RG Appendix 2b: Training program outline for using the mini-CEX (assessors/IMGs)

Last updated: October 2009

This 2.5-hour rater-training workshop described below is modified from that developed by Drs. Ravi Sidhu, Rose Hatala, and Gordon Page at the University of British Columbia, and is based on the Direct Observation of Competence Training program developed by Holmboe et al at the American Board of Internal Medicine (Holmboe, 2004).*

The accompanying videos contain nine taped patient encounters and three taped feedback encounters for use in the workshop. For each type of patient encounter, three different performances are depicted, which can be used at different points in the workshop:

NOTE: ALL PATIENTS AND CANDIDATES IN THE FOLLOWING VIDEOS ARE PAID ACTORS

  • A history taking encounter for a patient with angina complicated by anaemia (scenarios 1-3)
  • A physical examination encounter for a patient with shortness of breath (SOB), fatigue, and productive cough (scenarios 4-6)
  • A counselling encounter with a patient with high cholesterol – A treatment counselling session (scenarios 7-9)

For each of these three types of encounters, a feedback session is shown with one candidate:

  • Feedback for scenario 2 – the feedback session for one of the history taking encounters
  • Feedback for scenario 5 – the feedback session for one of the physical examination encounters
  • Feedback for scenario 8 – the feedback session for one of the counselling encounters.

Workshop Program

The following program can be completed in 2.5 hours.

  1. Introduction (10 minutes)
  2. This introduction will provide an overview/history of the mini-CEX, outlining the background (changes in the health care system, expectations of patients and current assessment techniques such as OSCEs and Miller’s pyramid), leading to the proposed use of the mini-CEX.

    The purpose of, and program for, the workshop will also be discussed.

  1. Looking at clinical performance: What is being assessed? (about 20 minutes)
  2. a. Watch scenario 3 – history taking for chest pain (5′ 49”). Then discuss what aspects of performance were seen in the encounter, what was good, not so good. Think about how you would rate this person.

    b. Watch scenario 6 – physical examination for shortness of breath (SOB), fatigue, cough (5′ 47”) – repeat discussion as in (a) above.

    c. Watch scenario 9 – counselling for raised cholesterol level (7′ 03”) – repeat discussion as in (a) above.

    d. Refer to the mini-CEX rating form – with the facilitator, discuss its background, the meaning of the rating categories – referencing the definitions on the form.

Short break

  1. Frame of reference and feedback session (about 90 minutes)

Frame of reference training: Watch the following scenarios in the order as outlined in this training program. These encounters display varying levels of proficiency. After each scenario, independently score the scenario on the mini-CEX form and then discuss the ratings as a group. Start the discussion by announcing your overall ‘grade’ – fail, borderline or pass, and explain ‘why’, and then pursue the ratings of individual competencies. Discuss your ratings and the reasons for any differences that exist between yourself and other assessors, discuss with the group what you agree was done well and not so well.

Please note: the structure of this session is to firstly address the frame of reference training for each type of patient encounter (that is, watch the scenarios, score individually and then discuss) and to then watch the taped feedback encounter relevant to that type of encounter.

History taking encounters

Watch the following scenarios:

Scenario 1 (2′ 59”) and score; discuss your ratings.

Scenario 2 (4′ 20”) and score; discuss your ratings.

Providing feedback

Watch Feedback for scenario 2.

With the group, share any comments you have on the feedback provided.

The supervisor will record key points raised about effective feedback on the whiteboard.

Physical examination encounters

Watch the following scenarios:

Scenario 4 (4′ 07”) and score; discuss your ratings.

Scenario 5 (5′ 28”) and score; discuss your ratings.

Providing feedback

Watch Feedback for scenario 5.

With the group, share any comments you have on the feedback provided.

The supervisor will record key points raised about effective feedback on the whiteboard.

Counselling encounters

Watch the following scenarios:

Scenario 7 (2′ 45”) and score; discuss your ratings.

Scenario 8 (4′ 04”) and score; discuss your ratings.

Providing feedback

Watch Feedback for scenario 8, the feedback session for the counselling scenario.

With the group, share any comments you have on the feedback provided.

The supervisor will record key points raised about effective feedback on the whiteboard.

  1. Providing feedback – a summary (10 minutes)

The supervisor will provide a summary related to giving effective feedback.

  1. Wrap-up (10 minutes)

The main points of the session will be recapped and a summary will be provided regarding involvement in mini-CEX assessment in the future.

* Holmboe ES, Hawkins RE, Huot S. Effects of training in direct observation of medical residents’ clinical competence. Annals of Intern Med 2004;140(11):874-881.


Posted in WBA resource guide.