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Assessing the mini-Clinical Evaluation Exercise in comparison to a national specialty examination


Dr Rose Hatala, Suite 5907 Burrard Bldg, St Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6. Tel; (604) 806 8668; Fax: (604) 806 8338; E-mail:


Purpose  To evaluate the reliability and validity of the Mini-Clinical Evaluation Exercise (mini-CEX) for postgraduate year 4 (PGY-4) internal medicine trainees compared to a high-stakes assessment of clinical competence, the Royal College of Physicians and Surgeons of Canada Comprehensive Examination in Internal Medicine (RCPSC IM examination).

Methods  Twenty-two PGY-4 residents at the University of British Columbia and the University of Calgary were evaluated, during the 6 months preceding their 2004 RCPSC IM examination, with a mean of 5.5 mini-CEX encounters (range 3–6). Experienced Royal College examiners from each site travelled to the alternate university to assess the encounters.

Results  The mini-CEX encounters assessed a broad range of internal medicine patient problems. The inter-encounter reliability for the residents' mean mini-CEX overall clinical competence score was 0.74. The attenuated correlation between residents' mini-CEX overall clinical competence score and their 2004 RCPSC IM oral examination score was 0.59 (P = 0.01).

Conclusion  By examining multiple sources of validity evidence, this study suggests that the mini-CEX provides a reliable and valid assessment of clinical competence for PGY-4 trainees in internal medicine.