Impact of a Simulated Mini-CEX on Clinical Performance During a Real-World Mini-CEX

Impact of a Simulated Mini-CEX on Clinical Performance During a Real-World Mini-CEX: A Multicenter Study in Anesthesiology and Intensive Care Medicine

Modern medical education is based on competency-based learning and the use of formative assessment tools in real clinical settings, such as the Mini-Clinical Evaluation Exercise (mini-CEX). However, the impact of a prior simulated mini-CEX experience on subsequent performance in real clinical settings remains insufficiently studied, particularly among medical students in anesthesiology-intensive care (DCEM3). This study aimed to assess the effect of a simulated mini-CEX on performance during a real mini-CEX in pre-anesthetic consultation.

Study Overview

• Status: Not yet recruiting
• Conditions: Volunteers Medical Students in Anesthesiology-intensive Care
• Intervention / Treatment: Other: Behavioral

Detailed Description

We conducted a prospective, multicenter interventional study over 4 weeks in three anesthesiology-intensive care departments in Tunis. Volunteer DCEM3 students were assessed by trained anesthesiology faculty using the mini-CEX tool. The intervention consisted of a structured two-step assessment of pre-anesthetic consultation: a standardized simulation followed by a real clinical encounter. Performance was evaluated using a 7-domain mini-CEX checklist, including direct observation, scoring, and immediate formative feedback. The primary outcome was the overall mini-CEX score. Secondary outcomes included domain-specific scores, inter-rater reliability, individual progression, and participant satisfaction.

• Study Type: Interventional
• Enrollment (Estimated): 18
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Mhamed Sami Mebazaa, professor; Phone Number: 00216 22252589; Email: msmebazaa@gmail.com
• Study Contact Backup: Name: Ben Haj youssef, assistant; Phone Number: 00216 96874336; Email: amani.benhajyoussef@fmt.utm.tn

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Fifth-year medical students (DCEM3) enrolled at the Faculty of Medicine of Tunis within the acute medicine program.
• Students completing their clinical clerkship during the second semester of the 2025-2026 academic year in one of the three participating anesthesiology and intensive care departments.
• Students who voluntarily agree to participate and have provided written informed consent.

Exclusion Criteria:

• Students who do not complete the entire educational curriculum (absence from either of the two assessments).
• Students who have already received similar training.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: DCEM3 students; Fifth-year medical students in the second cycle during their internship in anesthesiology and intensive care.

Other: Behavioral; Mini-CEX educational assessment during pre-anesthetic consultation: Volunteer fifth-year medical students were assessed by trained anesthesiology faculty using the mini-CEX tool. The intervention consisted of a structured two-step assessment of pre-anesthetic consultation: a standardized simulation followed by a real clinical encounter.; Other Names: Simulated Mini-CEX; Mini-CEX-based educational intervention

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
students' overall performance	measured by the mean score on the Mini-CEX checklist, compared between simulated consultation and real consultation. The overall performance is assessed using the unabbreviated Mini-Clinical Evaluation Exercise (Mini-CEX) checklist. The global score is measured on a 9-point Likert scale, ranging from 1 (insufficient/unsatisfactory performance) to 9 (exceptional/exemplary performance). Higher scores indicate a better clinical performance and greater student autonomy.	Through study completion, up to 4 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Scores for each domain	Scores for each domain (history taking, physical examination, clinical judgment, communication skills, professionalism, organization and efficiency, and overall clinical performance). Measured by the Mini-Clinical Evaluation Exercise (Mini-CEX) checklist, compared between the simulated consultation (baseline) and the real clinical consultation. The checklist uses a 9-point Likert scale where 1 represents the lowest performance (insufficient) and 9 represents the highest performance (exceptional). Higher scores indicate a better clinical outcome.	at the and of each Mini-CEX , Through study completion, up to 4 weeks
Inter-rater reproducibility of Mini-CEX	Inter-rater reproducibility was evaluated using the Intraclass Correlation Coefficient (ICC	at the end of the simulated Mini-CEx, Through study completion, up to 4 weeks
Individual performance gain	Individual performance gain (delta between simulated and real Mini-CEX scores) Calculated as the change score between the real clinical consultation and the simulated consultation (Real score minus Simulated score) using the unabbreviated Mini-Clinical Evaluation Exercise (Mini-CEX). The original Mini-CEX scale ranges from a minimum value of 1 (insufficient performance) to a maximum value of 9 (exceptional performance). The resulting performance gain score ranges from -8 to +8. A higher or positive score indicates a better outcome (improvement/performance gain), a score of 0 indicates no change, and a negative score indicates a decrease in performance.	at the end of the internship, Through study completion, up to 4 weeks
Learner and faculty satisfaction	Learner and faculty satisfaction, as well as their recommendation for the use of the Mini-CEX throughout the curriculum, assessed using a Likert scale. Assessed via a post-internship questionnaire completed by both students (learners) and professors (faculty) regarding their satisfaction with the Mini-Clinical Evaluation Exercise (Mini-CEX) and their recommendation for its integration throughout the curriculum. Responses are evaluated on a 5-point Likert scale, ranging from a minimum score of 1 (Strongly disagree / Very dissatisfied) to a maximum score of 5 (Strongly agree / Very satisfied). Higher scores indicate a better outcome, representing higher levels of satisfaction and a stronger recommendation for curriculum implementation.	at the end of internship, Through study completion, up to 4 weeks
The time required to complete the consultation	The time required to complete the consultation (measured in minutes)	at the end of each Mini-Cex, Through study completion, up to 4 weeks

Collaborators and Investigators

• Sponsor: Mongi Slim Hospital

Study record dates

Study Major Dates

• Study Start (Estimated): June 2, 2026
• Primary Completion (Estimated): June 26, 2026
• Study Completion (Estimated): June 26, 2026

Study Registration Dates

• First Submitted: June 2, 2026
• First Submitted That Met QC Criteria: June 18, 2026
• First Posted (Actual): June 23, 2026

Study Record Updates

• Last Update Posted (Actual): June 23, 2026
• Last Update Submitted That Met QC Criteria: June 18, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Medical education; Assessment; Anesthesiology; Competence
• Other Study ID Numbers: Simulated mini-CEX

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No