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Academia and the Profession |

The Mini-CEX (Clinical Evaluation Exercise): A Preliminary Investigation

John J. Norcini, PhD; Linda L. Blank, BA; Gerald K. Arnold, PhD; and Harry R. Kimball, MD
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From the American Board of Internal Medicine, Philadelphia, Pennsylvania. Acknowledgments: The authors thank the following program directors for their participation: Dr. Robert L. Benz (Lankenau Hospital, Philadelphia, Pennsylvania); Drs. John J. Kelly and David G. Smith (Abington Memorial Hospital, Abington, Pennsylvania); Dr. Oksana M. Korzenowski (Medical College of Pennsylvania, Philadelphia, Pennsylvania); Dr. Frank L. Kroboth (University of Pittsburgh, Pittsburgh, Pennsylvania); and Dr. Lisa J. Wallenstein (Albert Einstein Medical Center, Philadelphia, Pennsylvania). The authors thank Nancy L. Grant and Jane M. Luistro for their help in coordinating the study. Grant Support: This work was supported by the American Board of Internal Medicine but does not necessarily reflect the views or opinions of that Board. Requests for Reprints: John J. Norcini, PhD, American Board of Internal Medicine, 3624 Market Street, Philadelphia, PA 19104-2675. Current Author Addresses: Drs. Norcini, Arnold, and Kimball and Ms. Blank: The American Board of Internal Medicine, 3624 Market Street, 2nd Floor, Philadelphia, PA 19104-2675.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1995;123(10):795-799. doi:10.7326/0003-4819-123-10-199511150-00008
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Objective: To gather preliminary data on the mini-CEX (clinical evaluation exercise), a device for assessing the clinical skills of residents.

Design: Evaluation of residents by faculty members using the mini-CEX.

Setting: 5 internal medicine training programs in Pennsylvania.

Participants: 388 mini-CEX encounters involving 88 residents and 97 evaluators.

Measurements: A mini-CEX encounter consists of a single faculty member observing a resident while that resident conducts a focused history and physical examination in any of several settings. After asking the resident for a diagnosis and treatment plan, the faculty member rates the resident and provides educational feedback. The encounters are intended to be short (about 20 minutes) and to occur as a routine part of training so that each resident can be evaluated on several occasions by different faculty members.

Results: The encounters occurred in both inpatient and ambulatory settings and were longer than anticipated (median duration, 25 minutes). Residents saw either new or follow-up patients who collectively presented with a broad range of clinical problems. The median evaluator assessed two residents and was generally satisfied with the mini-CEX format; residents were even more satisfied with the format. The reproducibility of the mini-CEX is higher than that of the traditional CEX, and its measurement characteristics are similar to those of other test formats, such as standardized patients and standardized oral examinations.

Conclusions: The mini-CEX assesses residents in a much broader range of clinical situations than the traditional CEX, has better reproducibility, and offers residents greater opportunity for observation and feedback by more than one faculty member and with more than one patient. On the other hand, the mini-CEX may be more difficult to administer because multiple encounters must be scheduled for each resident. Exclusive use of the mini-CEX also prevents residents from being observed while doing a complete history and physical examination. Given the promising results and measurement characteristics of the mini-CEX, however, the American Board of Internal Medicine encourages the use of this method in conjunction with or as an alternative to the traditional CEX.

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