The Mini CEX from the lens of a trainee Clinical Perspective

Abstract

I handed over the patient’s daily progress file to our staff nurse and followed him to chamber number 8. Come on dear! You do these daily in your routine practise but let’s add a new flavour to it today. In few moments we were both standing at bed number 8 B and I received a command to take the patient as my long case and proceed, heard the timer started clicking.

Tangled mind and strained nerves but in no time, I found myself on the right side of the patient. Composed myself and then after greeting him I started to ask all the relevant questions in history. While my supervisor keenly observes my every move, I began to examine the patient physically. After the general steps I moved to examine chest. Inspect, Palpate, percuss was the spinal reflex while I kept on writing down the needful. Finally, what is called as the heart of examination of Chest I proceed to auscultating the patient, looked for my lucky lavender stethoscope and here you go I’m almost done. I summed up all my examination at the eleventh hour and we came out of that room after thanking and greeting the patient. It indeed was a game of nerves or a pressure test, couldn’t think of a better word.

            See me in my office in half an hour looking at his watch he commanded, over a cup of coffee. I nodded.

Mini CEX is a very well accepted and practical form of summative assessment which help us undertake licence and certificate examination. The concept of workplace-based assessment is most helpful for the medical residents who in the setting of our country particularly in the public sector would rarely get any chance to spare time for self learning. The mini CEX provides a real time experience while we encounter the patient and the best part is immediate feedback and reflection from the assessor. I heard of all this process in an online session of Medical Education.

Living in the era of COVID-19 if anything that has suffered the most on part of a resident and for instance Myself, would be the learning process that has slowed down. Our Postgraduate training is directed not merely at attainment of knowledge, attitude and skills but also observable responsiveness and appropriate functioning in real life situations. The medical education began with apprenticeship and transformed to competency-based assessment over a period of time. The training used to be confined in the walls of training halls and lecture theatres before but now has glorified to the hands on, simulations, distant learning, feedbacks and instant assessments.

I Spent 30 minutes waging my internal battle with all my insecurities and fears coming into reality. With all the steps I took towards his office I gathered my confidence back, Knocked the door and heard a come in please.

            So, let’s see what you have cooked for us today? he smiled and pointed out to the chair in front of him. I followed the command got myself seated and started to narrate the whole case right from the scratch of history, systemic review, examination findings and I moved step by step to conclude my case with what we call as differential diagnosis. The room had pin drop silence, it was only me who was heard speaking. Are you done? he asked. Oh yes! I suppose I said. He had a paper placed in front of him and I knew he marked me in six different areas. Let’s not look at it, the paper was folded and placed in drawer after he saw me curious about it. You ask yourself a ‘WHY’ about what happened to you in the last one hour. I responded instantly ‘because I was supposed to be assessed’.

He smiled and said we undergo assessment all our lives one way or the other. Right now, you only might be thinking of your CPSP exam assessment but there is a golden rule to find out answers to all of these assessments you come across and to facilitate your learning.

You carry so many tools to examine your patients but there are some tools of learning, I call them sincere friends of Hominid. If you learn to apply those tools to your history taking, examination and all the exercise you just did you will feel the difference. Note them down, the honestly serving men they are!

‘WHY WHAT HOW WHEN WHERE and WHO’.

Keep these alive in your day to day life and let them work for you. And once they do, you have your way out. The next twenty minutes were spent discussing about the case that I narrated and was reflected back there and then. I left the room very satisfied because I did not come out alone, I have my 6 tools to help me out in the next Mini CEX which was scheduled next week as I heard him speak while closing the door.

References:

1. The sincere friends of hominid?


2. Saeed, Nadia & Tariq, Nabia & Jaffery, Tara. (2015). Mini-CEX (Clinical Evaluation Exercise) as an assessment tool at Shifa College of Medicine, Islamabad, Pakistan. Rawal Medical Journal. 40. 220-224.