BARRIERS TO THE ROUTINE IMPLEMENTATION OF MINI-CLINICAL EVALUATION EXERCISE (MINI-CEX) IN POSTGRADUATE RESIDENCY: A QUALITATIVE STUDY IN ABBOTTABAD, PAKISTAN
Abstract
Background: Mini-Clinical Evaluation Exercise (Mini-CEX) is an internationally recognized workplace-based assessment tool that provides structured observation and feedback to trainees. Despite its established value as a formative assessment method, routine implementation remains limited in postgraduate training programs in Pakistan. The objective was to explore the barriers hindering the routine implementation of Mini-CEX in postgraduate obstetrics and gynaecology residency programs in Abbottabad and to identify strategies to enhance its integration. Methods: This qualitative study employed semi-structured interviews with 12 supervisors of the College of Physicians and Surgeons Pakistan (CPSP) involved in obstetrics and gynaecology residency training in public and private hospitals of Abbottabad. Participants were selected through purposive maximal variation sampling. Interviews were transcribed verbatim and thematically analyzed following Braun and Clarke’s framework. Credibility was ensured through member checking and triangulation. Results: Seven themes emerged: time constraints and heavy workload, lack of formal integration into curriculum, organizational and institutional barriers, resource-related challenges, faculty and resident attitudes, feedback and follow-up and suggested strategies for improvement. Supervisors consistently identified clinical workload, lack of structured scheduling, and minimal administrative support as major barriers. Constructive feedback was recognized as the strongest benefit of Mini-CEX, though follow-up and consistency were limited. Strategies suggested included embedding Mini-CEX into CPSP curriculum, incorporating it into ward academic schedules, simplifying documentation, and providing faculty training workshops.
Conclusion: Mini-CEX is a valuable formative tool but faces multiple barriers in routine use. Addressing these challenges through curricular reforms, institutional support, and faculty development can enhance the effective implementation of residency training.
References
1. Shah N, Desai C, Jorwekar G, Badyal D, Singh T. Competency-based medical education: An overview and application in pharmacology. Indian J Pharmacol 2016;48(Suppl 1):S5–9.
2. Liao KC, Pu SJ, Liu MS, Yang CW, Kuo HP. Development and implementation of a mini-Clinical Evaluation Exercise (mini-CEX) program to assess the clinical competencies of internal medicine residents: from faculty development to curriculum evaluation. BMC Med Educ 2013;13:31.
3. Weston PS, Smith CA. The use of mini-CEX in UK foundation training six years following its introduction: lessons still to be learned and the benefit of formal teaching regarding its utility. Med Teach 2014;36(2):155–63.
4. Batra P, Batra R, Verma N, Bokariya P, Garg S, Yadav S. Mini clinical evaluation exercise (Mini-CEX): A tool for assessment of residents in the department of surgery. J Educ Health Promot 2022;11:253.
5. Crossley J, Jolly B. Making sense of work-based assessment: ask the right questions, in the right way, about the right things, of the right people. Med Educ 2012;46(1):28–37.
6. Burgess A, van Diggele C, Roberts C, Mellis C. Feedback in the clinical setting. BMC Med Educ 2020;20(Suppl 2):460.
7. Rajan STM, Rahim A, Govindraj G. Faculty and resident perceptions on Mini-Clinical Examination Exercise (Mini-CEX) as an assessment tool in medical and surgical super-specialty departments of a teaching hospital. South-East Asian J Med Educ 2020;14(2):48.
8. Bashir K, Arshad W, Azad AM, Alfalahi S, Kodumayil A, Elmoheen A. Acceptability and feasibility of Mini Clinical Evaluation Exercise (Mini-CEX) in the busy emergency department. Open Access Emerg Med 2021;13:481–6.
9. Creswell JW. Research design: Qualitative, quantitative and mixed methods approaches. 4th ed. Thousand Oaks (CA): Sage, 2014; p.207.
10. Gossel BM. Analogies in entrepreneurial communication and strategic communication: definition, delimitation of research programs and future research. Int J Strateg Commun 2022;16(2):134–56.
11. Jacob SA, Furgerson SP. Writing interview protocols and conducting interviews: Tips for students new to the field of qualitative research. Qual Rep 2012;17(6):1–10.
12. Artino AR Jr, La Rochelle JS, Dezee KJ, Gehlbach H. Developing questionnaires for educational research: AMEE Guide No. 87. Med Teach 2014;36(6):463–74.
13. Siddiqui FG, Saleem O, Malik MUR, Pirzada MT, Habiba U. Feasibility of implementing mini-Clinical Evaluation Exercise (Mini-CEX) as a formative assessment tool in postgraduate surgical training. Pak J Med Health Sci 2023;17(4):420.
14. Shafqat S, Tejani I, Ali M, Tariq H, Sabzwari S. Feasibility and effectiveness of Mini-Clinical Evaluation Exercise (Mini-CEX) in an undergraduate medical program: A study from Pakistan. Cureus 2022;14(9):e29563.
15. Goel A, Singh T. The usefulness of mini clinical evaluation exercise as a learning tool in different pediatric clinical settings. Int J Appl Basic Med Res 2015;5(Suppl 1):S32–4.
16. Sudarso S, Rahayu GR, Suhoyo Y. How does feedback in mini-CEX affect students' learning response? Int J Med Educ 2016;7:407–13.
17. Soemantri D, Dodds A, McColl G. Überprüfen der art des feedbacks innerhalb mini clinical evaluation exercise (Mini-CEX): eine analyse von 1427 mini-CEX-bewertungsformularen. GMS J Med Educ 2018;35(4):Doc53.
18. Sultana S. Mini-CEX: feasibility, acceptability and effectiveness of its use in the learning of post graduate residents. Pak Armed Forces Med J 2018;68(3):601–7.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Shandana Jadoon, Tanzeela Khalid
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
