Physical Medicine and Rehabilitation

Implementing the PM&R Mini - CEX (Clinical Evaluation Exercise)

Goal:
A minimum of one mini-CEX per resident per rotation during the academic year.

Rationale:
The mini-CEX is designed to be an efficient "snapshot" of resident clinical performance. Modeled after the highly successful mini-CEX program administered by the American Board of Internal Medicine, the PM&R mini-CEX is intended to supplement existing formats used to evaluate the knowledge and skills of PM&R resident physicians.

In order to enhance the validity, reliability and generalizability of the results obtained by using the mini-CEX, it is important to use it in a variety of patient care settings (e.g., acute inpatient, outpatient, subacute, other). Ideally, it would be used several times to evaluate resident performance in various settings where a focused history and examination is conducted.

Evaluators:
Generally, resident performance will be evaluated by attending physicians who are ultimately responsible for a given clinical rotation. Other supervising physicians may also be expected to rate resident performance. And, some programs may also choose to allow senior residents (e.g., chief resident) to rate the performance of interns and/or junior residents.

Communication:
It is vitally important to convey written and verbal expectations of resident performance to both evaluators and residents who will be rated. The goals of the training program and how the mini-CEX ratings format will be used to help achieve program goals are important factors in clarifying a given program’s overall approach to effective evaluation of resident performance.

Implementation:
The mini-CEX focuses on the core skills that PM&R residents demonstrate in their encounters with patients. It can be easily implemented in most settings. The mini-CEX is a 15-20 minute observation of a resident/patient interaction. It is intended to be completed by the attending physician (or other rater) immediately after personal observation of a resident’s interaction with a patient, whereupon rater and resident discuss the interaction. Based on a series of multiple encounters over time, this method provides a valid, reliable measure of resident performance.

Form:
The mini-CEX form contains eight ratings items. All items are rated on a nine-point scale, with nine being the highest possible rating. These items and the nine-point scale correspond to selected items on the "Evaluation of PMR Residents Clinical Rotation Activities" form recommended for use by the American Board of PM&R. The ABPMR form is generally used in a summative, end-of-rotation fashion; the mini-CEX format is designed to be used in a formative, during-the-rotation format. Though the mini-CEX is not as detailed as the ABPMR form, it is easier to use and should facilitate completion of the ABPMR form since it provides formative information to program directors.

A key component of the pilot study will be to correlate results of these two disparate ratings formats (i.e., mini-CEX and ABPMR form) to see if they discriminate between residents’ clinical behaviors. The key difference in the two formats is that the mini-CEX is designed to be used to record the results of the rater’s personal observation of clinical behaviors.

Certain items on the pilot version of the mini-CEX form (e.g., resident gender, attending faculty rater gender, patient gender, primary diagnosis, and rater satisfaction) are variables which will be analyzed and used to establish the psychometric properties of the ratings format itself. These variables may or may not be retained in future versions of the form.

Further Adaptation:
The PM&R mini-CEX is a "work in progress"; further recommendations about how it can be improved (based on feedback from those who have used it in their training programs as part of the national pilot study) are welcome.

Further Information:
Available from David W. Musick, Ph.D., Voluntary Faculty, University of Kentucky College of Medicine, Department of Physical Medicine & Rehabilitation, Kentucky Clinic, Wing C349, Lexington, KY 40536-0284

Phone: (215) 349-8503
Fax: (215) 349-8680
Email: david.musick@uphs.upenn.edu

Mini-CEX  FORM