Chen Yen-Yuan, Chiu Yu-Chun, Chu Tzong-Shinn, Hsu Hong-Yuan, Chen Huey-Ling, Wu Chau-Chung, Huang Tien-Shang
Department of Medical Education, National Taiwan University Hospital, #7, Rd. Chong-Shan S., Taipei, 10002, Taiwan; Graduate Institute of Medical Education & Bioethics, National Taiwan University College of Medicine, #1, Rd. Ren-Ai Sec. 1, Taipei, 10051, Taiwan.
Department of Medical Education, National Taiwan University Hospital, #7, Rd. Chong-Shan S., Taipei, 10002, Taiwan; Department of Pediatrics, National Taiwan University Hospital, #7, Rd. Chong-Shan S., Taipei, 10002, Taiwan.
J Formos Med Assoc. 2022 May;121(5):943-949. doi: 10.1016/j.jfma.2021.07.005. Epub 2021 Jul 19.
Whether the rating result of mini-clinical evaluation exercise (Mini-CEX) for rating clinical skills is reliable is of a medical trainee's great concerns. The objectives of this study were to analyze the test-retest reliability, interrater reliability and internal consistency reliability of Mini-CEX.
Three clinical scenarios, each played by a standardized patient and resident, were developed and videotaped. A group of assessors were recruited to rate the resident's clinical skills using Mini-CEX with a nine-point grading scale in each videotaped clinical scenario. Each assessor was required: (1) to watch the videotaped clinical scenarios a sequential order; (2) to rate each medical trainee's clinical skills in each clinical scenario for two rating sessions, and there must be a minimum three-week interval between the first and the second Mini-CEX rating session.
A total of 38 assessors participated in this study. This study showed that: (1) an assessor carried out similar rating reuslts under the same clinical performance based on an acceptable test-retest reliability (Pearson's correlation coefficients = 0.24-0.76, P value=<0.01-0.14); (2) assessors gave similar rating results to a medical trainee's clinical performance based on a good interrater reliability (intra-class correlation coefficient = 0.57-0.83, P value=<0.01-0.03); and (3) the items reflected unidimensionally a construct-a medical trainee's clinical skills based on an excellent internal consistency reliability (Cronbach's alpha = 0.92-0.97).
This study convincingly showed that Mini-CEX is a reliable assessment tool for rating clinical skills, and can be widely used to assess medical trainees' clinical skills.
迷你临床评估练习（Mini-CEX）对临床技能的评分结果是否可靠是医学实习生极为关注的问题。本研究的目的是分析Mini-CEX的重测信度、评分者间信度和内部一致性信度。
设计了三个临床场景，每个场景由标准化病人和住院医师进行表演并录像。招募了一组评估者，在每个录像临床场景中使用九点分级量表，通过Mini-CEX对住院医师的临床技能进行评分。要求每位评估者：（1）按顺序观看录像临床场景；（2）在两个评分环节中对每个临床场景中每位医学实习生的临床技能进行评分，第一次和第二次Mini-CEX评分环节之间必须至少间隔三周。
共有38名评估者参与了本研究。本研究表明：（1）基于可接受的重测信度，评估者在相同临床表现下给出了相似的评分结果（Pearson相关系数 = 0.24 - 0.76，P值 = <0.01 - 0.14）；（2）基于良好的评分者间信度，评估者对医学实习生的临床表现给出了相似的评分结果（组内相关系数 = 0.57 - 0.83，P值 = <0.01 - 0.03）；（3）基于出色的内部一致性信度，各项目在单一维度上反映了一种结构——医学实习生的临床技能（Cronbach's α = 0.92 - 0.97）。
本研究令人信服地表明，Mini-CEX是一种用于评估临床技能的可靠评估工具，可广泛用于评估医学实习生的临床技能。
