This study explored the role of a new teaching model in residency training, called the mini-CEX-APR. The results reveal that the mini-CEX-APR on the basis of regular training is conducive to improving the overall clinical performance of residents (Fig. 2), and this new teaching model is more effective and more satisfactory than the traditional teaching way (Fig. 1). Besides, the excellent teaching effect of the mini-CEX-APR cannot be affected by hospitals of different grades (Fig. 4), and these results are applicable in both cardiology and gastroenterology departments (Fig. 3).
The mini-CEX is multifunctional, it is not simply an evaluation tool, but also an instructive teaching method. The mini-CEX mainly includes two constituents: evaluation and feedback. In evaluation part, residents have 15–20 minutes for history taking, physical examination, diagnosis and differential diagnosis, as well as formulation of diagnosis and treatment plan, then the attending physician will rate their mini-CEX scale according to their performance. In feedback part, attending physicians offer immediate feedback and instruction to residents to help them pinpoint their strengths and weaknesses based on latest mini-CEX assessment. Previous studies have shown, trainers and trainees all agreed that Mini-CEX can truly reflect the clinical ability of trainees, and they admitted that mini-CEX benefit both of them via putting forward refined feedback or accepting targeted feedback. It is worth mentioning that mini-CEX is a mini-type evaluation system, which can be carried out at any time during clinical routine work, saving time and effort. Owing to its feasibility, convenience, and effectiveness, the mini-CEX is regarded as one of the most powerful formative assessment methods and deserves to be promoted in residency training.
The standardized training system for Chinese residents has been widely implemented in China, however, the conventional evaluation of residents’ clinical ability still uses a single form such as written and oral exams. An essential cause of this status quo is that Mini-CEX fails to integrate with the current clinical practice system. On the one hand, using Mini-CEX only as an assessment tool, clinical trainers and trainees need to extra time to perform Mini-CEX assessment alone, which is time-consuming and laborious, making it more difficult for Mini-CEX to be widely implemented in the clinical training process. On the other hand, despite the fact that some hospitals have begun to use Mini-CEX to assess the ability of residents, the clinical ability of residents is not markedly improved because of the inapposite timing and frequency of taking Mini-CEX. Residents in these hospitals usually took part in the departmental evaluation (Mini-CEX evaluation) when their training in this department is about to end, and they will leave there soon after the evaluation. Therefore, the residents have no time to correct the problems reflected in the mini-CEX assessment, so its feedback effect is not completely utilized. In addition, the assessment may not be accurate if the Mini-CEX is performed only once during the examination, because the condition of the patient and evaluators alters between each assessment, which may lead to assessment deviations. When the mini-CEX can be performed repeatedly, it will reflect the residents’ capabilities more accurately, as having been pointed out by previous studies, the preferable frequency is at least 4 times. Consequently, a new model combining mini-CEX with clinical practice is warranted to improve the quality of residency training.
Attending physicians are the backbone in every department, who not only have the ability to solve clinical problems, but also have clinical teaching capabilities to cultivate the residents. The attending physician who has the closest connection with his residents is the perfect evaluator and trainer for residents. Attending physician rounds are pivotal components of the third-level physician rounds system, also are supposed to be the ideal time to educate, observe and evaluate the residents. The mini-CEX-APR expects that attending physicians provide mini-CEX oriented assessment and feedback timely to residents, and repeat above process moderately. By this means, residents can acquire targeted clinical correction and guidance, which is of great significance for them to raise their self-awareness, self-examination and self-improvement. As the new teaching model that fully organically integrates the mini-CEX and the attending physician rounds, the mini-CEX-APR can stimulate to from a positive feedback effect through accurate evaluation, timely feedback, corrective training and continuous improvement. In conclusion, followings are the advantages of mini-CEX-APR teaching model: firstly, the mini-CEX-APR can be carried out simultaneously with clinical routine work every 2 weeks, and its repeated assessment and feedback help residents keep improving, avoiding having no time to correct the problem discovered at the final exam. Secondly, the attending physician is the perfect evaluator who ought to observe residents most carefully and discover their problems most thoroughly. Thirdly, repeated mini-CEX assessment may enhance the psychological quality of residents, helping them to make full preparations for final exams. Lastly, the mini-CEX-APR can improve the teaching awareness of attending physicians, also standardize rounds and improve training quality. Each above will be a renewed push for incorporating the mini-CEX-APR into residency training.
The main limitation of our study lies in the deficiencies of the number of departments, the function of mini-CEX-APR in other departments of the internal medicine system and even in the surgical system remains to be tested and awaits further research.