study analyses experience with the mini-CEX after its introduction into anaesthesia departments in our institution.
We conducted surveys, focus groups, and interviews with trainees and specialists. Data were recorded, transcribed, and entered into NVivo 8. Themes were identified and data coded into these themes.
We identified six themes: assessor factors included skills needed to perform the assessments, influences on scoring decisions, and effects on the specialist-trainee relationship; trainee factors related to impact on trainee performance and value at the different training levels; teaching and learning included the effect of focused observation on structuring workplace learning; feedback described how the mini-CEX changed feedback and what was considered useful; mini-CEX process included implementation, initiation of assessments and case selection; and use in assessment included comparisons with existing assessments and the ability to identify poor performers.
Mini-CEX formalized the supervisory relationship, promoting educational interactions. During the observation period, trainees took responsibility for decisions, and specialists learnt more about their abilities. The structured format broadened the scope of feedback and made it easier to address performance gaps. We identified factors that facilitated or hindered implementation, or limited effective feedback and the ability to address poor performance. From this analysis, we propose strategies for the implementation of mini-CEX, and recommendations for assessor training to improve the quality and value of the assessments.
迷你临床评估练习（mini-CEX）是一种基于工作场所的评估，可能对麻醉培训有用。然而，其价值取决于主管如何与学员一起使用它。本研究分析了将mini-CEX引入我们机构麻醉科后的使用经验。
我们对学员和专家进行了调查、焦点小组讨论和访谈。数据被记录、转录并输入NVivo 8。确定了主题，并将数据编码到这些主题中。
我们确定了六个主题：评估者因素包括进行评估所需的技能、对评分决策的影响以及对专家-学员关系的影响；学员因素与对学员表现的影响以及在不同培训水平的价值有关；教学与学习包括重点观察对构建工作场所学习的影响；反馈描述了mini-CEX如何改变反馈以及什么被认为是有用的；mini-CEX流程包括实施、评估的启动和病例选择；评估中的使用包括与现有评估的比较以及识别表现不佳者的能力。
Mini-CEX使监督关系正规化，促进了教育互动。在观察期内，学员对决策负责，专家对他们的能力有了更多了解。结构化的形式拓宽了反馈范围，使解决绩效差距更容易。我们确定了促进或阻碍实施、限制有效反馈以及解决表现不佳问题能力的因素。通过这项分析，我们提出了实施mini-CEX的策略，以及评估者培训的建议，以提高评估的质量和价值。
