DOI: 10.32322/jhsm.1978723 ISSN: 2636-8579

Summative contribution, examiner variability, and faculty workload of the mini-CEX in an undergraduate orthopedic clerkship

Eşref Selçuk, Cem Çopuroğlu, Mert Özcan, Murat Erem, Savaş Yıldırım
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Aims: The mini-clinical evaluation exercise (mini-CEX) is widely used for workplace-based assessment, particularly in internal medicine, but its role in surgical clerkships remains less clear. This study evaluated the association between mini-CEX scores and summative performance, examiner-related variability, and the faculty time required for implementation in an undergraduate orthopedic clerkship. Methods: This retrospective observational study included 303 fifth-year medical students who completed the Movement System Diseases and Forensic Traumatology Clerkship at Trakya University, Turkiye, during 2024-2025. The orthopedics practical assessment consisted of an evaluation exam, mini-CEX, and an objective structured practical examination. Correlation, regression, and ROC analyses were performed to examine the relationship between assessment components and final grades. Examiner variability, faculty workload, and the estimated effect of removing mini-CEX from grade calculations were also assessed.Results: Mini-CEX scores correlated weakly with the orthopedics practical grade and overall practical module grade, but showed no association with final clerkship grades. In regression analysis, theoretical and practical module scores showed the strongest associations with final performance, whereas mini-CEX showed no significant additional association after accounting for the other assessment components. Implementing mini-CEX for all students required an estimated 76-101 hours of faculty time. Removing mini-CEX from the grading model caused only a 0.09-point change in mean final scores and did not alter pass/fail outcomes. Conclusion: In this high-volume undergraduate orthopedic clerkship, mini-CEX had limited summative value despite its potential formative role. Its potential formative value warrants further investigation, alongside streamlined or digital approaches to improve implementation efficiency.

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