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⌛  Deep Dive: Mini-CEX

⌛  Mini-CEX

A Mini-Clinical Evaluation Exercise (Mini-CEX) is a generic feedback tool that can be used to evaluate different and varied competencies. In this section, we will discuss when, why, and how to do a mini-CEX, and how to include mini-CEX as evidence in an appraisal.

What is a mini-CEX?

A mini-CEX is an assessment tool used for clinical skills that you might find in a typical medical school OSCE. The clinical interaction between doctor and patient can be broken down broadly into several categories;

  • History-taking
  • Obtaining informed consent
  • Clinical examination
  • Formulating management plans
  • Communicating with patients
  • Professional and interpersonal skills

Each of these categories can be assessed using a mini-CEX.

Why should I do a mini-CEX?

Mini-CEXs are quick and easy ways to get feedback and advice from a senior. Usually, they don’t add much extra effort to your usual work day and give you the benefit of some evidence of learning that brings you another step closer to a successful appraisal.

When should I do a mini-CEX?

A mini-CEX is generally used to evaluate clinical skills which are the elements of the clinical interaction that can be assessed but are more subject to personal style and technique. They are not used for evaluating technical or procedural skills, like setting up an IV infusion or inserting an IO line (you’d use a DOPS for these).

How do I do a mini-CEX?

If you decide that you would like to do a mini-CEX, discuss it with your assessor in advance. Provide them with a blank mini-CEX feedback form before starting so they can use it as a template for gathering feedback.

You should agree with your assessor in advance about which domain(s) you would like for them to focus their attention and feedback. Don’t try and assess more than 2 (or at a stretch, 3) domains per mini-CEX, particularly if your clinical interaction is very short.

The mini-CEX itself should take no longer than 20 minutes but can be much shorter (i.e. 5 minutes). Your assessor should provide you with feedback immediately after in both verbal and written form. Feedback should take around 5 minutes.

Do I need to inform the patient before I do a mini-CEX?

You should inform the patient that your encounter is being supervised for the purposes of getting feedback on your clinical skills, and introduce your assessor if they are not already known to the patient. You do not need to get written patient consent for a mini-CEX but it is important to get their verbal consent to participate.

Who can sign me off for a mini-CEX?

Many doctors assume that their assessments can only be signed off by a Consultant, however, this is not true.

In most cases, anyone can sign off on an assessment as long as they are competent to assess you (meaning they have the skill signed off themselves and the relevant experience to provide you with valuable feedback).

Your trainer does not need to know you in advance though you should have a discussion before the mini-CEX takes place to set your expectations for the assessment.

When you and your trainer complete the mini-CEX form you should include information on the grade/experience of the person who has assessed you. This can include nursing staff or physiotherapists who may be able to provide useful feedback on your interpersonal or communication skills.

You should avoid getting too many assessments signed by medical peers below ST3 grade for two reasons:

  1. Different training colleges or Trusts have different criteria on who can sign a WBA and some stipulate that the assessment won’t count unless signed by an ST3 or above.
  2. They may not have the relevant clinical knowledge or experience to provide you with useful insights and feedback into your practice.

How do I approach a senior for a mini-CEX?

If you are in a substantive post (contracted) then you will have lots of opportunities to get some mini-CEXs done. Try to agree with your clinical or educational supervisor at the start of your employment or in supervision about how many mini-CEX assessments you’d like to do (and what is realistic to achieve) over the period of your employment. If they are non-committal or very busy then try to set small, manageable goals that are easier for them to say yes to (i.e. can they observe you and feedback on one mini-CEX in the next fortnight).

If you are a locum doctor and are only working on a unit for a short period of time then inform the consultant or senior registrar you are working with that you are looking to get this assessment done and your time is limited. This works better if you are going to be with the same team for 2+ days and they can spend the first day or so getting to know you before you ask them for a mini-CEX. Bring mini-CEX assessment print-outs with you so that you can be opportunistic throughout your workday to get the sign-off. Be prepared to be flexible, stay late, and for unexpected emergencies to result in canceled assessments.

Can I get all my mini-CEXs from the same person?

If you are in a substantive post and will be working within the same team for a long time, then it is reasonable to conclude that many of your WBAs will be signed off by the same person. However, it is best practice to find a variety of assessors to give you feedback as it shows that you are seeking input from multiple team members and reduces the possibility of selection bias.

Remember that you can get your mini-CEX signed off by non-consultant doctors or other health professionals so it is worth considering whether there is anyone else who might be an appropriate person to provide you feedback.

How many mini-CEX do I need to do per year?

If you are collecting mini-CEX feedback for a training portfolio, there may be a minimum requirement for the number of assessments you should do. However, if you are a non-training doctor then your appraisal will not require a specific number of mini-CEX assessments in order to ‘pass’.

Where do I put my mini-CEX in my MAG?

The MAG form (Medical Appraisal Guide) is the document that non-training doctors in England use for their medical appraisals.

If you are preparing for an appraisal, you may want to use evidence of your mini-CEXs in your MAG to demonstrate your ongoing commitment to the principles outlined in the GMC’s Good Medical Practice document.

Your mini-CEX can be uploaded into the CPD section of the portfolio (section 7 of the MAG).

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Section 7 of the MAG looks like this:

You can upload your mini-CEX in any format that works best for you. It can be summarised directly on the MAG document, uploaded as a photo, screenshot, or scan of the hand-completed mini-CEX, or uploaded as a word document, or PDF. It doesn’t really matter how you upload your CPD so long as you can provide some evidence that you’ve done some, and learned from it.

Template & Worked Example

Next → Deep Dive: DOPS