Thikriat Al-Jewair, BDS, MBA, MSc, MS, FRCD(C), Dip Ortho, is Associate Professor and Director, Advanced Education Program in Orthodontics, Department of Orthodontics, School of Dental Medicine, University at Buffalo; Sonal Kumar, BA, graduated from Columbia University.
J Dent Educ. 2019 Nov;83(11):1332-1338. doi: 10.21815/JDE.019.131. Epub 2019 Jul 22.
The aims of this study were to review the evidence on the Mini-Clinical Evaluation Exercise (Mini-CEX) for work- based assessment and to assess, in a pilot study, the utility of the Mini-CEX in an advanced orthodontic education program. Three evaluators and six first-year orthodontic residents at one U.S. dental school were recruited for the study between July and December 2017. The evaluators used a modified Mini-CEX instrument with a nine-point scale (1=unsatisfactory to 9=superior) to observe 24 resident-patient encounters (four encounters per resident) that involved orthodontic screening and comprehensive consultation procedures. Seven domains were assessed: interviewing skills, clinical examination, professionalism, clinical judgment, counseling, organization, and overall competence. Evaluators gave individualized feedback immediately after each encounter and recorded the duration of encounter and feedback in minutes. Evaluators and residents also reported their satisfaction with the experience. The mean scores for the screening and consultation encounters were 7.21±1.39 and 7.96±0.97, respectively. Overall, the highest score of all the domains was in organization (8.00±1.14) and the lowest was in clinical judgment (7.11±0.96). Clinical performance improved over four encounters (7.80±0.92, 8.72±1.29, 8.98±1.13, and 8.52±1.45, respectively); however, the difference was not statistically significant. The mean duration of encounters was 15.05±2.39 minutes and of feedback was 8.25±4.64 minutes. Encounter duration was significantly longer in difficult cases than in moderate or simple cases (ANOVA, post-hoc p=0.004). The mean satisfaction rates of residents and evaluators were high (90% and 84%, respectively). Although there is no gold standard to assess clinical competence in dentistry, this study found that the Mini-CEX may be a potentially effective method of work-based assessment in advanced orthodontic education.
本研究旨在回顾 Mini-Clinical Evaluation Exercise（Mini-CEX）在基于工作的评估中的证据，并在试点研究中评估 Mini-CEX 在高级正畸教育计划中的效用。2017 年 7 月至 12 月期间，在美国一所牙科学校招募了三名评估员和六名一年级正畸住院医师参与该研究。评估员使用改良的 Mini-CEX 仪器（九点量表，1=不满意至 9=优秀）观察了 24 名住院医师-患者的接触（每名住院医师四次接触），涉及正畸筛查和全面咨询程序。评估了七个领域：访谈技巧、临床检查、专业性、临床判断、咨询、组织和整体能力。评估员在每次接触后立即提供个性化反馈，并以分钟记录接触和反馈的持续时间。评估员和住院医师还报告了他们对该体验的满意度。筛查和咨询接触的平均得分分别为 7.21±1.39 和 7.96±0.97。总体而言，所有领域中得分最高的是组织（8.00±1.14），得分最低的是临床判断（7.11±0.96）。经过四次接触，临床表现有所提高（分别为 7.80±0.92、8.72±1.29、8.98±1.13 和 8.52±1.45）；然而，差异无统计学意义。接触的平均持续时间为 15.05±2.39 分钟，反馈的平均持续时间为 8.25±4.64 分钟。在困难病例中，接触时间明显长于中度或简单病例（ANOVA，事后 p=0.004）。住院医师和评估员的平均满意度均较高（分别为 90%和 84%）。尽管在评估牙科临床能力方面没有金标准，但本研究发现 Mini-CEX 可能是高级正畸教育中基于工作的评估的一种潜在有效方法。
