framework for feedback: the peer mini-clinical examination as a formative assessment tool
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Correspondence: Robbert Duvivier, International Federation ofMedical Students’ Associations IFMSA PO Box 63, 01212 Ferney-Voltaire, France. Tel: 00 31 6 2835 9428; Fax: 00 31 6 2835 9428;E-mails: [email protected]
doi: 10.1111/j.1365-2923.2012.04234.x
Framework for feedback: the peer mini-clinicalexamination as a formative assessment tool
Deirdre Bennett, Martina Kelly & Siun O’Flynn
What problems were addressed? Our studentswanted more feedback on their performance withpatients in the clinical setting. We wanted todevelop students’ ability to deliver and accept usefulfeedback. The mini-clinical examination (mini-CEX)is part of our assessment programme and is familiarto students. It is a workplace-based assessment inwhich student performance during a focusedclinical encounter is evaluated. Immediate feedbackon performance and the teaching opportunityprovided have been identified as strengths of theprocess by students.1 We wondered if the mini-CEXformat could serve as a useful framework for aprocess of reciprocal peer feedback on clinicalplacements.What was tried? We ran a pilot study to assess theutility and acceptability to students of the mini-CEXas a framework for feedback. Forty students, assignedin pairs, undertook two peer mini-CEX evaluationswhilst on clinical attachments. In this way, eachstudent acted as both learner and assessor. TheNational Health Service mini-CEX form, with minormodifications for the undergraduate setting, wasused. The assessor assigned a mark and identifiedareas for improvement in his or her peer’sperformance. All students were asked to complete aqualitative survey evaluating the process. Responseswere coded and grouped into themes independentlyby the authors. The marks and written feedback onthe mini-CEX forms completed by the studentassessors were also examined.What lessons were learned? The mini-CEX provideda useful framework for formative peer feedback inthe undergraduate clinical setting. Peer assessorswere able to identify the areas in which studentshad performed well and those that requiredimprovement, and noted these, along with actionsfor improvement, on the mini-CEX forms. However,no student scored less than 4 out of 5. This isunlikely to accurately reflect the range of student
performance and suggests that students may havefound quantitative evaluation more challenging.Qualitative feedback revealed that students likedbenchmarking their own performances againstthose of their peers, receiving useful feedback,gaining experience for other examinations, the real-life context of the mini-CEX and the opportunity togain a different perspective by examining a peer’sperformance. Negative comments focused on thevalidity of the feedback in view of the lack ofqualification of peers, logistical issues concerningthe organisation of the assessment, and desire formore guidance regarding standards to apply inassessing peers.
Although the mini-CEX was effective in scaffold-ing peer feedback, students appeared to lackconfidence in the process. Although they recogni-sed that the feedback was useful, only half of thestudents felt that it was appropriate to be assessedby a peer. Building a culture of peer-assistedlearning might improve this. More guidance fromfaculty staff on standards and metrics underpinningjudgements is needed and we have piloted amore structured mini-CEX form in response to thisneed. Our students are trained in giving andreceiving feedback; however, their confidence inthese skills did not transfer to a real-life setting.Graduated real-life application of feedback skillsfacilitated by faculty members may help to bridgethis gap.
REFERENCE
1 Hill F, Kendall K. Adopting and adapting the mini-CEXas an undergraduate assessment and learning tool. ClinTeach 2007;4:244–8.
Correspondence: Dr Deirdre Bennett, Medical Education Unit, Schoolof Medicine, University College Cork, Cork, Ireland.Tel: 00 353 21 490 1591; Fax: 00 353 21 490 1594;E-mail: [email protected]
doi: 10.1111/j.1365-2923.2012.04230.x
Medical students teach basic life support inhospital
Bryan Sisk, S Beth Bierer, Meredith Lahl &Ehsan H Balagamwala
What problems were addressed? Hospitalised infantshave an elevated risk for cardiorespiratory arrest after
512 � Blackwell Publishing Ltd 2012. MEDICAL EDUCATION 2012; 46: 501–527
really good stuff