Creating a path for high quality care: implementation of the mini-CEX in a student-run clinic

Creating a Path to High Quality Care: Implementation of the mini‐CEX at a student run clinic. Paul D. Di Capua, Michael L. Green, Kathleen P. White, Eric S. Holmboe. Department of Internal Medicine, Yale University, School of Medicine, New Haven, CT. Purpose: This study examines the utility of implementing the mini‐CEX at a student‐run primary care clinic. The mini‐CEX is a validated tool for clinical skills feedback and evaluation. The implementation of the mini‐CEX sought to improve quality standards in providers’ clinical skills, and therefore to set a model for continuous quality improvement in medical education. Hypothesis: The primary hypothesis tested is that a minimum of three mini‐CEX’s per week will produce a positive “utility” for both students and faculty. Methods: A needs‐based analysis focus group solicited opinions on the mission and function of the clinic from the student‐providers. The mini‐CEX was then presented as a feedback tool that could create a more structured learning environment. After the providers agreed to a trial implementation of the mini‐CEX, the faculty at the clinic were instructed on observation and feedback using the mini‐CEX. During the trial study, the authors collected a copy of all mini‐CEX forms which were used to document number of evaluations per week, characteristics of the visit, and the feedback given. Interviews conducted during the trial study with both students and faculty were documented on a weekly basis. The utility of the mini‐CEX was determined according to a previously published model which examines the reliability, validity, educational impact, acceptability, cost and feasibility. Results: The student‐providers agreed to the trial implementation of the mini‐CEX in their clinic. During the trial period, there was a mean of 3.82 (median = 3) evaluations. Interviews with faculty revealed a lack of experience in observing trainees with patients but also increased attention to the teaching they could provide the students. Interviews with students revealed frustration at the lack of consistency in the teaching, but appreciation of the feedback process. Conclusions: The mini‐CEX was successfully implemented in this student‐run clinic. The feasibility is evidenced in the number of weeks in which the minimum of 3 evaluations were performed. The positive feedback during and after the trial period from both faculty and students evidences the acceptability of the mini‐CEX. The implementation of a feedback and evaluation tool by students for students represents a movement in structuring clinical education in a self‐regulatory manner to ensure higher quality clinical skills by future physicians. 3 Implementation of the mini‐CEX at the WEC Abstract Acknowledgments This project would not be possible without the support, enthusiasm and encouragement of my esteemed colleagues and peers at the Wednesday Evening Clinic: Janet Abou, Jacob Applebaum, Mary Badon, Sanjay Basu, Jessica Berwick, Jonathan Chen, Joanna Chin, Justin Cohen, Neil Desai, Laura Dichtel, Benjamin Marks, David Merrick, Yasha Modi, Kuda Mutyambizi, Deepak Rao, Swapna Reddy, Jonathan Romanyshyn, Rachel Rutishauser, Raj Sawh, Robert Stavert, and Elizabeth Wahl, MD. I would also like to thank Dr. Kathleen White, the Director the Clinic, whose unflagging energy over the past year helped fuel this project and without whose commitment the Clinic would not be possible. Dr. Dillard, thank you for your wisdom and dedication which have been essential to the clinic since its inception. I owe many thanks as well to Dr. Michael Green who helped shape this project and whose commitment over the year brought expertise and realism to ensure successful implementation of improvements in the Clinic. Your dedication to teaching stands out, perhaps only second to your capacity to lead a challenging discussion. Dr. Holmboe, thank you for your encouragement, support and expertise as I refined the goals of the project and the analysis of the work; your vision for bringing quality improvement measures to medical education are a blessing for those of us entering our training, and I aspire to rely on superb clinical skills in my care for patients. Lisa Sander helped in infinite ways in launching this project, and I wish her well in her own medical career. Matthew Kim provided critical support during difficult months to ensure the implementation went smoothly. The Yale University School of Medicine, Department of Internal Medicine, provided important support of the completion of my thesis. This project would not have been possible without the financial support of Yale University School of Medicine Medical Student Research Fellowship. Over the past year, I have depended on my friends in both the Schools of Medicine and Management to make this possible. Finally, I would like to thank my parents, brother and sister for their love and patience throughout the year and perhaps particularly at the end, in putting this project together. 4 Implementation of the mini‐CEX at the WEC Abstract Table of