Perceptions of purpose, value, and process of the mini-Clinical Evaluation Exercise in anesthesia training.
BACKGROUND
Workplace-based assessment is integral to programmatic assessment in a competency-based curriculum. In 2013, one such assessment, a mini-Clinical Evaluation Exercise (mini-CEX) with a novel "entrustability scale", became compulsory for over 1,200 Australia and New Zealand College of Anaesthetists (ANZCA) trainees. We explored trainees' and supervisors' understanding of the mini-CEX, their experience with the assessment, and their perceptions of its influence on learning and supervision.


METHODS
We conducted semi-structured telephone interviews with anesthesia supervisors and trainees and performed an inductive thematic analysis of the verbatim transcripts.


RESULTS
Eighteen supervisors and 17 trainees participated (n = 35). Interrelated themes concerned the perceived purpose of the mini-CEX, its value in trainee learning and supervision, and the process of performing the assessment. While few participants saw the mini-CEX primarily as an administrative burden, most focused on its potential for facilitating trainee improvement and reported positive impacts on the quantity and quality of feedback, trainee learning, and supervision. Finding time to schedule assessments and deliver timely feedback proved to be difficult in busy clinical workplaces. Views on case selection were divided and driven by contrasting goals - i.e., receiving useful feedback on challenging cases or receiving a high score by choosing lenient assessors or easy cases. Whether individual mini-CEXs were summative or formative was subject to intense debate, while the intended summative use of multiple mini-CEXs in programmatic assessment was poorly understood.


CONCLUSIONS
Greater clarity of purpose and consistency of time commitment are necessary to embed the mini-CEX in the culture of the workplace, to realize the full potential for trainee learning, and to reach decisions on trainee progression.
Department of Anaesthesia and Perioperative Medicine, Monash Medical Centre, 246 Clayton Road Clayton, Melbourne, VIC, 3168, Australia. Damian.Castanelli@monash.edu.|Department of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, VIC, Australia. Damian.Castanelli@monash.edu.
Damian J
http://orcid.org/0000-0002-5377-809X
DJ
Castanelli
Centre for Medical and Health Sciences Education, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Tanisha
T
Jowsey
Centre for Medical and Health Sciences Education, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Yan
Y
Chen
Centre for Medical and Health Sciences Education, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.|Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand.
Jennifer M
JM
Weller
D000072080:Anesthesiologists; D000776:Anesthesiology / Q000193:education*; D001315:Australia; D002983:Clinical Competence; D003162:Competency-Based Education / Q000379:methods*; D003479:Curriculum; D004503:Education, Medical, Graduate; D004521:Educational Measurement; D006801:Humans; D009520:New Zealand; D018794:Problem-Based Learning; D017132:Workplace