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Mini-CEX

Mini-CEX, otherwise known as Clinical Evaluation Exercise, are an essential component of getting through your hospital rotations. They are a module of your Workplace Based Assessment component of the MRCGP exam and your GP VTS training. They are a 15 minute assessment of a single episode of doctor patient interaction within the hospital setting. They are not performed in your final registrar year (ST3) within general practice as Consultation Observation Tool (COTs) are performed instead. They assess a range of areas including your clinical skills, behaviour and attitude and should assess a different clinical problem/presentation. They should reflect the wide spectrum of rotations you undergo through your GPVTS training and not focus on just one speciality.  

sample Mini-CEX form


ST1 GP VTS
You are required to complete 3 per every 6 months in ST1 i.e. 6 in one year

ST2 GP VTS
You are required to complete 3 per every 6 months in ST2 i.e. 6 in one year

ST3 GP VTS
ST3 do not have to perform any as they would have to complete Consultation Observation Tool (COTs) in lieu


Clinical areas
The Mini-CEXs have narrowed the assessment within hospital setting into common systems. These include:
  • Pain
  • Airway/Breathing
  • CVS/Circulation
  • Psych/Behaviour
  • Neuro
  • Gastro
  • Other
They should assess you on a particular domain including:
  • History
  • Diagnosis
  • Management
  • Explanation

The clinical interaction is further assessed into different domains. These include:
  • History Taking
  • Physical Examination Skills
  • Communication Skills
  • Clinical judgement
  • Professionalism
  • Organisation/Efficiency
  • Overall clinical care
  • Anything else that is especially good will also be noted

For each domain the assessor will grade you depending on your competency. If a particular area was not assessed they should deem this domain as 'insufficient evidence'. This domain can be assessed later on another occasion. Over 3 years the intention is that all areas would have been assessed on and reflected within your e-portfolio. 
  • Insufficient evidence
  • Below expectations
  • Borderline for completion
  • Meets expectations for completion
  • Above expectation

Assessor
The assessor, who can be a senior i.e. consultant, registrar, staff grade doctor, nurse practitioner or clinical nurse specialist. It can also be your clinical supervisor, trainer or educational supervisor. They should not be a fellow colleague i.e. fellow GP VTS trainee or a doctor in another training specialty within similar level and stage of training. 


Recommendation
You should aim to have a different assessor for each mini-cex and received instant feedback from the assessor after being assessed. The advice given should include an agreed plan between the observer and trainee of how one can improve themselves. Any feedback should be also recorded into your e-portfolio to permit you to reflect on it.

We recommend to aim to do them monthly as go through your rotation. Often people may hoard several to do prior to the end of year sign off putting unnecessary pressure upon themselves to complete. This may be further hindered by annual leave or rotation change of their seniors i.e. registrars. 

We also recommend to consider obtaining more than the minimum 6 Mini-cex per 6 months. This would reflect well on your e-portfolio and your annual appraisal. 


Falsifying your e-portfolio
Sadly there has been reported cases of doctors falsifying information when adding to their eportfolio. This applies to both the assessor and trainee. Intentionally falsifying information with the intent to deceive is considered as a potentially seriously probity issue and can result in a referral to the GMC with cases resulting in suspension or in more serious cases eraser from the register