Physical Medicine and Rehabilitation

Introducing the PM&R Mini-CEX Ratings Format

Dear Residency Program Director & Other Interested Persons:

At the 1999 annual meeting of the Association of Academic Physiatrists, a paper was presented which explained the basis of a new evaluative instrument, the PM&R Mini-Clinical Evaluation Exercise (CEX) form. A copy of this form (as it was presented by Dr. Musick at the meeting) is posted elsewhere on this web site. The March/April 2000 issue of the American Journal of PM&R also contains a paper (co-authored by myself and Dr. Susan McDowell) that explains the details and results of pilot testing at the University of Kentucky of this new evaluative format.

It is our belief, based on the feedback received from PM&R residency program directors at the AAP meeting, that PM&R residency training programs need to adopt a specialty-wide tool of this nature to facilitate the timely evaluation of the clinical skills of our resident physicians. The PM&R Mini-CEX is modeled after a highly successful instrument developed by the American Board of Internal Medicine. Their Mini-CEX ratings format is now a required component of the overall evaluation of Internal Medicine residents’ clinical knowledge and skills. The program is administered by the ABIM, and residency directors are routinely provided valuable data on how this tool correlates with other forms of evaluation.

This tool is intended to be used as a means of "real time", formative feedback for residents. Short and easy to use in the clinical setting, it is intended to be completed by the attending physician immediately after personal observation of a resident’s interaction with a patient, whereupon the attending and resident physician discuss the patient encounter. It can be used in either an inpatient or outpatient setting.

The results of our pilot testing of this ratings format for the past two academic years at the University of Kentucky are encouraging. Both faculty and resident physicians view the use of the Mini-CEX format as a valuable means of providing formative feedback on clinical performance. The reliability coefficient of this format (based on our data) was .95, and other psychometric properties of the form were acceptable. However, our sample size was small (N=31 ratings) and further work is needed to establish the reliability and validity of this tool.

There are certain variables on this "test version" of the form that are included primarily as a means of performing psychometric testing of the form (e.g., gender, primary diagnosis, inpatient-outpatient setting). These variables may or may not ultimately need to be included in the final version. The nine point rating scale used is intended to match the scale used on the current summative ratings instrument provided by the American Board of PM&R.

We are actively seeking PM&R residency programs that will collaborate with us in gathering additional pilot data from across the country, so that we may further establish the form as a reliable and valid evaluative tool. It is our hope that we can eventually see this format adopted by the AAP or the ABPM&R as a tool that all programs should use. If you are interested or desire more information, please write to Dr. Musick at the above address or email him at david.musick@uphs.upenn.edu. Thank you for your consideration!

Sincerely,