Date of Award

10-19-2009

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Kathleen P White MD

Second Advisor

Michael L Green MD

Abstract

Purpose: This study examines the utility of implementing the mini-CEX at a student-run primary care clinic. The mini-CEX is a validated tool for clinical skills feedback and evaluation. The implementation of the mini-CEX sought to improve quality standards in providers clinical skills, and therefore to set a model for continuous quality improvement in medical education. Hypothesis: The primary hypothesis tested is that a minimum of three mini-CEXs per week will produce a positive utility for both students and faculty. Methods: A needs-based analysis focus group solicited opinions on the mission and function of the clinic from the student-providers. The mini-CEX was then presented as a feedback tool that could create a more structured learning environment. After the providers agreed to a trial implementation of the mini-CEX, the faculty at the clinic were instructed on observation and feedback using the mini-CEX. During the trial study, the authors collected a copy of all mini-CEX forms which were used to document number of evaluations per week, characteristics of the visit, and the feedback given. Interviews conducted during the trial study with both students and faculty were documented on a weekly basis. The utility of the mini-CEX was determined according to a previously published model which examines the reliability, validity, educational impact, acceptability, cost and feasibility. Results: The student-providers agreed to the trial implementation of the mini-CEX in their clinic. During the trial period, there was a mean of 3.82 (median = 3) evaluations. Interviews with faculty revealed a lack of experience in observing trainees with patients but also increased attention to the teaching they could provide the students. Interviews with students revealed frustration at the lack of consistency in the teaching, but appreciation of the feedback process. Conclusions: The mini-CEX was successfully implemented in this student-run clinic. The feasibility is evidenced in the number of weeks in which the minimum of 3 evaluations were performed. The positive feedback during and after the trial period from both faculty and students evidences the acceptability of the mini-CEX. The implementation of a feedback and evaluation tool by students for students represents a movement in structuring clinical education in a self-regulatory manner to ensure higher quality clinical skills by future physicians.

Comments

This is an Open Access Thesis.

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