Factors Influencing Mini-Clinical Evaluation Exercise Scores: A Review Article

The Mini-Clinical Evaluation Exercise (Mini-CEX) is widely used to assess clinical performance because of its practicality. Although initial studies have supported its reliability and validity, the utility of Mini-CEX is under serious debate due to inconsistencies in rater judgments. This study aimed to review the relevant literature on the utility of Mini-CEX in order to find out the influencing factors on Mini-CEX scores. In this narrative review study,the MEDLINE, EMBASE, SCOPUS, SID & Magiran were searched to retrieve the relevant articles published from 1995 to 2014, using the key words such as Mini-CEX, ‘utility’, ‘validity’, ‘reliability’,‘score variability’. Subsequently, nineteen relevant studies out of 51 articles were selected to be reviewed. Factors influencing Mini-CEX scores were related to the raters, rating forms and clinical exposures, in order of importance. Variability in raters’ stringency and leniency and high intercorrelation between items were the most influencing factors affecting test scores. The results of the studies regarding factors such as rater trainingon Mini-CEX scores were not conclusive. Considering the inconsistencies in Mini-CEX exam scores and uncertainty about the influencing circumstances on scoring, it is recommended that Mini-CEX scores should not be used for summative assessment purposes, especially in order to rank the performance of the students.