American Board of Medical Specialties, Chicago, Illinois 60601, USA.
Acad Med. 2010 Sep;85(9):1453-61. doi: 10.1097/ACM.0b013e3181eac3e6.
The mini-Clinical Evaluation Exercise (mCEX) is increasingly being used to assess the clinical skills of medical trainees. Existing mCEX research has typically focused on isolated aspects of the instrument's reliability and validity. A more thorough validity analysis is necessary to inform use of the mCEX, particularly in light of increased interest in high-stakes applications of the methodology.
Kane's (2006) validity framework, in which a structured argument is developed to support the intended interpretation(s) of assessment results, was used to evaluate mCEX research published from 1995 to 2009. In this framework, evidence to support the argument is divided into four components (scoring, generalization, extrapolation, and interpretation/decision), each of which relates to different features of the assessment or resulting scores. The strength and limitations of the reviewed research were identified in relation to these components, and the findings were synthesized to highlight overall strengths and weaknesses of existing mCEX research.
The scoring component yielded the most concerns relating to the validity of mCEX score interpretations. More research is needed to determine whether scoring-related issues, such as leniency error and high interitem correlations, limit the utility of the mCEX for providing feedback to trainees. Evidence within the generalization and extrapolation components is generally supportive of the validity of mCEX score interpretations.
Careful evaluation of the circumstances of mCEX assessment will help to improve the quality of the resulting information. Future research should address issues of rater selection, training, and monitoring which can impact rating accuracy.
迷你临床演练评估（mCEX）越来越多地被用于评估医学实习生的临床技能。现有的 mCEX 研究通常集中在该工具的可靠性和有效性的孤立方面。需要更全面的有效性分析来为 mCEX 的使用提供信息，特别是考虑到该方法在高风险应用中的兴趣日益增加。
凯恩（2006 年）的有效性框架，其中提出了一个结构化的论点，以支持评估结果的预期解释，用于评估 1995 年至 2009 年期间发表的 mCEX 研究。在这个框架中，支持论点的证据分为四个部分（评分、概括、推断和解释/决策），每个部分都与评估或产生的分数的不同特征有关。根据这些组成部分，确定了审查研究的优势和局限性，并对研究结果进行了综合，以突出现有 mCEX 研究的总体优势和局限性。
评分部分与 mCEX 评分解释的有效性最相关，最令人关注。需要进一步研究以确定评分相关问题（如宽松错误和高项目间相关性）是否限制了 mCEX 为学员提供反馈的效用。概括和推断部分的证据通常支持 mCEX 评分解释的有效性。
仔细评估 mCEX 评估的情况将有助于提高所产生信息的质量。未来的研究应解决评分者选择、培训和监测等问题，这些问题会影响评分的准确性。
