With increasing numbers of Australian medical graduates, there has been a significant increase in the intern teaching and supervision workload in emergency departments (EDs). As a result, there is the potential for dilution of supervision, making assessment of intern performance more challenging. The current process for evaluating interns has no formal requirement for direct observation of an intern’s history taking or clinical examination skills. Rather the assessment of their abilities is largely derived from the quality of presentation of their clinical findings to the senior doctors supervising them. In most EDs end of term assessments are based on facilitated discussion involving these senior medical staff at the end of term. This method has a number of potential problems. It may miss critical gaps in performance through lack of direct observation. Moreover, it is likely to disproportionately favour those with excellent communication skills.
It has been suggested that deficiencies with the current work based assessment practices in pre-vocational medical education may be addressed through use of a tool called the mini-CEX. The mini-CEX was introduced in the mid 1990s. It requires direct observation of intern’s clinical skills on a real patient, providing information in an authentic context for summative assessment purposes. It also facilitates timely and case relevant feedback to the interns, and thus is useful for formative feedback.