title: Reliability of Mini-CEX Assessment of Medical Students in General Practice Clinical Attachments.
abstract: OBJECTIVE
  Mini Clinical Evaluation eXercise (mini-CEX) involves observation of routine clinical encounters, initially developed to assess clinical competencies of postgraduate doctors. This study aimed to measure its inter-rater reliability in assessment of medical students in general practice settings.
  
  
  METHODS
  General practitioners (GPs) supervising medical students were invited to complete online teaching on how to conduct a mini-CEX. This included three randomly presented scripted films of clinical scenarios representing different levels of student performance. Consenting participants completed an online mini-CEX. Mean marks were calculated for each case, Intraclass Correlation Coefficients (ICC) for overall clinical and four individual competencies, one-way analysis of variance to compare scores, and internal consistency measured by Cronbach's alpha.
  
  
  RESULTS
  RESULTS were collated for the first 100 completing GPs, majority aged 40-59 years (71%), male (59%), New Zealand European (58%). Forty-four percent were in rural practice, with 21 mean years in practice. Mean mini-CEX grades increased as standardized performance increased, indicating that GPs reliably agreed about ranking of student performance from poor to very good. The intraclass correlation coefficient (ICC) for overall clinical competency was 0.78 (95% confidence interval 0.48-0.99), indicating good reliability regarding their agreement with each other. A Cronbach's alpha calculated with the overall scores was 0.85, indicating good internal consistency.
  
  
  CONCLUSIONS
  Mini-CEXs in undergraduate general practice attachments provide a reliable measure of assessing performance. However, they may be less useful in identifying exceptional performance or weaknesses in key competencies. In addition, caution must be applied in relying upon mini-CEXs to supply a summative assessment.
authors.affiliation: Department of General Practice and Primary Health Care, The University of Auckland, Auckland, New Zealand.
authors.forename: Kyle
authors.initials: K
authors.lastname: Eggleton
authors.forename: Felicity
authors.initials: F
authors.lastname: Goodyear-Smith
authors.forename: Lois
authors.initials: L
authors.lastname: Paton
authors.forename: Karen
authors.initials: K
authors.lastname: Falloon
authors.forename: Chris
authors.initials: C
authors.lastname: Wong
authors.forename: Liza
authors.initials: L
authors.lastname: Lack
authors.forename: John
authors.initials: J
authors.lastname: Kennelly
authors.forename: Tana
authors.initials: T
authors.lastname: Fishman
authors.forename: Simon A
authors.initials: SA
authors.lastname: Moyes
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D004521:Educational Measurement / Q000379:methods* / Q000592:standards; D005260:Female; D058006:General Practice / Q000592:standards; D058005:General Practitioners / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D013337:Students, Medical