Mini-CEX

Goals of the Mini-CEX

1. Learn the advanced neurologic exam by the end of the course and be able to demonstrate either the reflex or sensory exam benchmarks in a clinical setting.
2. Recognize that bioethical issues arise frequently in neurology; identify, observe and reflect on at least one clinical scenario.

Clinical & Bioethical Mini-CEX

Away students will need to ensure that you have completed both types of mini-CEX successfully by the end of the clerkship. Sending options for the clinical CEX card include:

• Take a picture of the card and email to ekraus@uw.edu
• Fax to Dr. Eric Kraus, 206-598-7698
• Mail to box 356169, 1959 NE Pacific St, Seattle, WA 98195-6169

The mini-CEXs in neurology will be of two types: Clinical and Bioethical

Clinical:

The first mini-CEX is an observed, focused clinical encounter followed by immediate feedback. The goal is to make students more proficient in two aspects of the exam that are often poorly done by the non-neurologist. It is not meant to be thorough in every aspect of the reflex and sensory exams, but rather an achievable benchmark for the student. Both exams will be taught, but the student is only required to perform one exam of their choice in the presence of their preceptor.

Performance of the clinical mini-CEX is best done at the midpoint (3rd week) of the rotation so that if remediation is necessary there will be time to complete it. Estimated time to complete a mini-CEX is 5-10 minutes followed by 5 minutes of feedback. The clinical opportunity for the mini-CEX is huge. In every inpatient or outpatient encounter with a student, the preceptor could ask the student to perform a portion of the exam. It is also the student’s responsibility to make sure the mini-CEX is accomplished. For example, “Dr. _______, at some point today can we complete the reflex/sensory mini-CEX?”

The forms below will be incorporated into the pocket syllabus.

• DTRs and Plantar Stimulation (51K PDF)*
• Sensory History and Exam (54K PDF)*

Videos demonstrating the mini-CEX should be viewed by both student and preceptor alike.

• Reflex Mini-CEX Demonstration Video (QuickTime)**
• Sensory Mini-CEX Demonstration Video (QuickTime)**

Click here to see Dr. Kraus perform a broader list of exam techniques:  Mental status, cranial nerves, motor, sensory, reflexes, cerebellar.

Bioethical:

The second mini-CEX focuses on a few of the many bioethical issues that arise in neurology. In contrast to the clinical mini-CEX, the bioethical mini-CEX is more passive. You are required to identify a bioethical problem during your 4 weeks and reflect on how it was dealt with. For instance, Dr. Jones told a 54 year-old male that he had ALS (breaking bad news). How did the preceptor handle the situation? Who was present? Was enough time set aside? Etc.

Remember that bioethical issues happen all the time. Look for them. Physicians may or may not be particularly skilled at resolving these issues. At times, it may seem like the encounter went poorly though everything was done right. Use these encounters to adopt what is done well and reject what is not. Negative role modeling can be as useful as positive.

Requirements:

1. CHOOSE TOPIC: Which bioethical discussion did you observe? 
   • Breaking Bad News
   • Do Not Resuscitate Orders
   • Termination of Life-Sustaining Treatment
2. READ: Read about the issue in the UW Ethics in Medicine website, work through the sample cases, and read the reserved article. Articles listed below are available on E-Reserves (UWNet ID required).
   Breaking Bad News
   • Ethics in Medicine issue: https://depts.washington.edu/bhdept/ethics-medicine/bioethics-topics/detail/55
   • E-Reserve article: Dias L, Chabner BA, Lynch TJ Jr, Penson RT. Breaking bad news: a patient’s perspective. Oncologist. 2003;8(6):587-96

   Do Not Resuscitate Orders

   • Ethics in Medicine Issue: http://depts.washington.edu/bhdept/node/148
   • E-Reserve article: Biegler P. Should patient consent be required to write a do not resuscitate order? J Med Ethics. 2003 Dec;29(6):359-63

   Termination of Life-Sustaining Treatment

   • Ethics in Medicine Issue: https://depts.washington.edu/bhdept/ethics-medicine/bioethics-topics/detail/81
   • E-Reserve article: Gillon R. Persistent vegetative state, withdrawal of artificial nutrition and hydration, and the patient’s “best interests”. J Med Ethics. 1998 Apr;24(2):75-6
3. WRITE-UP: Write-up your observed patient encounter by either:
   –Writing a reflection paper (1/2 to 1 page typed), or
   –Filling in the 4-box paradigm and a short paragraph explaining how the information was applied and outcome: http://depts.washington.edu/bioethx/tools/4boxes.html.
   Email your write-up to Dr. Kraus before the end of the course to ekraus@uw.edu.
   *Adobe Acrobat Reader is required for viewing or printing this file. Acrobat Reader is available free of charge from the Adobe website at http://www.adobe.com/prodindex/acrobat/readstep.html**Apple QuickTime is required for viewing this file. QuickTime is available free of charge from the Apple website at http://www.apple.com/quicktime/download/