Shafqat Shameel, Tejani Isbaah, Ali Muhammad, Tariq Hemaila, Sabzwari Saniya
College of Medicine, Aga Khan University Medical College, Karachi, PAK.
Family Medicine, Aga Khan University Hospital, Karachi, PAK.
Cureus. 2022 Sep 25;14(9):e29563. doi: 10.7759/cureus.29563. eCollection 2022 Sep.
Background In clinical settings, direct observation (DO) with feedback is an effective method to assess and improve learner performance. One tool used for DO is the mini-clinical evaluation exercise (Mini-CEX). We conducted a study to assess the effectiveness and feasibility of Mini-CEX for medical students at Aga Khan University, Karachi. Methods Utilizing a purposive sampling technique, a total of 199 students in six core clerkships of Years 3 and 4 were selected for this study. Participating faculty underwent training workshops for use of Mini-CEX and feedback strategies. Each student was assessed twice by one faculty, using a modified version of the Mini-CEX, which assessed four domains of clinical skills: Data Gathering, Communication, Diagnosis/Differential, and Management Plan and Organization. Feedback was given after each encounter. Faculty and students also provided detailed feedback regarding the process of DO. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 26 (IBM Corp., Armonk, NY, USA), with categorical variables arranged as frequencies and percentages. The Chi-squared test was used for further statistical analyses, and a P-value of < 0.05 was considered statistically significant. Effectiveness was assessed via a change in student performance between the first and second Mini-CEX, and feasibility was assessed via qualitative feedback. Results We obtained three sets of results: Mini-CEX forms (523), from which we included a total 350 evaluations for analysis, 216 from Year 3 and 134 from Year 4, and feedback on DO: student (70) and faculty (18). Year 3 students performed significantly better in all foci of the Mini-CEX between the first and second assessment (P ≤ 0.001), whereas in Year 4, significant improvement was limited to only two domains of the Mini-CEX [Communication of History/Physical Examination (P = 0.040) and Diagnosis/Differential and Management Plan (P < 0.001)]. Students (65.7%) and faculty (94.4%) felt this exercise improved their interaction. 83.3% faculty recommended its formal implementation compared to 27.1% of students, who reported challenges in implementation of the Mini-CEX such as time constraints, logistics, the subjectivity of assessment, and varying interest by faculty. Conclusion Direct observation using Mini-CEX is effective in improving the clinical and diagnostic skills of medical students and strengthens student-faculty interaction. While challenges exist in its implementation, the strategic placement of Mini-CEX may enhance its utility in measuring student competency.
背景 在临床环境中，带反馈的直接观察（DO）是评估和提高学习者表现的有效方法。用于直接观察的一种工具是迷你临床评估练习（Mini-CEX）。我们开展了一项研究，以评估Mini-CEX在卡拉奇阿迦汗大学对医学生的有效性和可行性。
方法 采用目的抽样技术，本研究共选取了199名三、四年级六个核心实习科室的学生。参与的教师参加了关于使用Mini-CEX和反馈策略的培训工作坊。每位学生由一名教师评估两次，使用Mini-CEX的修订版，该版本评估临床技能的四个领域：数据收集、沟通、诊断/鉴别诊断以及管理计划与组织。每次评估后都会给出反馈。教师和学生还就直接观察的过程提供了详细反馈。使用社会科学统计软件包（SPSS）26版（美国纽约州阿蒙克市IBM公司）对数据进行分析，分类变量以频率和百分比形式呈现。使用卡方检验进行进一步的统计分析，P值<0.05被认为具有统计学意义。通过第一次和第二次Mini-CEX之间学生表现的变化评估有效性，通过定性反馈评估可行性。
结果 我们获得了三组结果：Mini-CEX表格（523份），从中我们总共纳入350份评估进行分析，三年级216份，四年级134份，以及关于直接观察的反馈：学生（70份）和教师（18份）。三年级学生在第一次和第二次评估之间的Mini-CEX所有重点方面表现显著更好（P≤0.001），而在四年级，显著改善仅限于Mini-CEX的两个领域[病史/体格检查沟通（P = 0.040）以及诊断/鉴别诊断和管理计划（P < 0.001）]。学生（65.7%）和教师（94.4%）认为这项练习改善了他们的互动。83.3%的教师建议正式实施，而报告在实施Mini-CEX时存在挑战（如时间限制、后勤、评估的主观性以及教师兴趣各异）的学生占27.1%。
结论 使用Mini-CEX进行直接观察有效地提高了医学生的临床和诊断技能，并加强了师生互动。虽然在实施过程中存在挑战，但Mini-CEX的合理安排可能会提高其在衡量学生能力方面的效用。
