The requirements
- In ST1, a minimum of four COTS and/or Mini CEXs are required (this is four in total – for example, two COTs and two MiniCEXs).
- In ST2, a minimum of four COTS and/or Mini CEXs are required (this is four in total – for example, two COTs and two MiniCEXs).
MiniCEXs are completed in non-primary care placements and in ST1 and in ST2, two MiniCEXs should be completed per non-primary care placement. COTS are completed in primary care placements, and in ST2 two COTS should be completed per primary care placement.
- As ST3 takes place in primary care placements, MiniCEXs are not required in ST3 (a minimum of seven COTS are required in ST3).
For clarity, if there are no primary care placements in a training year (e.g. ST2 consists only of non-primary care placements), only MiniCEXs should be completed and a minimum of four would still apply – for example, if the ST2 year consists only of non-primary care placements, four MiniCEXs should be completed.
What's involved
Each MiniCEX should represent a different clinical problem and a MiniCEX and Case-Based Discussion (CbD) should not be done on the same patient. It is helpful to vary the types of cases that are assessed using MiniCEXs so that competence is reviewed with different challenges. The full range of complexities should be completed.
Reviewing and assessing the MiniCEX
It is the responsibility of the GP Registrar to identify and approach an appropriate clinician to be an assessor. It is advisable to arrange a time and date for the assessment in advance. On occasion, real time opportunities present themselves that are suitable for MiniCEXs. However, this should not be seen as the norm. The assessments should be spread out across the duration of the post and the assessment should not last more than fifteen minutes.
MiniCEXs can be carried out in hospital by the Clinical Supervisor (which is best practice), by doctors who are ST4 or above in that speciality, or Speciality and Associate Specialist (SAS) doctors with equivalent experience and who have met the GMC assessor requirements. The Registrar chooses who undertakes a MiniCEX and are encouraged to complete assessments with a range of assessors, though the named Clinical Supervisor should complete at least one MiniCEX during each rotation.
The assessor will give immediate, specific constructive feedback on this interaction, focusing on:
- Professionalism
- Communication and consultation skills
- Clinical assessment and judgement
- Clinical management
- Organisation/efficiency
The assessor will rate performance and document their verbal feedback on the assessment form. This feedback will subsequently be used as evidence of progress within the Educational Supervisor Review (ESR).
A Registrar should be graded in relation to other doctors in that Speciality at the same stage of training. When grading, there is the option to put ‘Not applicable’ which means that the identified area was not covered as it was not within the context of the case. This is different to ‘Significantly below expectation and/or below expectation’, which mean that either the identified area was not covered to a competent level or was not demonstrated at all, but should have been.
Some assessors will have full access to the Trainee Portfolio, but in non-primary care settings they may need to be sent a ticket code to enable the assessment form to be completed.
In this situation, having ideally agreed a mutually appropriate time to complete an assessment, it is preferable to send the ticket code in advance to the assessor. To use the ticketed feedback system, click on ‘generate a new ticket’ within the Portfolio, select the ‘MiniCEX assessment form’ and complete the assessor’s details. An email will then be sent providing a login code for the assessor to use to complete the ticketed MiniCEX assessment form.
The MiniCEX overall is assessed as:
- Below the level expected prior to starting on a GP Training programme
- Below the level expected of a GP trainee working in the current clinical post
- At the level expected of a GP trainee working in the current clinical post
- Above the level expected of a GP trainee working in the current clinical post
This assessment along with the individual grades and feedback will be used as evidence of progress within the ESR. Areas of strength and suggestions for development are both encouraged.
Consultations that were assessed with a MiniCEX can be reflected on in a Clinical Case Review (CCR) to demonstrate additional capabilities.