Evaluación de las competencias clínicas en una residencia de pediatría con el Mini-CEX (Mini-Clinical Evaluation Exercise)

Abstract

Purpose. Assess the clinical competence of pediatric residents with the implementation of Mini-Clinical Evaluation Exercise (Mini-CEX), determining its validity, reliability, feasibility and satisfaction of examiners and residents. Methods. 14 examiners and 8 residents of pediatrics took part. The Mini-CEX, a method based on direct observation of residents during their daily training, was used. A nine-point rating scale was used in order to evaluate their skills regarding medical interviewing, physical examination, professionalism, clinical judgment,counselling, organization, overall competence and satisfaction with the method. Results. 181 observations were made, an average of 12.92 observations per examiner (range-2-39). Each examiner assessed 5.78 residents, (range 2-8). There was an average of 22.6 assessments per resident, range (18-30). The observations took place in outpatient clinic 38.7%, pediatric inpatient unit 19.3%, neonatal intensive care unit 17.1%, neonatal reception unit 14.4% and rooming-in 10.5%. The mean scores were: professionalism 7.15; interviewing 6.64; physical examination 6.67; clinical judgment 6.70; counselling 6.79 and organization 6.73. The overall competence score varied according to experience levels. Mean scores were: first-year residents 6.57; second-year residents 6.87 and third-year residents 7.3; p= 0.004. The score related to examiners's satisfaction was 7.89 and that of the residents was 7.74. The duration of the observation period was 28.35 minutes. Cronbach alfa coefficient was 0.97 showing the high reliability of the assessment method. The ANOVA score for overall competence of all examiners showed statistically significant differences, p <0.0001 in relation to stricter or more lenient judgment to evaluate skills. Conclusions. The implementation of the Mini- CEX in the Pediatrics Residency was feasible and positively accepted by residents and examiners. It allowed the assessment of different levels of performance among residents according to their experience, in every clinical setting of a pediatrician's practice. The variability criteria among examiners and the lack of constructive criticism are matters to be dealt with in future investigations.