The Construct and Criterion Validity of the Mini-CEX: A Meta-Analysis of the Published Research

Purpose To conduct a meta-analysis of published studies to determine the construct and criterion validity of the mini-clinical evaluation exercise (mini-CEX) to measure clinical performance. Method The authors included all peer-reviewed studies published from 1995 to 2012 that reported the relationship between participants' performance on the mini-CEX and on other standardized academic and clinical performance measures. Moderator variables and performance and standardized exam measures were extracted and reviewed independently using a standardized coding protocol. Results Performance measures from 11 studies were identified. A random-effects model of weighted mean effect size differences (d) resulted in: (1) construct validity coefficients for the mini-CEX on the trainees' performance across different residency year levels ranging from d = 0.25 (95% confidence intervals [CCI]: 0.04-0.46) to d = 0.50 (95% CI: 0.31-0.70), and (2) concurrent validity coefficients for the mini-CEX based on personnel ratings ranging from d = 0.23 (95% CI: 0.04-0.50) to d = 0.50 (95% CI: 0.34-0.65). Also, a random-effects model of weighted correlation effect size differences (r) resulted in predictive validity coefficients for the mini-CEX on trainees' performance across different standardized measures ranging from r = 0.26 (95% CI: 0.16-0.35) to r = 0.85 (95% CI: 0.47-0.96). Conclusions The construct and criterion validity of the mini-CEX was supported by small to large effect size differences based on measures between trainees' achievement and clinical skills performance, indicating that it is an important instrument for the direct observation of trainees' clinical performance.