Professor Kevin Forsyth FRACP

Welcome to this edition of the From the Dean Newsletter. The focus of this newsletter is on the new formative assessment tool for new Trainees at the basic physician training one level, the mini-Clinical Evaluation Exercise (mini-CEX). There are also some other issues to comment on as follows;

1. Recruitment of Supervisors

A number of Fellows, DPTs and DPPTs have written enquiring about the process for recruiting additional Supervisors to support the increased workload involved with the Trainees. Most people will be aware that there has been a suggested framework around supervision, with the notion that approximately one Fellow per 10 Trainees may be an appropriate number. If indeed this is implemented there will need to be an increase in the number of Supervisors. There is still further consultation required around the fit and recruitment of Supervisors. These processes will be worked out in the next few weeks after the appropriate consultation processes have occurred.

2. Physician Educator Program

Enquiries have been received as to when the resource for the new program will be available. A manual consisting of approximately 130 pages has recently been prepared and is in the final stages of review. This is a technical resource manual and will be available on the web shortly in the Members section.

There are two other aspects of the Physician Educator Program under development. The first is the provision of an online tool to enable Supervisors to work through the requirements to be an effective Supervisor. It is anticipated that this will be available for use in the coming 3-4 months. The second aspect is the use of workshops. We aim, through the workshops, to use the most effective process we can for the face – to - face interactions. It is considered that the giving of feedback is the most critical aspect of effective supervision and best learned through a workshop process.

At the RACP Congress in Adelaide in May, there are training workshops planned for giving feedback, effective supervision and mini-CEX. A list of the education sessions for the Congress is below:

Monday 12 May
Professional Skills Day including Trainee Professional Development
09:45 - 10:00: Launch of New Education Initiatives and New CPD Program
13:00 - 13:45: MyCPD demonstration
13:45 - 15:00: Effective teaching and learning; Supervision of Trainees
15:30 - 17:00: Effective teaching and learning; Giving feedback

Tuesday 13 May
07:45 - 08:45: Using the Mini – CEX
16:00 - 17:30: Using the Mini – CEX

Wednesday 14 May
07:45 - 08:45: Using the Mini – CEX
16:00 - 17:30: Using the Mini – CEX

3. Mini-CEX

Most of you will be aware that the College is introducing mini-CEX as a formative assessment tool, to be used by Trainees four times a year to assist them in their development. In consultation with our Education Committee Leads in assessment and a range of other experts, we have now finalised development of the mini-CEX for use with Trainees in the new program (1st year basic physician/paediatric Trainees). Trainees in the old program should not be using this tool.

The mini-CEX will provide basic Trainees with structured formative assessments, to help their educational experience and to give those providing feedback a sound framework for doing so. The key element in the mini-CEX is observation of a clinical encounter by an experienced physician/paediatrician, and then the provision of structured feedback to the Trainee to enable them to grow in their clinical skills.

By using this assessment tool, that has been validated elsewhere, we are able to avoid the need for extensive calibration. Many of you will have used the mini-CEX on undergraduate medical students. The form is designed to be self-explanatory, with a description of the rating categories provided on the reverse and in the separate framework document.

In addition, we will provide short workshop type sessions on mini-CEX at the RACP Congress in Adelaide in May 2008 (refer to the table above for session times). In February 2008, a half-day session was held with the National Examining Panel exploring the use of mini-CEX as a formative assessment tool with our Trainees.

During 2008, Trainees enrolled in the new program are required to undertake a minimum of two mini-CEX formative assessments (four if possible), and from 2009 at least four per year. This assessment is formative and takes place in the workplace. It is designed to give Trainees specific feedback on their performance as judged according to their level of training. Through being observed undertaking a number of cases, over a period of time, with a number of different assessors, these individual brief encounters can provide a reliable measure of a trainee’s performance.

Skills such as history taking, communication skills, physical examination and patient management can be assessed well using the mini-CEX. Please note this is formative, although a mark is given it is not used in any pass/fail sense, rather, to give guidance to the trainee as to their level of performance.
The mini-CEX is Trainee led. The Trainees will request of their consultants provision of time to enable the completion of their mini-CEX.

The RACP mini-CEX procedure is that:

• Each mini-CEX assessment should focus on a limited number of competencies.
• Trainees will be required to complete encounters on a range of cases with each focussing on specific aspects of the clinical encounter (e.g. history taking, physical examination etc.).
• Encounters should take place in the normal working environment (e.g. CCU, ICU, Ward, Outpatients and emergency department) and a variety of environments should be assessed throughout basic training (i.e. not all cases undertaken in the emergency department).
• During the encounter, the assessor will rate the Trainee’s performance on the mini-CEX form and provide an overall rating based on the outcome of the encounter.
• Each case should take about 15-20 minutes for the observed encounter followed directly by a feedback session of about 10-15 minutes.

During 2008, we will be evaluating many of the developments with the training program, including the feasibility and reliability of the mini-CEX as a formative assessment tool.

To access further background on mini-CEX, the form and the framework table, go to http://www.racp.edu.au/index.cfm?objectid=232F917F-A5A2-2C17-FCB0E94622F4E692  

On Friday, in the Divisional e-newsletters, there will also be a segment on the mini-CEX for the information of all Divisional Fellows.

There will be a further Dean’s newsletter in a couple of week’s time, describing in detail the recently developed on-line learning plan tool. This exciting development is in final stages of beta testing at the present time.