Mini-CEX Rating Instrument- Internal Medicine Residency Program
Resident (name, PGY level and clinical context)____________________
Date____________________
Observer name and Rotation: _____________________________
Case description (ie patient with dyspnea, abnormal lab results, pre-op):______________________________
Once the form has been completed the resident is to fax the completed page to the Internal
Medicine Residency office at 403-290-6655 or photograph evaluation page and email it to
[email protected]
Directions: Please circle features of each item done CORRECTLY as well as the
applicable rating.
Only evaluate ONE of the FOUR sections during each mini-CEX evaluation.
1. Medical Interviewing
a) Interpersonal/Communication skills (Greeting, set agenda, “anything else?” uses openended & non-leading questions, gives /responds to patient’s non-verbal cues, uses summarizing
/clarifying/ reflective statements, demonstrates empathy “that must have been upsetting”, avoids
medical jargon, attentive)
Poor
offended patient,
obviously negative
interaction
Marginal
missed >2 items or borderline
egregious mistake; marginal
connection with patient
Good
Missed 1-2 items without
egregious mistake
Excellent
Demonstrated all of
above, outstanding
interaction
Comments are mandatory and greatly add to the VALUE of the evaluation:
_________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
b) Data Collection: Medical Knowledge (Elicits focused chief complaint, general-to-specific
questioning, obtained relevant past medical history, social etc, asked discriminatory questions
that prioritized differential diagnosis
Poor
Tangential data
collector; missed
major topics; “lost”
in data
Marginal
Missed 1 or more vital data
points; failed to discriminate
differential diagnosis or
prioritize complaints
Good
Collected enough to
correctly rank differential
diagnosis, stayed on track
Excellent
Understands
historical nuances;
no irrelevant data
collected
Comments are mandatory and greatly add to the VALUE of the evaluation:
_________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
c) Professional Conduct (Non-judgmental, does not make patient “prove” illness, respectful to
person/privacy/spirituality)
Poor to Marginal
Good to Excellent
Any of the above features are of concern
Patient pleased with the interaction
Comments are mandatory and greatly add to the VALUE of the evaluation:
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
Details regarding feedback given to trainee and overall comments:
Name and signature of observing physician: _________________________________________________________________________
Ref: thank you to Dr. Anthony Donato for permitting the use of this form in our residency program. It has been
modified from his initial MHPE thesis, 2012
Mini-CEX Rating Instrument- Internal Medicine Residency Program
Resident (name, PGY level and clinical context)____________________
Date____________________
Observer name and Rotation: _____________________________
Case description (ie patient with dyspnea, abnormal lab results, pre-op):______________________________
Once the form has been completed the resident is to fax the completed page to the Internal
Medicine Residency office at 403-290-6655 or photograph evaluation page and email it to
[email protected]
Directions: Please circle features of each item done CORRECTLY as well as the
applicable rating.
Only evaluate ONE of the FOUR sections during each mini-CEX evaluation.
2. Physical Examination Skills
a) Medical knowledge: physical diagnosis skills (Technically proficient at exam maneuvers,
avoided irrelevant exam portions, used tools/positioning appropriately, did not omit necessary
elements of exam)
Poor
appeared not to
understand
relevant exam
Marginal
missed or incorrectly
interpreted findings of major
item or non-focused exam
Good
Excellent
1-2 less important omissions or
1 irrelevant exam feature
explored
No omissions
Comments are mandatory and greatly add to the VALUE of the evaluation:
_________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
b) Medical reasoning and physical exam interpretation (Understood extenuating
circumstances that limit exam’s usefulness (e.g. steroids masking peritonitis), understood general
sensitivity and specificity of findings)
Poor
not able to use
exam to refine
historical inquiry
Marginal
did general physical of that
organ system; omitted/did not
comprehend discriminators
Good
Excellent
understands relation
between disease suspected
and test performed
Can use findings to
effectively rank differential
diagnosis; aware of
limitations of exam
findings
Comments are mandatory and greatly add to the VALUE of the evaluation:
_________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
c) Professional Conduct (asked permission/ explained exam, respects comfort/modesty,
appropriate draping, washes hands)
Poor to Marginal
Good to Excellent
any major infraction
No or minor omissions
Comments are mandatory and greatly add to the VALUE of the evaluation:
_________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
Details regarding feedback given to trainee and overall comments:
Name and signature of observing physician: _________________________________________________________________________
Ref: thank you to Dr. Anthony Donato for permitting the use of this form in our residency program. It has been
modified from his initial MHPE thesis, 2012
Mini-CEX Rating Instrument- Internal Medicine Residency Program
Resident (name, PGY level and clinical context)____________________
Date____________________
Observer name and Rotation: _____________________________
Case description (ie patient with dyspnea, abnormal lab results, pre-op):______________________________
Once the form has been completed the resident is to fax the completed page to the Internal
Medicine Residency office at 403-290-6655 or photograph evaluation page and email it to
[email protected]
Directions: Please circle features of each item done CORRECTLY as well as the
applicable rating.
Only evaluate ONE of the FOUR sections during each mini-CEX evaluation.
3. Assessment of findings
a) Oral case presentation (Could logically organize all relevant data, omitted irrelevant data,
incorporated pertinent positive and negative data, data given aids listener in assembling/ranking
differential diagnosis)
Poor
Marginal
Student lost or
unfamiliar with
relevant features;
dangerous misses
Rambling presentation,
all data captured; major
ddx item missed but
organ system correct
Good
minor differential diagnosis
item or finding neglected;
major differential diagnosis
captured.
Excellent
Flowing, relevant
presentation; top and next
differential diagnosis items
obvious from data given
Comments are mandatory and greatly add to the VALUE of the evaluation:
_________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
b) Data synthesis/reasoning (medical knowledge components)- Logic, prioritization of
differential is consistent, accurate, values data points appropriately. Not reliant on single data
point. No omission of relevant data points that may refute diagnosis. Recognizes knowledge
gaps, formulates appropriate clinical questions. Avoids early closure.
Poor
unable to synthesize
data or faulty
reliance on bad data
point
Marginal
Good
Got major ddx item and
correct organ system
but 1 or greater major
error; or can’t see error
correct ddx, possibly miss or
omit data, did not
use/understand prevalence,
sensitivity or specificity
Excellent
No omissions, clear, accurate logic
for ddx, Formulates appropriate
clinical diagnosis.
Comments are mandatory and greatly add to the VALUE of the evaluation:
_________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
c) Plan: systems-based practice Able to incorporate comorbid conditions into test/ treat.
Chooses cost-conscious, ethical approach to testing. Correctly identifies level of urgency of
evaluation. Understands what to do with (positive or negative) test results. Uses ancillary
staff/resources appropriately. Understands limitations of tests chosen (sensitivity, specificity, risks
of false positive results)
Poor
makes 2 or
more major
mistakes
Marginal
“shotguns” tests, not aware of
disease history, fails to use ancillary
staff, fail to consider patient issues
Good
Orders correct tests relevant to
disorder without considering
comorbidities or cost
Excellent
Mature, forward- thinking decisions
consideration of patient’s unique
circumstances
Comments are mandatory and greatly add to the VALUE of the evaluation:
_________________________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________________
Details regarding feedback given to trainee and overall comments:
Name and signature of observing physician: _________________________________________________________________________
Ref: thank you to Dr. Anthony Donato for permitting the use of this form in our residency program. It has been
modified from his initial MHPE thesis, 2012
Mini-CEX Rating Instrument- Internal Medicine Residency Program
Resident (name, PGY level and clinical context)____________________
Date____________________
Observer name and Rotation: _____________________________
Case description (ie patient with dyspnea, abnormal lab results, pre-op):______________________________
Once the form has been completed the resident is to fax the completed page to the Internal
Medicine Residency office at 403-290-6655 or photograph evaluation page and email it to
[email protected]
Directions: Please circle features of each item done CORRECTLY as well as the
applicable rating.
Only evaluate ONE of the FOUR sections during each mini-CEX evaluation.
4. Presentation of plan to patient (Counseling regarding diagnostic and/or therapeutic
intervention)
a) Interpersonal/Communication Skills: Defines issue. Shared decision-making “Let’s do this
together”. Good pace. Common ground/patient education/understanding evaluated “what do you
understand about...”Avoids medical jargon. Explores variables that would affect patient’s choice.
Pauses for/invites questions. Respects patient opinions and preferences. Gives and responds to
patient’s non-verbal cues. Summarizes
Poor
dictatorial;
patient with
negative
experience
Marginal
Missed 1 major (defining
“where patient is” student
not aware that they are not
understood)
Good
missed some minor
(defining/shaping
discussion) issues overall
positive
Excellent
Found common ground,
shared decision making
and uncertainty
comfortably
Comments are mandatory and greatly add to the VALUE of the evaluation:
_________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
b) Medical Knowledge components: (Addresses uncertainties with choice (limitations of
testing/therapy/varied patient response to treatment) Discussion of pros/cons of options (including
doing nothing). Conveys risk in testing/treating. Demonstrates understanding of limitations in
tests/treatment.
Poor
Makes > 2
major errors
Marginal
Can name 1-2 options and
basic disease course;
unaware of major
alternatives.
Good
Knows major options may
miss minor nuances of
treatment. less important
side effects
Excellent
Thorough understanding of all
diagnostic and therapeutic
options; comfort with
uncertainty
Comments are mandatory and greatly add to the VALUE of the evaluation:
_________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
c) Professionalism (No demonstrated bias, not condescending, patients preferences
considered, not disrespectful)
Poor to Marginal
Any major infarction
Good to Excellent
No or minor omissions
Comments are mandatory and greatly add to the VALUE of the evaluation:
_________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
Details regarding feedback given to trainee and overall comments:
Name and signature of observing physician: _________________________________________________________________________
Ref: thank you to Dr. Anthony Donato for permitting the use of this form in our residency program. It has been
modified from his initial MHPE thesis, 2012