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BJA Advance Access originally published online on March 31, 2009
British Journal of Anaesthesia 2009 102(5):633-641; doi:10.1093/bja/aep055
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© The Author [2009]. Published by Oxford University Press on behalf of The Board of Directors of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Mini-clinical evaluation exercise in anaesthesia training

J. M. Weller1,2,*, B. Jolly3, M. P. Misur1, A. F. Merry4, A. Jones2, J. G. M Crossley5, K. Pedersen1 and K. Smith1

1 Auckland City Hospital, Park Road, Grafton, Auckland, New Zealand
2 Centre for Medical and Health Sciences Education, University of Auckland, Private Bag 92019, Auckland, New Zealand
3 Centre for Medical and Health Sciences Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria 3800, Australia
4 Department of Anaesthesiology, University of Auckland, Private Bag 92019, Auckland, New Zealand
5 Academic Unit of Medical Education, University of Sheffield, 85 Wilkinson Street, Sheffield S10 2GJ, UK

* Corresponding author. E-mail: j.weller{at}auckland.ac.nz

Background: The Mini-Clinical Evaluation Exercise (Mini-CEX) is a workplace-based assessment tool of potential value in anaesthesia to assess and improve clinical performance. Its reliability and positive educational impact have been reported in other specialities, but not, to date, in anaesthesia. In this study, we evaluated the psychometric characteristics, logistics of application, and impact on the quality of supervision of the Mini-CEX in anaesthesia training.

Methods: A Mini-CEX encounter consisted of a single specialist anaesthetist observing a trainee over a defined period of time, completing an online Mini-CEX form with the trainee, and providing written and verbal feedback. We sought trainee and supervisor perspectives on its value and ease of use and used Generalizability Theory to estimate reliability.

Results: We collected 331 assessments from 61 trainees and 58 assessors. Survey responses strongly supported the positive effect of the Mini-CEX on feedback, its relative feasibility, and acceptance as a potential assessment tool. In this cohort, we found variable assessor stringency and low trainee variation. However, a feasible sample of cases and assessors would produce sufficiently precise scores to decide that performance was satisfactory for each trainee with 95% confidence. To generate scores that could discriminate sufficiently between trainees to allow ranking, a much larger sample of cases would be needed.

Conclusions: The Mini-CEX in anaesthesia has strengths and weaknesses. Strengths include: its perceived very positive educational impact and its relative feasibility. Variable assessor stringency means that large numbers of assessors are required to produce reliable scores.

Keywords: education, junior staff


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Home page
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J. M. Weller, A. Jones, A. F. Merry, B. Jolly, and D. Saunders
Investigation of trainee and specialist reactions to the mini-Clinical Evaluation Exercise in anaesthesia: implications for implementation
Br. J. Anaesth., October 1, 2009; 103(4): 524 - 530.
[Abstract] [Full Text] [PDF]


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