Introduction, development, and evaluation of the miniclinical evaluation exercise in postgraduate education of chiropractors

Objective To determine if the clinical evaluation exercise (CEX) format is reliable, applicable and useful for evaluating clinical competency in the postgraduate chiropractic program as formative feedback. Methods Twelve mini-CEX clinical encounters were evaluated by 2 assessors per clinical encounter (7 assessors per session) in 23 chiropractic residents over a 12-month period. Two different rating scales (9 point and 5 point) were used, and the 2 assessors completed the forms independently. Individual competencies assessed consisted of history taking, physical examination, organization/efficiency, clinical judgment, professionalism/communication, counseling, and overall clinical performance. Interassessor reliability was calculated using κ and intraclass correlation coefficient statistics. Cronbach α assessed internal consistency of the mini-CEX. Spearman correlation coefficient evaluated correlation between the various competencies. The Mann-Whitney U test evaluated differences between the assessors' median numerical scores. Results The κ value for the 9-point rating scale was 0.31 (fair) and for the 5-point scale was 0.42 (moderate) with statistically significant intraclass correlation values (p < .05) for 4 of the 6 competencies. High correlation coefficients (p = .0001) were found when comparing the various competencies at each clinical encounter. There were no significant differences between the 2 assessors per clinical encounter for the scores awarded to the residents. Conclusions The mini-CEX is a reliable and useful tool to provide valuable formative feedback to postgraduate chiropractic residents. The 5-point grading scale was more user-friendly with better reliability.