Review and Application of the Mini-Clinical Evaluation Exercise (Mini-CEX) in Advanced Orthodontic Education: A Pilot Study.

The aims of this study were to review the evidence on the Mini-Clinical Evaluation Exercise (Mini-CEX) for work- based assessment and to assess, in a pilot study, the utility of the Mini-CEX in an advanced orthodontic education program. Three evaluators and six first-year orthodontic residents at one U.S. dental school were recruited for the study between July and December 2017. The evaluators used a modified Mini-CEX instrument with a nine-point scale (1=unsatisfactory to 9=superior) to observe 24 resident-patient encounters (four encounters per resident) that involved orthodontic screening and comprehensive consultation procedures. Seven domains were assessed: interviewing skills, clinical examination, professionalism, clinical judgment, counseling, organization, and overall competence. Evaluators gave individualized feedback immediately after each encounter and recorded the duration of encounter and feedback in minutes. Evaluators and residents also reported their satisfaction with the experience. The mean scores for the screening and consultation encounters were 7.21±1.39 and 7.96±0.97, respectively. Overall, the highest score of all the domains was in organization (8.00±1.14) and the lowest was in clinical judgment (7.11±0.96). Clinical performance improved over four encounters (7.80±0.92, 8.72±1.29, 8.98±1.13, and 8.52±1.45, respectively); however, the difference was not statistically significant. The mean duration of encounters was 15.05±2.39 minutes and of feedback was 8.25±4.64 minutes. Encounter duration was significantly longer in difficult cases than in moderate or simple cases (ANOVA, post-hoc p=0.004). The mean satisfaction rates of residents and evaluators were high (90% and 84%, respectively). Although there is no gold standard to assess clinical competence in dentistry, this study found that the Mini-CEX may be a potentially effective method of work-based assessment in advanced orthodontic education.