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.

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.

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.