Initiating Formative Assessment of Postgraduate Students In Obstetrics & Gynecology
Formative Assessment in PG Obstetrics & Gynecology
Keywords:
Formative Assessment, Postgraduate Students, mini-CEXAbstract
Background and Objectives: Postgraduate (PG) students, in India have a vast clinical exposure & see a diversity of cases, yet lack confidence during practical assessments. There is an observed gap between their performance in exams and performance in actual workplace.Some aspects of their clinical skills are never observed or assessed. MCI guidelines emphasize that the Postgraduate training be competency based & formative assessment be done.The mini-CEX involves direct observation of student’s skills in authentic setting with immediate feedback and has been used in a variety of clinical settings, and levels of training with documented validity and reliability. As we are in the implementation stage of formative assessment, we initiated with mini-CEX as a tool of performance assessment, to evaluate its feasibility, and acceptability in our setup. Methodology: After an orientation workshop on mini-CEX, PG students of obstetrics were given ‘schedule plan’ of 1 mini-CEX per month, each to be taken by a different faculty and address a different clinical problem. The faculty observed while resident performed a focused history taking and physical examination over 15-20 minutes. The resident presented a diagnosis & treatment plan. Faculty member rated the resident using the mini-CEX evaluation form and provided educational feedback. After 6 months, the perceptions of the faculty and the students were noted. Results: 22 residents took part in the study. 83% of scheduled mini-CEX took place. The mean time taken for observation and feedback was 18.56 and 7.25 minutes respectively. The residents and faculty perceived need for such assessments, and improvement in clinical skills. The residents reported increased communication skills, thought organization and confidence levels. Residents first apprehensive, were later comfortable being observed during their clinical encounters and welcomed the one to one interaction with faculty. Initial difficulties the faculty faced, improved with provision of rating scale and structuring feedback. Observation of performance in authentic clinical settings, case diversity, flexibility of time and multiple encounters with different assessors contributed to the utility of mini-CEX. The faculty & residents reiterated their willingness to continue with mini-CEX as one of the tools for formative assessments of clinical skills.
References
2. Medical Council of India – Postgraduate Medical Education Regulations 2000 amended up to Feb’12.
3. De Lima AA, Henquin R, Thierer J, Paulin J, et al. A qualitative study of the impact on learning of the mini clinical evaluation exercise in postgraduate training. Medical Teacher. 2005; 27(1):46–52.
4. Singh T, Sharma M. Mini -clinical examination as a tool for formative assessment. The National Medical Journal of India 2010; vol23, No 2, page100
5. Norcini JJ, The Mini Clinical Evaluation Exercise, The Clinical Teacher 2005;vol2, No 1,page25
6. Norcini JJ, Blank LL, Arnold GK, Kimball HR. The Mini-CEX (Clinical Evaluation Exercise): A
Preliminary Investigation. Ann Intern Med. 1995; 123:795-799.
7. Hatala R, Ainslie M, Kassen B, Mackie I, Roberts J M. Assessing the mini-Clinical Evaluation Exercise in comparison to a national specialty examination. Medical Education. 2006;40:950–956
8. Hampton JR, Harrison MJG, Mitchell JRA, Prichard JS, Seymour C. 1975.Relative contributions of history-taking, physical examination, and laboratory investigation to diagnosis and management of medical outpatients. Br Med J 2:486–489.,
9. Norcini J, Burch V. Workplace-based assessment as an educational tool: AMEE Guide No. 31. Med Teach 2007; 29(9):855-871.
10. Nair BR, Alexander HG, McGrath BP, Parvathy MS, Kilsby EC. The mini clinical evaluation exercise (mini-CEX) for assessing clinical performance of international medical graduates. The Medical Journal of Australia. 2008; 189(3):159-161.
11. Van Der Vleuten CPM. The assessment of professional competence, developmental research and practical implication. Adv. Health Sci. Edu 1996;1: 41-67.
12. Kogan JR, Bellini LM, and SheaJA, Feasibility, Reliability, and Validity of the Mini-Clinical Evaluation Exercise (mini-CEX) in a Medicine Core Clerkship Academic Medicine 2003, Vol. 7 8, No. 10 / October Supplement
13. Durning SJ, Cation LJ, Markert RJ, Pangaro LN. Assessing the reliability and validity of the mini-clinical evaluation exercise for internal medicine residency training. Acad Med. 2002; 77:900–4.
14. Malhotra S, Hatala R, CourneyaCA, Internal Medicine resident’s perceptions of the mini clinical evaluation exercise. Med Teach 2008; 30(4):414.
