Journal of General Internal Medicine

, Volume 11, Issue 9, pp 551–553 | Cite as

Didactic value of the clinical evaluation exercise missed opportunities

  • Frank J. Kroboth
  • Barbara H. Hanusa
  • Susan C. Parker
Brief Reports


The clinical evaluation exercise (CEX), a direct observation of trainees’ clinical skills, is a common method of house officer evaluation. During our studies of its reliability, the extent of the CEX’s didactic value surfaced. This brief report describes the amount of information passed from the evaluator to the house officer in 73 CEXs. On average, evaluators made eight teaching points in postexamination sessions. However, there were as many points recorded on the CEX forms that evaluators never mentioned. In a subset of CEXs carried out with two observers present, agreement in the teaching points presented to the house officer within the pairs witnessing the same examination was 18%. Positive feedback constituted 9% to 12% of the points presented. Our observations suggest that the more systematic feedback mechanisms may enhance the didactic value of the CEX.

Key words

clinical evaluation exercise house officer evaluation didactic value 


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  1. 1.
    Noel GL, Herbers JE, Caplow MP, et al. How well do internal medicine faculty members evaluate the clinical skills of residents? Ann Intern Med. 1992;117:757–65.PubMedGoogle Scholar
  2. 2.
    Kroboth FJ, Hanusa BH, Parker S, et al. The inter-rater reliability and internal consistency of a clinical evaluation exercise. J Gen Intern Med. 1992;7:174–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Kroboth FJ, Kapoor W, Brown FH, et al. A comparative trial of the clinical evaluation exercise. Arch Intern Med. 1985;145:1121–3.PubMedCrossRefGoogle Scholar
  4. 4.
    Norcini JJ, Blank LL, Arnold GK, Kimball HR. The mini-CEX (Clinical Evaluation Exercise): a preliminary investigation. Ann Intern Med. 1995;123:795–9.PubMedGoogle Scholar
  5. 5.
    Kroboth FJ, Kapoor WN, Brown F, et al. Enhanced yield of the clinical evaluation exercise. In: Teaching Internal Medicine Symposia. Philadelphia, Pa: 1987.Google Scholar
  6. 6.
    Kroboth, FJ, Kapoor WN, Brown FH, et al. Clinical Evaluation Exercise Standardization Project, Final Report to ABIM, Philadelphia, PA: October 1990.Google Scholar
  7. 7.
    Blank LL, Naylor JD, Benson JA. Perceptions of residents regarding assessment of their clinical competence. In: SGIM Education, Program Supplement. Washington, DC: SGIM; 1989;17.Google Scholar
  8. 8.
    Hinz CF. Direct observation as a means of teaching and evaluating clinical skills. J Med Educ. 1966;41:150–61.PubMedGoogle Scholar
  9. 9.
    Wiener S, Nathanson M. Physical examination: frequently observed errors. JAMA. 1976;236:852–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Ende J. Feedback in clinical medical education. JAMA. 1983;250:777–81.PubMedCrossRefGoogle Scholar
  11. 11.
    Godkins TR, Duffy D, Greenwood J, Stanhope WD. Utilization of simulated patients to teach the “routine” pelvic examination. J Med Educ. 1974;49:1174–8.PubMedGoogle Scholar
  12. 12.
    Anderson KK, Meyer TC. The use of instructor-patients to teach physical examination techniques. J Med Educ. 1978;53:831–6.PubMedGoogle Scholar
  13. 13.
    Black NMI, Harden RM. Providing feedback to students on clinical skills by using the Objective Structured Clinical Examination. Med Educ. 1986;20:48–52.PubMedCrossRefGoogle Scholar
  14. 14.
    Stillman PL, Regan MB, Philbin M, Haley HL. Results of a survey on the use of standardized patients to teach and evaluate clinical skills. Acad Med. 1990;65:288–92.PubMedCrossRefGoogle Scholar
  15. 15.
    Ainsworth MA, Rogers LP, Markus JF, et al. Standardized patient encounters: a method for teaching and evaluation. JAMA. 1991;266:1390–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Wolf FM, Woolliscroft JO, Calhoun JG, Boxer GJ. A controlled experiment in teaching students to respond to patients’ emotional concerns. J Med Educ. 1987;62:25–34.PubMedGoogle Scholar

Copyright information

© Blackwell Science, Inc. 1996

Authors and Affiliations

  • Frank J. Kroboth
    • 1
  • Barbara H. Hanusa
  • Susan C. Parker
  1. 1.Department of Medicine, Division of General MedicineMontefiore University HospitalPittsburgh

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