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The mini-CEX: Good, but not perfect
The Construct and Criterion Validity of the Mini-CEX: A Meta-Analysis of the Published Research. Al Ansari A et al. Academic Medicine 2013; 88(3):413-420.
Reviewed by Paola Palma Sisto

What was the study question?
The mini-CEX is a seven-item, global rating scale that is designed to evaluate medical students' and residents' patient encounters in about 15 to 20 minutes in a broad range of clinical settings. There are concerns, however, about the reliability and validity of the tool, so the authors conducted a meta-analysis of all published data comparing the mini-CEX to other tools used to evaluate clinical performance.

How was the study done?
The authors conducted an exhaustive literature search and vetted all published articles that addressed use of the mini-CEX. The studies that were included met strict quality criteria and addressed the comparability of the mini-CEX with other measures of clinical skills. Results from each study were extracted and re-analyzed by the authors.

What were the results?
Eleven studies were included in the meta-analysis. They fell into four groups: studies of differences between trainees in different years of residency, studies of differences in scores among trainees in the same year of residency, differences in ratings when the mini-CEX is completed by residents versus faculty, and comparison of mini-CEX results and other measures of clinical performance. Construct validity was supported by findings that trainees' scores tend to increase as their years of residency increase, and among residents in the same year, those with high scores on one portion of the mini-CEX tend to have high scores on the other portions. Also noted was that residents consistently rate medical students more leniently on the mini-CEX than faculty. The criterion-related validity was supported by findings that there is reasonable correlation between mini-CEX scores and other measures of clinical performance.

What are the implications of these findings?
The mini-CEX is a useful assessment measure with good evidence of construct- and criterion related validity. Despite this, the authors caution it should not be the only measure used to assess trainees' clinical skill development.

Editor's note: The details of the statistics for this paper are too complex to capture in detail here, but the author's caution about using the mini-CEX alone to measure clinical skills is based partially on the specifics of the calculations and size of the actual differences, and partially on what we all know… that clinical skills are multi-factorial and the more ways they are captured the more accurate our assessments will be (LL).

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