Internal medicine residents' perceptions of the mini-clinical evaluation exercise

Background: The mini-clinical evaluation exercise (mini-CEX) is a 30 minute observed clinical encounter which allows assessment of a resident's clinical competence with feedback on their performance. Aims: To assess residents' perceptions of the mini-CEX using qualitative methods. Methods: After introducing the mini-CEX into the University of British Columbia's Internal Medicine Residency Program, a one hour semi-structured focus group with voluntary first and second year residents was undertaken. The focus groups were conducted by an independent moderator, audio-taped, and transcribed verbatim. Using a phenomenological approach, the comments made by the focus group participants were read independently by the three authors and organized into major themes. Results: The major themes included Education, Assessment and Exam Preparation. Residents described a conflict between the mini-CEX's role as a method of assessment and its utility as an educational tool. During initial mini-CEX encounters, they perceived the assessment format as anxiety-provoking. Over time, they felt that the mini-CEX provided insight into their clinical competence. Participants believed that the mini-CEX experience would benefit them in preparation and successful completion of their national specialty exam. Conclusions: Residents' perceptions of the mini-CEX reflected a tension between the tool's dual roles of assessment and education.