Early experience with Mini-CEX in otorhinolaryngology residency: feasibility, feedback quality, and perceived educational impact

Objectives To describe the implementation of the Mini-Clinical Evaluation Exercise (Mini-CEX) in an Otorhinolaryngology residency program and to analyze assessment outcomes, feedback, and residents’ and preceptors’ perceptions during the first 21 months. Methods This retrospective observational study with a cross-sectional quantitative survey and brief open-ended responses comprised a retrospective review of Mini-CEX forms completed between January 2022 and October 2023 in the Otorhinolaryngology outpatient clinics of Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da USP (HCFMRP/USP). Assessments were summarized by subspecialty, complexity, training year, and preceptor experience (≤ 10 vs. >10 years). Participants answered a 27-item online questionnaire on Mini-CEX knowledge and perceptions, plus three open-ended questions. Results Forty Mini-CEX encounters were completed for 22 residents by 17 preceptors. Most assessments occurred in otology (52.5%), whereas laryngology was the least represented subspecialty (2.8%). Cases were predominantly of moderate or high complexity (>60%). 46% of assessments were rated as “above expectations”, with no significant differences among assessed domains (p = 0.19). Less experienced preceptors were selected more often and assigned lower scores than more experienced preceptors (p < 0.0001); non-faculty preceptors assigned lower scores than faculty members (p = 0.0032). First-year residents scored lower than second- and third-year residents (p = 0.0014). Although 90% received feedback, only 2.5% of feedback entries met completeness criteria, regardless of preceptor experience (p = 0.72). The survey response rate was 90%. Correct responses averaged 87% for knowledge items, while agreement for impact items was 58%; preceptors reported a higher impact than residents (p = 0.006). Conclusion Mini-CEX implementation in an Otorhinolaryngology residency program was feasible and captured the expected progression by training year; however, it revealed insufficient feedback documentation and potential rating leniency. To enhance its educational impact, rater training, protected time for assessment, standardized feedback, and broader subspecialty sampling are recommended. Level of evidence IV.