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A teamwork CEX
The teamwork mini-clinical evaluation exercise (T-MEX):  A workplace-based assessment focusing on collaborative competencies in health care. 
Olupeliyawa AM et al.  Academic Medicine 2014; 89:359-365.
Reviewed by Gary Beck

What was the study question?
Can a valid and feasible CEX be develop to assess teamwork?

How was the study done?
The T-MEX was developed at the University of New South Wales in Australia based on a review of the literature, interviews with preceptors, and multiple Delphi processes.  The final version can be found at It consists of the following six behaviors:

  • Communicates needs and concerns expressed by the patient
  • Includes the other health professionals appropriately in the patient's care
  • Accepts responsibility for completion of tasks within own role
  • Recognizes own limitations in the clinical situation
  • Communicates significant changes in the patient's condition
  • Expresses concern and urgency appropriate to the situation

Seventy-five senior students volunteered to pilot the T-MEX;  25 students submitted forms representing 88 clinical encounters.  The authors analyzed the forms.

What were the results?
Of the six collaborative behaviors, 4 were rated as applicable to >95% of the encounters and the other 2 were rated as applicable to >87% of the encounters.  These findings indicate that the behaviors were not redundant and were applicable to clinical contexts, supporting content validity.  There was good inter-rater reliability (0.93).  The generalizability study indicated that 8 encounters resulted in a G-coefficient of 0.82.  The mean observation time was 11 minutes, plus an additional 8 minutes for feedback.

What are the implications of these findings?
The results indicate that the T-MEX is a valid and reliable tool for obtaining multisource feedback about students' collaborative skills.  This instrument could be implemented in clerkships in a variety of settings to document some entrustable professional activities (EPAs) of students.


Editor's note:  This tool may be of use in our clerkship programs.  It would help assess interprofessional education and assist in the assessment of the CanMEDS Collaborator role and the ACGME’s Interprofessional and Communic

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