A Pilot Study of Modified Mini-Clinical Evaluation Exercises (Mini-CEX) in Rotation Students in the Department of Endocrinology

Development of a tool for assessing the clinical competency of Chinese master's nursing students based on the mini-CEX: a Delphi method study

OBJECTIVE

To construct a scientific and systematic competency evaluation tool for master of nursing specialists (MNS) and to provide a reference for the training, assessment and competency evaluation of MNS.

METHODS

A first draft of the indicators for assessing MNS core competencies was developed on the basis of published research and group discussions. Between June and December 2020, the indicators were revised using two rounds of the Delphi expert consultation method, with questionnaires completed by 16 experts from five provinces in China.

RESULTS

The valid retrieval rate of the two questionnaires was 100.00%, and the coefficient of expert authority was 0.931. The Kendall's concordance coefficients of the two rounds of questionnaires were 0.136 (p<0.05) and 0.147 (p<0.05), respectively. Consensus was reached on the seven dimensions and 52 items of the MNS competency assessment instrument. The instrument dimensions included nurse‒patient communication (9 items), health assessment (7 items), clinical decision-making (8 items), operational skills (7 items), health promotion (6 items), humanistic care (9 items) and organisational effectiveness (6 items).

CONCLUSIONS

The MNS competency assessment tool constructed in this study is focused and highly credible. The findings can be used as a guide for the training, assessment and competence evaluation of MNS in the future.

The Barriers to Insulin Therapy Initiation in Type 2 Diabetes Patients: A Study of General Practitioner Perceptions in Huinan Community in South Shanghai

Background

Despite the demonstrated benefits of insulin therapy, many general practitioners (GPs) are hesitant to administer it due to challenges such as a lack of knowledge, time constraints, and patient reluctance. The barriers that prevent a GP from initiating insulin therapy may vary in comparison to those encountered by a diabetic patient; this aspect of clinical research in the South Shanghai metropolitan area has received limited attention so far.

Objective

This is a 6-months of interventional analytic cohort study. The prime aim is to investigate the barriers general practitioners (GPs) face when initiating insulin therapy for patients with type 2 diabetes (T2D).

Materials and Methods

As part of a training program, all 189 registered GPs in Nanhui Health Service Center in Shanghai were given a structured online-multi-choice questionnaire before and after a six-month interval, during which the GPs received sessions of training on insulin therapy either on theoretic classes or clinical practices.

Results

Before and after training, via the methods of multiple-response analyses, the results showed that social, GP's, and patient barriers to initiating insulin therapy were comparable. However, through the crosstabs chi-square test, we found significant changes in the basal insulin initiation following the prescription of the senior endocrinologists, the titration of insulin, and the need for training (p<0.05). The Spearman analyses discovered significant changes associated with the cause of initial insulin refusal and the factors influencing insulin administration. Finally, the binary logistic regression analysis revealed that distinct causes such as social factors, insurance, GP experience, insulin dosage calculation, follow-up, and patients' feelings are related to insulin treatment application before and after training.

Conclusion

According to this study, training increased general practitioners' confidence in initiating insulin administration, especially basal insulin. General practitioners require additional education on insulin therapy, with a potential need for increased face-to-face training for insulin initiation.

Perception and Satisfaction of Undergraduate Medical Students of the Mini Clinical Evaluation Exercise Implementation in Orthopedic Outpatient Setting

PURPOSE

The Mini Clinical Evaluation Exercise (mini-CEX) is a brief and direct observational assessment of trainee-patient interactions that helps to assess several clinical domains. There is limited evidence of mini-CEX implementation in orthopedics and undergraduate perceptions toward such an approach. This study investigated the perception of mini-CEX among undergraduate medical students through a questionnaire-based survey in an orthopedic outpatient setting.

PATIENTS AND METHODS

Undergraduate medical students completing their orthopedic clinical posting were invited to participate in an anonymous, self-administered questionnaire written in English to evaluate their perceptions toward mini-CEX implementation in the orthopedic outpatient setting for the 2016-2017 academic session. The questionnaire comprised 28 closed-ended questions with a five-point Likert rating-scale, and five open-ended questions. The survey responses were analyzed for reliability, validity, and quantitative and qualitative analyses.

RESULTS

A total of 350 students completed the questionnaire; the questionnaire was proven to be valid and reliable. The closed-ended questions were designed to assess the knowledge of the mini-CEX as an assessment tool. The participants demonstrated a satisfactory understanding of the mini-CEX methodology, purpose, clarity, comprehensiveness, and as a self-assessment tool for undergraduate medical students. Instructor support for the implementation of mini-CEX appeared inadequate and was rated with non-confidence among most students. Most participants appreciated better clinical skills, which was reflected through improvements in clinical exam preparation, the Objective Structured Clinical Examination, and clinical judgment.

CONCLUSION

Undergraduate medical students perceived the mini-CEX as an effective tool for clinical teaching in an outpatient orthopedic setting. However, most students indicated suboptimal instructor involvement in the teaching and assessment process; this raises concerns regarding inadequate direct observation and limited feedback for student performance. Additional measures are needed to ensure high quality clinical encounters, teacher training, integration with other assessment tools, and standardized coverage mini-CEX implementation in orthopedics.