RG Appendix 1: A toolkit of workplace-based assessment forms

Last updated: October 2009

This appendix presents sample forms for assessing IMG performance in the workplace, for the following assessment methods:

Mini-Clinical Evaluation Exercise (Mini-CEX) Form

Direct Observation of Procedural Skills (DOPS) Form

Case-based Discussion (CBD) Form

Multisource feedback (360 degree assessment) forms:

Co-worker Questionnaire

Medical Colleague Questionnaire

Assessment forms for structured supervision assessment are available via the CPMEC website.

Descriptors of Competencies Assessed during the Mini-CEX

  1. Medical Interviewing and Communication Skills:
  • Facilitates patient’s telling of story; effectively listens and uses questions/directions to obtain accurate, adequate information needed; responds appropriately to affect non-verbal cues.
  1. Physical Examination Skills:
  • Follows efficient, logical sequence; balances screening/diagnostic steps for problem; informs patient; sensitive to patient’s comfort, modesty.
  1. Professionalism/Humanistic Qualities:
  • Shows respect, compassion, empathy, establishes trust, attends to patient’s needs of comfort, modesty, confidentiality, modesty.
  1. Counselling Skills:
  • Explains rationale for test/treatment, obtains patient’s consent, educates/counsels regarding management.
  1. Clinical Judgment:
  • Selectively orders/performs appropriate diagnostic studies, considers risks and benefits, arrives at an accurate diagnosis or differential diagnosis and identifies effective management strategies.
  1. Organisation/Efficiency:
  • Prioritises; is timely and succinct.

Overall Clinical Competence:

Demonstrates judgment, synthesis, caring, effectiveness and efficiency.


Posted in WBA resource guide.