Cited by 730Innovations in Medical EducationClinical Reasoning and Diagnostic SkillsSimulation-Based Education in Healthcare

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The Mini-CEX: A Method for Assessing Clinical Skills

Norcini, John J., Blank, Linda L., Duffy, F Daniel, Fortna, Gregory S.·2003·Annals of Internal Medicine

DOI 10.7326/0003-4819-138-6-200303180-00012

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Abstract

OBJECTIVE: To evaluate the mini-clinical evaluation exercise (mini-CEX), which assesses the clinical skills of residents. DESIGN: Observational study and psychometric assessment of the mini-CEX. SETTING: 21 internal medicine training programs. PARTICIPANTS: Data from 1228 mini-CEX encounters involving 421 residents and 316 evaluators. INTERVENTION: The encounters were assessed for the type of visit, sex and complexity of the patient, when the encounter occurred, length of the encounter, ratings provided, and the satisfaction of the examiners. Using this information, we determined the overall average ratings for residents in all categories, the reliability of the mini-CEX scores, and the effects of the characteristics of the patients and encounters. MEASUREMENTS: Interviewing skills, physical examination, professionalism, clinical judgment, counseling, organization and efficiency, and overall competence were evaluated. RESULTS: Residents were assessed in various clinical settings with a diverse set of patient problems. Residents received the lowest ratings in the physical examination and the highest ratings in professionalism. Comparisons over the first year of training showed statistically significant improvement in all aspects of competence, and the method generated reliable ratings. CONCLUSIONS: The measurement characteristics of the mini-CEX are similar to those of other performance assessments, such as standardized patients. Unlike these assessments, the difficulty of the examination will vary with the patients that a resident encounters. This effect is mitigated to a degree by the examiners, who slightly overcompensate for patient difficulty, and by the fact that each resident interacts with several patients. Furthermore, the mini-CEX has higher fidelity than these formats, permits evaluation based on a much broader set of clinical settings and patient problems, and is administered on site.

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Additional file 2 of Do clinical interview transcripts generated by speech recognition software improve clinical reasoning performance in mock patient encounters? A prospective observational study
Shikino, K., Tsukamoto, T., Noda, K., Ohira, Y., Yokokawa, D., Hirose, Y., Sato, E., Mito, T., Ota, T., Katsuyama, Y., et al. (2023) · Figshare · doi:10.6084/m9.figshare.22678215
Additional file 2 of A novel model of ambulatory teaching of residents in general practice in China: a cross-sectional study
Liang, L., Liu, X., Zhang, L., & 苏巧俐 (2024) · Figshare · doi:10.6084/m9.figshare.26066193
Additional file 1 of How students and specialists appreciate the mini-clinical evaluation exercise (mini-CEX) in Indonesian clerkships
Suhoyo, Y., Schönrock-Adema, J., Emilia, O., Kuks, J. B. M., & Cohen‐Schotanus, J. (2020) · Figshare · doi:10.6084/m9.figshare.12277040
Additional file 2 of Structured work-based learning in undergraduate clinical radiology immersion experience
Teichgräber, U. K.-M., Ingwersen, M., Bürckenmeyer, F., Malouhi, A., Arndt, C., Herzog, A. B., Franiel, T., Mentzel, H.-J., & Aschenbach, R. (2021) · Figshare · doi:10.6084/m9.figshare.14235087
Additional file 1 of A novel model of ambulatory teaching of residents in general practice in China: a cross-sectional study
Liang, L., Liu, X., Zhang, L., & 苏巧俐 (2024) · Figshare · doi:10.6084/m9.figshare.26066098
Additional file 4 of A novel model of ambulatory teaching of residents in general practice in China: a cross-sectional study
Liang, L., Liu, X., Zhang, L., & 苏巧俐 (2024) · Figshare · doi:10.6084/m9.figshare.26736303
Additional file 3 of A novel model of ambulatory teaching of residents in general practice in China: a cross-sectional study
Liang, L., Liu, X., Zhang, L., & 苏巧俐 (2024) · Figshare · doi:10.6084/m9.figshare.26736300
Additional file 1 of Do clinical interview transcripts generated by speech recognition software improve clinical reasoning performance in mock patient encounters? A prospective observational study
Shikino, K., Tsukamoto, T., Noda, K., Ohira, Y., Yokokawa, D., Hirose, Y., Sato, E., Mito, T., Ota, T., Katsuyama, Y., et al. (2023) · Figshare · doi:10.6084/m9.figshare.22678212
Tele-therapy based tele-clinical learning in Speech and Hearing Sciences – Evaluation and validation of an evaluation tool
Bakmeewewa, D., Devagiri, B., Kodituwakku, G., & Chandratilake, M. N. (2025) · The Asia Pacific Scholar · doi:10.29060/taps.2025-10-4/oa3613

Authors: Norcini, J. J., Blank, L. L., Duffy, F. D., & Fortna, G. S.
Affiliations: Foundation for Advancement of International Medical Education and Research (US)
ORCID: Norcini, John J.
Venue: Annals of Internal Medicine
Publisher: American College of Physicians
Published: 2003-03-18
Volume: 138
Issue: 6
Pages: 476-481
ISSN: 0003-4819 (ISSN-L)
1539-3704
DOI: 10.7326/0003-4819-138-6-200303180-00012
OpenAlex: W1973975145
Cited by: 730
References: 10
Citations by year: 2026: 25 · 2025: 21 · 2024: 27 · 2023: 35 · 2022: 32 · 2021: 26 · 2020: 39 · 2019: 36 · 2018: 27 · 2017: 35 · 2016: 29 · 2015: 43 · 2014: 32 · 2013: 51 · 2012: 34
FWCI: 25.06
Type: journal article
Language: en
Open access: closed
Licence: www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
Locations: Annals of Internal Medicine (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Education › Innovations in Medical Education
Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
Social Sciences › Education › Simulation-Based Education in Healthcare
Keywords: Mini-CEX, clinical skills assessment, internal medicine residents, performance evaluation (human resources), inter-rater reliability, professionalism, physical examination, clinical judgment, standardized patients, resident competence
MeSH terms: Clinical Competence, Counseling, Educational Measurement, Female, Humans, Internal Medicine, Internship and Residency, Interviews as Topic, Male, Physical Examination, Psychometrics

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The Mini-CEX: A Method for Assessing Clinical Skills

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