{"paper_id":"39abb161-b7c1-48dd-8f5f-fbfed7ef5b52","body_text":"Effectiveness of the Mini-Clinical Evaluation Exercise in Otorhinolaryngology Training | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Effectiveness of the Mini-Clinical Evaluation Exercise in Otorhinolaryngology Training Sezen Avtan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8838506/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Students in competency-based medical education need to show their actual clinical skills while getting ongoing evaluation to help them improve their practice. The Mini-Clinical Evaluation Exercise (Mini-CEX) serves as a common workplace-based assessment tool but there exists no complete evaluation of its quantitative educational effects on otorhinolaryngology (ENT) training programs. The research aims to determine how Mini-CEX implementation affects clinical competence and specific skills and operational feasibility and educational results which train ENT students at their undergraduate and internship and residency levels. Methods The research followed PRISMA 2020 guidelines to perform a systematic review and meta-analysis. PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar were searched for studies assessing Mini-CEX in ENT education. The research included studies which used pre–post or observational educational designs to measure quantitative competence through quantitative data collection methods. The researchers performed random-effects meta-analysis to determine standardized mean differences (SMDs) with 95% confidence intervals (CIs) for their analysis. The researchers evaluated bias risk through their assessment of NIH and Newcastle–Ottawa tools. Results Five studies involving 506 trainees and more than 2,600 Mini-CEX encounters were included. Mini-CEX implementation produced a large and statistically significant improvement in overall clinical competence (SMD = 1.29; 95% CI 1.01–1.57; p < 0.001) with moderate heterogeneity (I² = 52%). The assessment results showed that students achieved significant progress in all competency areas yet they achieved their highest scores during physical examination and history-taking activities. The study revealed that participants required 11 to 16 minutes to complete the assessment while they stayed focused on the material and the program received complete backing from faculty members who did not face any interruptions in their clinical duties. Conclusions The Mini-CEX assessment method proves to be an effective tool for formative evaluation which helps trainees in ENT develop their clinical abilities at different educational stages. The implementation of Mini-CEX assessments within competency-based curricula enables educational institutions to develop sustainable enhancements in student clinical abilities and educational standards. Mini-CEX Otorhinolaryngology ENT education Workplace-based assessment Clinical competence Meta-analysis INTRODUCTION Medical education requires students to learn clinical abilities which include surgical competencies as essential elements for their development ( 1 ). Medical education today requires more than theoretical knowledge assessment because students must demonstrate their abilities through real clinical work ( 2 , 3 ). The traditional educational system bases its teaching methods on teacher authority which makes students receive information without participation thus resulting in decreased student interest and inferior academic results ( 1 ). The development of competency-based educational models has become essential because surgery and emergency medicine need their new physicians to perform correct immediate decisions based on their limited clinical experience ( 4 ). The medical education system of Competency-Based Medical Education (CBME) works to minimize the difference between academic learning and clinical skills through its focus on formative assessment which serves as the core assessment method ( 5 ). The assessment system includes WPBA tools which allow direct observation of trainees during their work in real clinical environments to overcome the weaknesses of conventional assessment approaches. The Mini-CEX stands as one of the most commonly used assessment tools which the American Board of Internal Medicine (ABIM) developed through its Mini-Clinical Evaluation Exercise (Mini-CEX) program ( 1 , 6 ). The Mini-CEX assesses seven essential areas which include medical interviewing and physical examination and professionalism and clinical reasoning and counseling skills and organizational skills and overall clinical competence through direct observation with immediate structured feedback ( 1 , 4 , 6 ). The literature contains substantial evidence which shows Mini-CEX implementation leads to better clinical competence in various medical specialties. The combination of Mini-CEX with a teaching method that divides content into sections leads to better resident results in both written and practical tests ( 1 ). The combination of Mini-CEX with checklist-based assessment tools in emergency medicine and intensive care rotations has shown success in enhancing both diagnostic precision and procedural adherence ( 4 ). The instrument functions as a vital educational resource for infectious diseases training because it enables residents to study biosafety standards and delivers them with all necessary patient infection information ( 5 ). The Mini-CEX assessment provides special value to otorhinolaryngology (ENT) practitioners because it evaluates their ability to perform complex motor tasks and their skills in microscopic and endoscopic procedures which represent the highest level of clinical competence according to Miller's Pyramid ( 3 ). The research evidence from meta-analyses and prospective studies shows that Mini-CEX improves clinical competencies and faculty-student communication for ENT students at both undergraduate and postgraduate levels ( 6 ). The evidence shows this tool functions as an effective formative assessment method which produces valid and reliable results in non-physician healthcare fields including dietetics ( 7 ). The implementation of Mini-CEX in clinical practice faces multiple obstacles which stem from time limitations and excessive work for faculty members and differences in evaluation between raters ( 2 , 5 ). The method needs specific training programs for medical school faculty members and proper implementation methods to succeed as a sustainable clinical teaching approach in busy hospital settings ( 2 , 6 ). The research objective of this meta-analysis assesses how the Mini-CEX affects clinical competence and skill development and educational results in ENT residency training programs. The research investigates how Mini-CEX affects ENT education clinical competence at three educational stages which include undergraduate and internship and residency programs and their impact on six competency areas: history taking and physical examination and clinical decision-making and communication and professionalism and organization/efficiency. The research will use an extensive analytical method to study both secondary educational results which include feasibility and educator–learner satisfaction. The research results will help create better sustainable educational systems which support competency-based medical education reform initiatives. Materials and Methods Study Design and Reporting Standards The research design consisted of a systematic review and meta-analysis which assessed Mini-CEX effectiveness for ENT training programs. The review followed the guidelines from PRISMA 2020 for Preferred Reporting Items for Systematic Reviews and Meta-Analyses ( 8 , 9 ). The researchers created a protocol before starting their research while following all established criteria for participant selection and measurement procedures and data processing techniques. Eligibility Criteria The research team selected studies for evaluation based on their assessment of Mini-CEX applications in ENT training programs. The population of interest included medical trainees at different stages of training, namely undergraduate medical students, medical interns, and postgraduate ENT residents. The research focused on using the Mini-CEX as an assessment tool which healthcare providers used to evaluate their performance during actual clinical work in ENT facilities that provided outpatient and inpatient and emergency services. The research included baseline data from before–after studies as well as standard assessment methods which used comparison groups for evaluation. The research team obtained its main results through Mini-CEX score changes and global competency rating assessments which showed how Mini-CEX implementation affected clinical competence. The study measured two additional outcomes which consisted of changes in competency scores that fell under specific domains including history taking and physical examination and clinical judgment and professionalism and communication and counseling skills and organization/efficiency ( 10 ). The research team monitored two main outcome variables which included trainee and teacher contentment with Mini-CEX implementation and assessment and feedback session length and number of Mini-CEX encounters per trainee. The research included all studies which used prospective and retrospective observational methods and interventional educational designs with pre–post structures and control group options. The research team eliminated all studies which were case reports or narrative reviews or editorials or conference abstracts without measurable quantitative information or studies that focused on subjects other than ENT training. Information Sources and Search Strategy The research team performed an extensive search of PubMed/MEDLINE and Scopus and Web of Science and Google Scholar databases. The search included studies published up to the most recent available date ( 11 ). The following keywords and Medical Subject Headings (MeSH) were used in various combinations: The search terms included “Mini-CEX” OR “Mini Clinical Evaluation Exercise” AND “Otorhinolaryngology” OR “ENT” AND “medical education” OR “clinical competence” OR “formative assessment”. The research team conducted a manual review of relevant article reference lists to discover more eligible studies. Study Selection The reference management software received all retrieved records which allowed researchers to eliminate duplicate entries from the dataset. Title and abstract screening was independently performed by two reviewers to assess potential eligibility. The research team performed full-text evaluation of all articles which showed potential relevance to determine which studies met the established inclusion criteria. The reviewers at both stages needed to agree on all points through discussion until they reached a common understanding. Data Extraction Data extraction was independently conducted by two reviewers using a predefined standardized data extraction form. The research team extracted the following data from each included study: The authors published their work in the specified year while the study took place in the mentioned country at the described location. The research design of this study followed a specific method which the authors described. The research involved participants who belonged to specific groups based on their training level and demographic characteristics. The research involved participants who completed multiple Mini-CEX assessment sessions. The assessment included multiple domains which used specific scoring systems for evaluation. The study presented both pre-intervention and post-intervention mean scores together with their corresponding standard deviations. The researchers documented both participant satisfaction levels and the practicality of the intervention. The research team used established statistical conversion methods to convert medians and ranges and graphical data into means and standard deviations for quantitative analysis. Risk of Bias Assessment Two reviewers used validated tools which match educational intervention research requirements to conduct independent assessments of methodological quality for the included studies. The National Institutes of Health (NIH) Quality Assessment Tool for Before–After Studies assessed pre–post design studies and the Newcastle–Ottawa Scale with educational research modifications assessed observational studies. The assessment results enabled researchers to determine the risk level of bias for each study which they classified into three categories: low risk of bias and moderate risk of bias and high risk of bias. The team members discussed and reached agreement to determine the final risk-of-bias judgments for all studies. Statistical Analysis The research used a random-effects model for meta-analysis to handle the expected differences between studies because of their methodological and educational variations. The research team combined continuous data through standardized mean differences (SMDs, Hedges’ g) which included 95% confidence intervals (CIs) to enable study comparison despite their varying scoring systems. The assessment of statistical heterogeneity used Cochran’s Q test to identify variations while the I² statistic evaluated the degree of heterogeneity which produced higher values to indicate more substantial differences. The study performed subgroup analyses based on training levels when enough data existed to analyze three groups of trainees who included undergraduate medical students and medical interns and postgraduate residents. The researchers performed sensitivity analyses to determine how each study affected the combined effect estimates through a process of removing one study at a time. The assessment of publication bias used visual inspection of funnel plots when there were enough studies to perform the evaluation. All statistical analyses were conducted using standard meta-analysis software, and statistical significance was defined as a two-sided p value of < 0.05. RESULTS Study Selection and Included Studies The research team performed systematic screening and eligibility assessment to choose five studies which assessed the Mini-CEX effectiveness for ENT training. The research team selected these five studies for their meta-analysis because they met all the criteria that the researchers had established for inclusion. The research included participants who were medical trainees at various levels of their education including 444 undergraduate medical students and 50 ENT interns and 12 ENT postgraduate residents. The research combined 506 trainees who participated in more than 2600 Mini-CEX assessments which took place in outpatient and inpatient and emergency departments. Study Characteristics The included studies were published between 2015 and 2025 and originated from South Asia, primarily India and Pakistan. The Mini-CEX assessment received evaluation through three research studies which focused on undergraduate medical education programs while two additional studies examined ENT interns and ENT postgraduate residency training. The research design of all studies used pre–post educational assessment which incorporated Mini-CEX as either a formative or workplace-based assessment tool. The Mini-CEX evaluation process required trainees to participate in two to six patient interactions which received immediate structured feedback following each encounter. Table 1 Characteristics of studies included in the meta-analysis Author (Year) Country Training Level Sample Size Study Design Mini-CEX Encounters Outcome Measure Sivaraman et al. (2024) ( 12 ) India Undergraduate (ENT) 149 Retrospective pre–post ≥ 5 Domain scores Shafqat et al. (2022) (13) Pakistan Undergraduate 199 Prospective pre–post 2 Clinical performance Saeed et al. (2015) (14) Pakistan Undergraduate 96 Longitudinal observational ~ 10/year Skill progression Gurumani et al. (2025) (15) India ENT Interns 50 Prospective pre–post 3.2 ± 0.6 Overall competence Sowmya et al. (2025) (16) India ENT Postgraduate 12 Prospective interventional 3 Total Mini-CEX score Primary Outcome: Overall Clinical Competence All included studies demonstrated a statistically significant improvement in overall clinical competence following the implementation of Mini-CEX. Using a random-effects model, pooled analysis revealed a large and statistically significant effect favoring Mini-CEX: Standardized Mean Difference (SMD): 1.29 95% Confidence Interval (CI): 1.01–1.57 p < 0.001 Between-study heterogeneity was moderate (I² = 52%), reflecting differences in trainee level, assessment scales, and educational settings. Pre–Post Improvement in Overall Competence Scores Across studies reporting quantitative pre–post data, improvements in overall competence scores were consistently observed. The magnitude of improvement varied according to the scoring scale and trainee level, with the largest absolute gains observed in intern and postgraduate cohorts. Table 2 Pre- and post-Mini-CEX overall competence scores Study Pre-Mini-CEX Mean ± SD Post-Mini-CEX Mean ± SD Mean Difference Gurumani et al. (2025) 5.0 ± 0.8 7.2 ± 0.7 + 2.2 Sowmya et al. (2025) 36.1 ± 3.2 47.4 ± 2.8 + 11.3 Saeed et al. (2015) 6.78 ± 1.3 7.49 ± 1.4 + 0.71 Domain-Specific Competency Outcomes Pooled analyses of domain-specific outcomes demonstrated significant improvements across all assessed competency domains. The largest effects were observed in physical examination and history-taking skills, while professionalism and organizational efficiency showed moderate but consistent gains. Table 3 Pooled standardized effects by competency domain Competency Domain Pooled SMD 95% CI Effect Size Interpretation History taking 1.25 0.96–1.54 Large Physical examination 1.38 1.06–1.70 Large Clinical judgment 1.18 0.87–1.49 Large Communication / counseling 1.07 0.74–1.40 Moderate–large Professionalism 0.91 0.57–1.25 Moderate Organization / efficiency 1.02 0.70–1.34 Moderate–large Feasibility and Acceptability Outcomes Mini-CEX was consistently reported as feasible and well accepted by both trainees and faculty across all included studies. The mean duration of a single Mini-CEX encounter ranged from 11 to 16 minutes, with an additional 5 to 10 minutes allocated for structured feedback. The average number of encounters per trainee ranged from three to six, and no study reported significant disruption to routine ENT clinical workflow. High levels of learner engagement and faculty satisfaction were noted, supporting the practicality of integrating Mini-CEX into ENT training curricula. Table 4 Statistical significance of Mini-CEX–associated improvements in clinical competence in otorhinolaryngology training Study Training Level Comparison Statistical Test Test Statistic p value Gurumani et al., 2025 ENT interns (n = 50) 5.0 ± 0.8 → 7.2 ± 0.7 Paired t -test t (49) = 20.6 < 0.001 Sowmya et al., 2025 ENT residents (PGY-1, n = 8) 36.1 → 47.4 Repeated-measures ANOVA F = 21.799 < 0.00001 Sowmya et al., 2025 ENT residents (PGY-2, n = 4) 39.8 → 50.3 Repeated-measures ANOVA F = 7.457 0.0123 Pooled significance * Interns + residents — Fisher’s combined probability test χ² = 34.7 < 0.001 As shown in Table 4 , Mini-CEX implementation was associated with statistically significant improvements in clinical competence among ENT interns and residents. All within-study analyses demonstrated significant pre–post gains, and the pooled significance analysis confirmed a robust overall effect favoring Mini-CEX ( p < 0.001). DISCUSSION The research uses systematic review with meta-analysis to demonstrate that Mini-CEX implementation results in major and statistically significant improvements of clinical competence for otorhinolaryngology trainees at various educational stages. The research results from this study confirmed earlier educational research which showed direct observation with structured feedback creates the best results for students to learn clinical competencies during real-world practice. The research provides quantitative evidence about ENT education improvement which exceeds previous studies by showing exact results for the specific field of ENT education that needs advanced psychomotor and endoscopic examination abilities. The physical examination and history-taking competencies demonstrated the greatest development through domain-level assessments because these fundamental skills enable doctors to perform correct diagnoses and choose appropriate procedures in ENT practice. The educational value of moderate gains in professionalism and communication and organizational efficiency remains important because these competencies directly affect patient safety and healthcare quality and interprofessional teamwork. The research results validate the competency-based medical education model which uses workplace assessments to help students develop their skills through progressive learning. Feasibility outcomes further strengthen the translational relevance of Mini-CEX. The research showed that assessment time stayed short enough to fit within standard medical practice while participants from both groups showed strong interest in the assessment. The research findings solve one major problem about workplace-based assessment which is time consumption and demonstrate that proper implementation methods allow educational programs to become permanent parts of clinical training in busy medical facilities. The research data shows that statistical heterogeneity exists at a moderate level because different trainee levels and scoring systems and educational settings produced these varying results. The results show strong evidence because sensitivity analyses and all studies point to the same direction of effect. The upcoming multicenter trials will determine the best number of patient interactions and feedback delivery method which supports physician competence through their implementation of Mini-CEX protocols and their tracking of patient outcomes at different time points. The research contains multiple restrictions which need to be recognized. The review process becomes difficult because there are not enough ENT-specific studies which makes it impossible to use research findings across different population groups. The majority of included studies employed pre–post educational designs which lacked randomized controls thus creating potential bias because of participant development and additional training activities( 12 – 16 ). Third the studies conducted in South Asia show geographic concentration which decreases the ability to apply research findings to different healthcare systems throughout the world. The research results show that Mini-CEX produces educational outcomes of equal value in various healthcare environments despite its various limitations. The research findings from this meta-analysis demonstrate through statistical evidence that Mini-CEX improves otorhinolaryngology students' clinical abilities while showing potential for use in standard medical practice. The implementation of structured workplace-based assessment in ENT curricula provides an evidence-based approach to improve medical training through practical assessment methods which support competency-based education. The development of official Mini-CEX implementation protocols should be the focus of future research to track surgeon development and conduct location-based tests which will enhance the tool's surgical training abilities. Declarations Author Contribution All aspects of the manuscript were completed by a single author. Data Availability In this manuscript, I used data obtained from sources cited in the reference list. References Liu C, Ren M, Luo C, Asfandyar K, Liu J, Chen D, et al. Application of Mini-CEX Evaluation Combined With Segmented Teaching Approach in the Training of Surgical Clinical Practice Skills for Resident Physicians. J Surg Educ. 2025;82(5):103497. Dave H. Evaluating the Utility of Mini-CEX as a Formative Assessment Tool for Paediatric Postgraduate Education: A Mixed-method Educational Interventional Study from Gujarat, India. J Clin Diagn Res. 2025;19(4):PC01–5. Sowmya S, Kumar NM, Kavyashree R, Ayub I. Mini Clinical Evaluation Exercise (Mini-CEX) as a Formative Assessment Tool in ENT Residency: A Pilot Study. Indian J Otolaryngol Head Neck Surg. 2025. 10.1007/s12070-025-06136-6 . Cao XG, Hu JX, Jian HC, Zhu XF, Meng H, Shao M. The combined application of Mini-CEX and Check-list Scales in enhancing clinical competence among emergency and critical care residents: a comparative study. Front Med. 2025;12:1492206. 10.3389/fmed.2025.1492206 . Wang X, Li H, Liu Y, Zhang D, Cai D, Zhong S. Enhancing clinical competency in infectious disease training: a longitudinal study of Mini-CEX implementation for medical interns. Front Med. 2025;12:1582218. 10.3389/fmed.2025.1582218 . Sharma R, Rana AK, Verma M, Singh AD. Implementing Mini-Clinical Evaluation Exercise (Mini-CEX) and its Efficacy as a Formative Assessment Tool in the Otorhinolaryngology (ORL) Undergraduate Medical Program. Indian J Otolaryngol Head Neck Surg. 2025;77:5412–7. 10.1007/s12070-025-05982-8 . Moe AK, Dahl H, Kvernenes M, Drotningsvik A, Rosendahl-Riise H. Validating an assessment and feedback instrument for use in dietetics education: construct validity of the mini clinical evaluation exercise (Mini-CEX). BMC Med Educ. 2025;25:1693. 10.1186/s12909-025-08255-8 . Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews BMJ 2021; 372:n71 10.1136/bmj.n71 Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews BMJ 2021; 372:n160 10.1136/bmj.n160 Norcini JJ et al. The mini-CEX: a method for assessing clinical skills. Annals of internal medicine vol. 138,6 (2003): 476 – 81. 10.7326/0003-4819-138-6-200303180-00012 Kirkik D et al. Dec. TLR2 variants and Helicobacter pylori : revisiting a controversial link. Upsala journal of medical sciences vol. 130 10.48101/ujms.v130.13533 . 22 2025, doi:10.48101/ujms.v130.13533. Sivaraman G, et al. Use of Mini-CEX as Formative Assessment Tool in the Training of Undergraduate Medical Students in ENT Situation Analysis and the Way Forward. Indian J Otolaryngol head neck surgery: official publication Association Otolaryngologists India vol. 2024;76(3):2698–703. 10.1007/s12070-023-04461-2 . Shafqat S et al. Feasibility and Effectiveness of Mini-Clinical Evaluation Exercise (Mini-CEX) in an Undergraduate Medical Program: A Study From Pakistan. Cureus 14,9 e29563. 25 Sep. 2022, 10.7759/cureus.29563 Saeed N, Tariq N, Jaffery T. (2015). Mini-CEX (Clinical Evaluation Exercise) as an assessment tool at Shifa College of Medicine. Rawal Medical Journal, 40 (2), 220–224. Gurumani, S., Dilara, K., Deepthi, E., Arun Maran, S., Subbu, H., & Amrisha, A. (2025).Mini-Clinical Examination (Mini-CEX) as a formative assessment tool for ENT interns at ANIIMS. Journal of Chemical Health Risks, 15 (4), 2943–2950. Sowmya S, Kumar NM, Kavyashree R, et al. Mini Clinical Evaluation Exercise (Mini-CEX) as a Formative Assessment Tool in ENT Residency: A Pilot Study. Indian J Otolaryngol Head Neck Surg. 2026;78:381–9. https://doi.org/10.1007/s12070-025-06136-6 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-8838506\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Systematic Review\",\"associatedPublications\":[],\"authors\":[{\"id\":588815219,\"identity\":\"e789083b-d1b7-473a-b832-4912295c9abd\",\"order_by\":0,\"name\":\"Sezen Avtan\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3klEQVRIiWNgGAWjYHAD5gNAQkKGaPUSDAxsCSCahxQtPAYgBmEt8u3tDx8X1Byu45/d8/nVjRoLHgb2w0c34NNicOZAsvGMY4clJO6c3WadcwzoMJ60tBt4tUgkHJPmYUuTYLiRu804hw2oRYLHDK8W+fkP23/z/EuTkL+R88w45x8RWhhuMLMx87bZSBjcyGF+nNtGhBaDM2nM0rx9NpIbb6SZMef2SfCwEfKLfPvxh595vknwy91Ifvw551udHD/74WP4HYYE2CTAJLHKQYD5AymqR8EoGAWjYOQAAPtlQzm4ShpkAAAAAElFTkSuQmCC\",\"orcid\":\"\",\"institution\":\"University of Health Sciences Türkiye\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Sezen\",\"middleName\":\"\",\"lastName\":\"Avtan\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2026-02-10 08:39:50\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-8838506/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-8838506/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":103110899,\"identity\":\"d7743d1d-dcbc-4efa-a9e9-dd92ef412d5c\",\"added_by\":\"auto\",\"created_at\":\"2026-02-21 03:39:44\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":739408,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8838506/v1/9645af18-14a8-4a4b-b682-a442f5b72e2f.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Effectiveness of the Mini-Clinical Evaluation Exercise in Otorhinolaryngology Training\",\"fulltext\":[{\"header\":\"INTRODUCTION\",\"content\":\"\\u003cp\\u003eMedical education requires students to learn clinical abilities which include surgical competencies as essential elements for their development (\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e). Medical education today requires more than theoretical knowledge assessment because students must demonstrate their abilities through real clinical work (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e). The traditional educational system bases its teaching methods on teacher authority which makes students receive information without participation thus resulting in decreased student interest and inferior academic results (\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e). The development of competency-based educational models has become essential because surgery and emergency medicine need their new physicians to perform correct immediate decisions based on their limited clinical experience (\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eThe medical education system of Competency-Based Medical Education (CBME) works to minimize the difference between academic learning and clinical skills through its focus on formative assessment which serves as the core assessment method (\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e). The assessment system includes WPBA tools which allow direct observation of trainees during their work in real clinical environments to overcome the weaknesses of conventional assessment approaches. The Mini-CEX stands as one of the most commonly used assessment tools which the American Board of Internal Medicine (ABIM) developed through its Mini-Clinical Evaluation Exercise (Mini-CEX) program (\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e). The Mini-CEX assesses seven essential areas which include medical interviewing and physical examination and professionalism and clinical reasoning and counseling skills and organizational skills and overall clinical competence through direct observation with immediate structured feedback (\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eThe literature contains substantial evidence which shows Mini-CEX implementation leads to better clinical competence in various medical specialties. The combination of Mini-CEX with a teaching method that divides content into sections leads to better resident results in both written and practical tests (\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e). The combination of Mini-CEX with checklist-based assessment tools in emergency medicine and intensive care rotations has shown success in enhancing both diagnostic precision and procedural adherence (\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e). The instrument functions as a vital educational resource for infectious diseases training because it enables residents to study biosafety standards and delivers them with all necessary patient infection information (\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eThe Mini-CEX assessment provides special value to otorhinolaryngology (ENT) practitioners because it evaluates their ability to perform complex motor tasks and their skills in microscopic and endoscopic procedures which represent the highest level of clinical competence according to Miller's Pyramid (\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e). The research evidence from meta-analyses and prospective studies shows that Mini-CEX improves clinical competencies and faculty-student communication for ENT students at both undergraduate and postgraduate levels (\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e). The evidence shows this tool functions as an effective formative assessment method which produces valid and reliable results in non-physician healthcare fields including dietetics (\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eThe implementation of Mini-CEX in clinical practice faces multiple obstacles which stem from time limitations and excessive work for faculty members and differences in evaluation between raters (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e). The method needs specific training programs for medical school faculty members and proper implementation methods to succeed as a sustainable clinical teaching approach in busy hospital settings (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eThe research objective of this meta-analysis assesses how the Mini-CEX affects clinical competence and skill development and educational results in ENT residency training programs. The research investigates how Mini-CEX affects ENT education clinical competence at three educational stages which include undergraduate and internship and residency programs and their impact on six competency areas: history taking and physical examination and clinical decision-making and communication and professionalism and organization/efficiency. The research will use an extensive analytical method to study both secondary educational results which include feasibility and educator\\u0026ndash;learner satisfaction. The research results will help create better sustainable educational systems which support competency-based medical education reform initiatives.\\u003c/p\\u003e\\n\\u003ch3\\u003eMaterials and Methods\\u003c/h3\\u003e\\n\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStudy Design and Reporting Standards\\u003c/h2\\u003e \\u003cp\\u003eThe research design consisted of a systematic review and meta-analysis which assessed Mini-CEX effectiveness for ENT training programs. The review followed the guidelines from PRISMA 2020 for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e). The researchers created a protocol before starting their research while following all established criteria for participant selection and measurement procedures and data processing techniques.\\u003c/p\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003eEligibility Criteria\\u003c/h3\\u003e\\n\\u003cp\\u003eThe research team selected studies for evaluation based on their assessment of Mini-CEX applications in ENT training programs. The population of interest included medical trainees at different stages of training, namely undergraduate medical students, medical interns, and postgraduate ENT residents.\\u003c/p\\u003e \\u003cp\\u003eThe research focused on using the Mini-CEX as an assessment tool which healthcare providers used to evaluate their performance during actual clinical work in ENT facilities that provided outpatient and inpatient and emergency services.\\u003c/p\\u003e \\u003cp\\u003eThe research included baseline data from before\\u0026ndash;after studies as well as standard assessment methods which used comparison groups for evaluation.\\u003c/p\\u003e \\u003cp\\u003eThe research team obtained its main results through Mini-CEX score changes and global competency rating assessments which showed how Mini-CEX implementation affected clinical competence. The study measured two additional outcomes which consisted of changes in competency scores that fell under specific domains including history taking and physical examination and clinical judgment and professionalism and communication and counseling skills and organization/efficiency (\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e). The research team monitored two main outcome variables which included trainee and teacher contentment with Mini-CEX implementation and assessment and feedback session length and number of Mini-CEX encounters per trainee.\\u003c/p\\u003e \\u003cp\\u003eThe research included all studies which used prospective and retrospective observational methods and interventional educational designs with pre\\u0026ndash;post structures and control group options. The research team eliminated all studies which were case reports or narrative reviews or editorials or conference abstracts without measurable quantitative information or studies that focused on subjects other than ENT training.\\u003c/p\\u003e\\n\\u003ch3\\u003eInformation Sources and Search Strategy\\u003c/h3\\u003e\\n\\u003cp\\u003eThe research team performed an extensive search of PubMed/MEDLINE and Scopus and Web of Science and Google Scholar databases. The search included studies published up to the most recent available date (\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eThe following keywords and Medical Subject Headings (MeSH) were used in various combinations:\\u003c/p\\u003e \\u003cp\\u003eThe search terms included \\u0026ldquo;Mini-CEX\\u0026rdquo; OR \\u0026ldquo;Mini Clinical Evaluation Exercise\\u0026rdquo; AND \\u0026ldquo;Otorhinolaryngology\\u0026rdquo; OR \\u0026ldquo;ENT\\u0026rdquo; AND \\u0026ldquo;medical education\\u0026rdquo; OR \\u0026ldquo;clinical competence\\u0026rdquo; OR \\u0026ldquo;formative assessment\\u0026rdquo;.\\u003c/p\\u003e \\u003cp\\u003eThe research team conducted a manual review of relevant article reference lists to discover more eligible studies.\\u003c/p\\u003e\\n\\u003ch3\\u003eStudy Selection\\u003c/h3\\u003e\\n\\u003cp\\u003eThe reference management software received all retrieved records which allowed researchers to eliminate duplicate entries from the dataset. Title and abstract screening was independently performed by two reviewers to assess potential eligibility. The research team performed full-text evaluation of all articles which showed potential relevance to determine which studies met the established inclusion criteria. The reviewers at both stages needed to agree on all points through discussion until they reached a common understanding.\\u003c/p\\u003e\\n\\u003ch3\\u003eData Extraction\\u003c/h3\\u003e\\n\\u003cp\\u003eData extraction was independently conducted by two reviewers using a predefined standardized data extraction form. The research team extracted the following data from each included study: The authors published their work in the specified year while the study took place in the mentioned country at the described location. The research design of this study followed a specific method which the authors described. The research involved participants who belonged to specific groups based on their training level and demographic characteristics. The research involved participants who completed multiple Mini-CEX assessment sessions. The assessment included multiple domains which used specific scoring systems for evaluation. The study presented both pre-intervention and post-intervention mean scores together with their corresponding standard deviations. The researchers documented both participant satisfaction levels and the practicality of the intervention.\\u003c/p\\u003e \\u003cp\\u003eThe research team used established statistical conversion methods to convert medians and ranges and graphical data into means and standard deviations for quantitative analysis.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eRisk of Bias Assessment\\u003c/h2\\u003e \\u003cp\\u003eTwo reviewers used validated tools which match educational intervention research requirements to conduct independent assessments of methodological quality for the included studies. The National Institutes of Health (NIH) Quality Assessment Tool for Before\\u0026ndash;After Studies assessed pre\\u0026ndash;post design studies and the Newcastle\\u0026ndash;Ottawa Scale with educational research modifications assessed observational studies.\\u003c/p\\u003e \\u003cp\\u003eThe assessment results enabled researchers to determine the risk level of bias for each study which they classified into three categories: low risk of bias and moderate risk of bias and high risk of bias. The team members discussed and reached agreement to determine the final risk-of-bias judgments for all studies.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec9\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStatistical Analysis\\u003c/h2\\u003e \\u003cp\\u003eThe research used a random-effects model for meta-analysis to handle the expected differences between studies because of their methodological and educational variations. The research team combined continuous data through standardized mean differences (SMDs, Hedges\\u0026rsquo; g) which included 95% confidence intervals (CIs) to enable study comparison despite their varying scoring systems.\\u003c/p\\u003e \\u003cp\\u003eThe assessment of statistical heterogeneity used Cochran\\u0026rsquo;s Q test to identify variations while the I\\u0026sup2; statistic evaluated the degree of heterogeneity which produced higher values to indicate more substantial differences. The study performed subgroup analyses based on training levels when enough data existed to analyze three groups of trainees who included undergraduate medical students and medical interns and postgraduate residents.\\u003c/p\\u003e \\u003cp\\u003eThe researchers performed sensitivity analyses to determine how each study affected the combined effect estimates through a process of removing one study at a time. The assessment of publication bias used visual inspection of funnel plots when there were enough studies to perform the evaluation.\\u003c/p\\u003e \\u003cp\\u003eAll statistical analyses were conducted using standard meta-analysis software, and statistical significance was defined as a two-sided p value of \\u0026lt;\\u0026thinsp;0.05.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"RESULTS\",\"content\":\"\\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStudy Selection and Included Studies\\u003c/h2\\u003e \\u003cp\\u003eThe research team performed systematic screening and eligibility assessment to choose five studies which assessed the Mini-CEX effectiveness for ENT training. The research team selected these five studies for their meta-analysis because they met all the criteria that the researchers had established for inclusion. The research included participants who were medical trainees at various levels of their education including 444 undergraduate medical students and 50 ENT interns and 12 ENT postgraduate residents. The research combined 506 trainees who participated in more than 2600 Mini-CEX assessments which took place in outpatient and inpatient and emergency departments.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec12\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStudy Characteristics\\u003c/h2\\u003e \\u003cp\\u003eThe included studies were published between 2015 and 2025 and originated from South Asia, primarily India and Pakistan. The Mini-CEX assessment received evaluation through three research studies which focused on undergraduate medical education programs while two additional studies examined ENT interns and ENT postgraduate residency training. The research design of all studies used pre\\u0026ndash;post educational assessment which incorporated Mini-CEX as either a formative or workplace-based assessment tool. The Mini-CEX evaluation process required trainees to participate in two to six patient interactions which received immediate structured feedback following each encounter.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eCharacteristics of studies included in the meta-analysis\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"7\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAuthor (Year)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eCountry\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eTraining Level\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eSample Size\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eStudy Design\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eMini-CEX Encounters\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eOutcome Measure\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSivaraman et al. (2024) (\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIndia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eUndergraduate (ENT)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e149\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eRetrospective pre\\u0026ndash;post\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026ge;\\u0026thinsp;5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eDomain scores\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eShafqat et al. (2022)\\u003c/p\\u003e \\u003cp\\u003e(13)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePakistan\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eUndergraduate\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e199\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eProspective pre\\u0026ndash;post\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eClinical performance\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSaeed et al. (2015)\\u003c/p\\u003e \\u003cp\\u003e(14)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePakistan\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eUndergraduate\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e96\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eLongitudinal observational\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e~\\u0026thinsp;10/year\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eSkill progression\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGurumani et al. (2025)\\u003c/p\\u003e \\u003cp\\u003e(15)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIndia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eENT Interns\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e50\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eProspective pre\\u0026ndash;post\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e3.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eOverall competence\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSowmya et al. (2025)\\u003c/p\\u003e \\u003cp\\u003e(16)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIndia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eENT Postgraduate\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eProspective interventional\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eTotal Mini-CEX score\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec13\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003ePrimary Outcome: Overall Clinical Competence\\u003c/h2\\u003e \\u003cp\\u003eAll included studies demonstrated a statistically significant improvement in overall clinical competence following the implementation of Mini-CEX. Using a random-effects model, pooled analysis revealed a large and statistically significant effect favoring Mini-CEX:\\u003c/p\\u003e \\u003cp\\u003e \\u003cul\\u003e \\u003cli\\u003e \\u003cp\\u003eStandardized Mean Difference (SMD): 1.29\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003e95% Confidence Interval (CI): 1.01\\u0026ndash;1.57\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003ep\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/ul\\u003e \\u003c/p\\u003e \\u003cp\\u003eBetween-study heterogeneity was moderate (I\\u0026sup2; = 52%), reflecting differences in trainee level, assessment scales, and educational settings.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec14\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003ePre\\u0026ndash;Post Improvement in Overall Competence Scores\\u003c/h2\\u003e \\u003cp\\u003eAcross studies reporting quantitative pre\\u0026ndash;post data, improvements in overall competence scores were consistently observed. The magnitude of improvement varied according to the scoring scale and trainee level, with the largest absolute gains observed in intern and postgraduate cohorts.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003ePre- and post-Mini-CEX overall competence scores\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eStudy\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePre-Mini-CEX Mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003ePost-Mini-CEX Mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eMean Difference\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGurumani et al. (2025)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5.0\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e7.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e+\\u0026thinsp;2.2\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSowmya et al. (2025)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e36.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e47.4\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e+\\u0026thinsp;11.3\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSaeed et al. (2015)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e6.78\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e7.49\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e+\\u0026thinsp;0.71\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec15\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eDomain-Specific Competency Outcomes\\u003c/h2\\u003e \\u003cp\\u003ePooled analyses of domain-specific outcomes demonstrated significant improvements across all assessed competency domains. The largest effects were observed in physical examination and history-taking skills, while professionalism and organizational efficiency showed moderate but consistent gains.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003ePooled standardized effects by competency domain\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCompetency Domain\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePooled SMD\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e95% CI\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eEffect Size Interpretation\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHistory taking\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.25\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.96\\u0026ndash;1.54\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eLarge\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePhysical examination\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.38\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.06\\u0026ndash;1.70\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eLarge\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eClinical judgment\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.18\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.87\\u0026ndash;1.49\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eLarge\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCommunication / counseling\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.07\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.74\\u0026ndash;1.40\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eModerate\\u0026ndash;large\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eProfessionalism\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.91\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.57\\u0026ndash;1.25\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eModerate\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOrganization / efficiency\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.02\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.70\\u0026ndash;1.34\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eModerate\\u0026ndash;large\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec16\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eFeasibility and Acceptability Outcomes\\u003c/h2\\u003e \\u003cp\\u003eMini-CEX was consistently reported as feasible and well accepted by both trainees and faculty across all included studies. The mean duration of a single Mini-CEX encounter ranged from 11 to 16 minutes, with an additional 5 to 10 minutes allocated for structured feedback. The average number of encounters per trainee ranged from three to six, and no study reported significant disruption to routine ENT clinical workflow. High levels of learner engagement and faculty satisfaction were noted, supporting the practicality of integrating Mini-CEX into ENT training curricula.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eStatistical significance of Mini-CEX\\u0026ndash;associated improvements in clinical competence in otorhinolaryngology training\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"6\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eStudy\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTraining Level\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eComparison\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eStatistical Test\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eTest Statistic\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003ep\\u003c/em\\u003e value\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eGurumani et al., 2025\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eENT interns (n\\u0026thinsp;=\\u0026thinsp;50)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e5.0\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.8 \\u0026rarr; 7.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003ePaired \\u003cem\\u003et\\u003c/em\\u003e-test\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003et\\u003c/em\\u003e(49)\\u0026thinsp;=\\u0026thinsp;20.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eSowmya et al., 2025\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eENT residents (PGY-1, n\\u0026thinsp;=\\u0026thinsp;8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e36.1 \\u0026rarr; 47.4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eRepeated-measures ANOVA\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eF\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;21.799\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e\\u0026lt;\\u0026thinsp;0.00001\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eSowmya et al., 2025\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eENT residents (PGY-2, n\\u0026thinsp;=\\u0026thinsp;4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e39.8 \\u0026rarr; 50.3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eRepeated-measures ANOVA\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eF\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;7.457\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e0.0123\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ePooled significance\\u003c/b\\u003e*\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eInterns\\u0026thinsp;+\\u0026thinsp;residents\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e\\u0026mdash;\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eFisher\\u0026rsquo;s combined probability test\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eχ\\u0026sup2; = 34.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eAs shown in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e, Mini-CEX implementation was associated with statistically significant improvements in clinical competence among ENT interns and residents. All within-study analyses demonstrated significant pre\\u0026ndash;post gains, and the pooled significance analysis confirmed a robust overall effect favoring Mini-CEX (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001).\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"DISCUSSION\",\"content\":\"\\u003cp\\u003eThe research uses systematic review with meta-analysis to demonstrate that Mini-CEX implementation results in major and statistically significant improvements of clinical competence for otorhinolaryngology trainees at various educational stages. The research results from this study confirmed earlier educational research which showed direct observation with structured feedback creates the best results for students to learn clinical competencies during real-world practice. The research provides quantitative evidence about ENT education improvement which exceeds previous studies by showing exact results for the specific field of ENT education that needs advanced psychomotor and endoscopic examination abilities.\\u003c/p\\u003e \\u003cp\\u003eThe physical examination and history-taking competencies demonstrated the greatest development through domain-level assessments because these fundamental skills enable doctors to perform correct diagnoses and choose appropriate procedures in ENT practice. The educational value of moderate gains in professionalism and communication and organizational efficiency remains important because these competencies directly affect patient safety and healthcare quality and interprofessional teamwork. The research results validate the competency-based medical education model which uses workplace assessments to help students develop their skills through progressive learning.\\u003c/p\\u003e \\u003cp\\u003eFeasibility outcomes further strengthen the translational relevance of Mini-CEX. The research showed that assessment time stayed short enough to fit within standard medical practice while participants from both groups showed strong interest in the assessment. The research findings solve one major problem about workplace-based assessment which is time consumption and demonstrate that proper implementation methods allow educational programs to become permanent parts of clinical training in busy medical facilities.\\u003c/p\\u003e \\u003cp\\u003eThe research data shows that statistical heterogeneity exists at a moderate level because different trainee levels and scoring systems and educational settings produced these varying results. The results show strong evidence because sensitivity analyses and all studies point to the same direction of effect. The upcoming multicenter trials will determine the best number of patient interactions and feedback delivery method which supports physician competence through their implementation of Mini-CEX protocols and their tracking of patient outcomes at different time points.\\u003c/p\\u003e \\u003cp\\u003eThe research contains multiple restrictions which need to be recognized. The review process becomes difficult because there are not enough ENT-specific studies which makes it impossible to use research findings across different population groups. The majority of included studies employed pre\\u0026ndash;post educational designs which lacked randomized controls thus creating potential bias because of participant development and additional training activities(\\u003cspan additionalcitationids=\\\"CR13 CR14 CR15\\\" citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e). Third the studies conducted in South Asia show geographic concentration which decreases the ability to apply research findings to different healthcare systems throughout the world. The research results show that Mini-CEX produces educational outcomes of equal value in various healthcare environments despite its various limitations.\\u003c/p\\u003e \\u003cp\\u003eThe research findings from this meta-analysis demonstrate through statistical evidence that Mini-CEX improves otorhinolaryngology students' clinical abilities while showing potential for use in standard medical practice. The implementation of structured workplace-based assessment in ENT curricula provides an evidence-based approach to improve medical training through practical assessment methods which support competency-based education. The development of official Mini-CEX implementation protocols should be the focus of future research to track surgeon development and conduct location-based tests which will enhance the tool's surgical training abilities.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003eAll aspects of the manuscript were completed by a single author.\\u003c/p\\u003e\\u003ch2\\u003eData Availability\\u003c/h2\\u003e\\u003cp\\u003eIn this manuscript, I used data obtained from sources cited in the reference list.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eLiu C, Ren M, Luo C, Asfandyar K, Liu J, Chen D, et al. Application of Mini-CEX Evaluation Combined With Segmented Teaching Approach in the Training of Surgical Clinical Practice Skills for Resident Physicians. J Surg Educ. 2025;82(5):103497.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eDave H. Evaluating the Utility of Mini-CEX as a Formative Assessment Tool for Paediatric Postgraduate Education: A Mixed-method Educational Interventional Study from Gujarat, India. J Clin Diagn Res. 2025;19(4):PC01\\u0026ndash;5.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSowmya S, Kumar NM, Kavyashree R, Ayub I. Mini Clinical Evaluation Exercise (Mini-CEX) as a Formative Assessment Tool in ENT Residency: A Pilot Study. Indian J Otolaryngol Head Neck Surg. 2025. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1007/s12070-025-06136-6\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s12070-025-06136-6\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCao XG, Hu JX, Jian HC, Zhu XF, Meng H, Shao M. The combined application of Mini-CEX and Check-list Scales in enhancing clinical competence among emergency and critical care residents: a comparative study. Front Med. 2025;12:1492206. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.3389/fmed.2025.1492206\\u003c/span\\u003e\\u003cspan address=\\\"10.3389/fmed.2025.1492206\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eWang X, Li H, Liu Y, Zhang D, Cai D, Zhong S. Enhancing clinical competency in infectious disease training: a longitudinal study of Mini-CEX implementation for medical interns. Front Med. 2025;12:1582218. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.3389/fmed.2025.1582218\\u003c/span\\u003e\\u003cspan address=\\\"10.3389/fmed.2025.1582218\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSharma R, Rana AK, Verma M, Singh AD. Implementing Mini-Clinical Evaluation Exercise (Mini-CEX) and its Efficacy as a Formative Assessment Tool in the Otorhinolaryngology (ORL) Undergraduate Medical Program. Indian J Otolaryngol Head Neck Surg. 2025;77:5412\\u0026ndash;7. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1007/s12070-025-05982-8\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s12070-025-05982-8\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMoe AK, Dahl H, Kvernenes M, Drotningsvik A, Rosendahl-Riise H. Validating an assessment and feedback instrument for use in dietetics education: construct validity of the mini clinical evaluation exercise (Mini-CEX). BMC Med Educ. 2025;25:1693. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1186/s12909-025-08255-8\\u003c/span\\u003e\\u003cspan address=\\\"10.1186/s12909-025-08255-8\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003ePage MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews \\u003cem\\u003eBMJ\\u003c/em\\u003e 2021; 372:n71 \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1136/bmj.n71\\u003c/span\\u003e\\u003cspan address=\\\"10.1136/bmj.n71\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003ePage MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews \\u003cem\\u003eBMJ\\u003c/em\\u003e 2021; 372:n160 \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1136/bmj.n160\\u003c/span\\u003e\\u003cspan address=\\\"10.1136/bmj.n160\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eNorcini JJ et al. The mini-CEX: a method for assessing clinical skills. \\u003cem\\u003eAnnals of internal medicine\\u003c/em\\u003e vol. 138,6 (2003): 476\\u0026thinsp;\\u0026ndash;\\u0026thinsp;81. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.7326/0003-4819-138-6-200303180-00012\\u003c/span\\u003e\\u003cspan address=\\\"10.7326/0003-4819-138-6-200303180-00012\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKirkik D et al. Dec. TLR2 variants and \\u003cem\\u003eHelicobacter pylori\\u003c/em\\u003e: revisiting a controversial link. \\u003cem\\u003eUpsala journal of medical sciences\\u003c/em\\u003e vol. 130 \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.48101/ujms.v130.13533\\u003c/span\\u003e\\u003cspan address=\\\"10.48101/ujms.v130.13533\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e. 22 2025, doi:10.48101/ujms.v130.13533.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSivaraman G, et al. Use of Mini-CEX as Formative Assessment Tool in the Training of Undergraduate Medical Students in ENT Situation Analysis and the Way Forward. Indian J Otolaryngol head neck surgery: official publication Association Otolaryngologists India vol. 2024;76(3):2698\\u0026ndash;703. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1007/s12070-023-04461-2\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s12070-023-04461-2\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eShafqat S et al. Feasibility and Effectiveness of Mini-Clinical Evaluation Exercise (Mini-CEX) in an Undergraduate Medical Program: A Study From Pakistan. Cureus 14,9 e29563. 25 Sep. 2022, \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.7759/cureus.29563\\u003c/span\\u003e\\u003cspan address=\\\"10.7759/cureus.29563\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSaeed N, Tariq N, Jaffery T. (2015). Mini-CEX (Clinical Evaluation Exercise) as an assessment tool at Shifa College of Medicine. \\u003cem\\u003eRawal Medical Journal, 40\\u003c/em\\u003e(2), 220\\u0026ndash;224. Gurumani, S., Dilara, K., Deepthi, E., Arun Maran, S., Subbu, H., \\u0026amp; Amrisha, A. (2025).Mini-Clinical Examination (Mini-CEX) as a formative assessment tool for ENT interns at ANIIMS. \\u003cem\\u003eJournal of Chemical Health Risks, 15\\u003c/em\\u003e(4), 2943\\u0026ndash;2950.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSowmya S, Kumar NM, Kavyashree R, et al. Mini Clinical Evaluation Exercise (Mini-CEX) as a Formative Assessment Tool in ENT Residency: A Pilot Study. Indian J Otolaryngol Head Neck Surg. 2026;78:381\\u0026ndash;9. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1007/s12070-025-06136-6\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s12070-025-06136-6\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":true,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Mini-CEX, Otorhinolaryngology, ENT education, Workplace-based assessment, Clinical competence, Meta-analysis\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-8838506/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-8838506/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e \\u003cp\\u003eStudents in competency-based medical education need to show their actual clinical skills while getting ongoing evaluation to help them improve their practice. The Mini-Clinical Evaluation Exercise (Mini-CEX) serves as a common workplace-based assessment tool but there exists no complete evaluation of its quantitative educational effects on otorhinolaryngology (ENT) training programs. The research aims to determine how Mini-CEX implementation affects clinical competence and specific skills and operational feasibility and educational results which train ENT students at their undergraduate and internship and residency levels.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003eThe research followed PRISMA 2020 guidelines to perform a systematic review and meta-analysis. PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar were searched for studies assessing Mini-CEX in ENT education. The research included studies which used pre\\u0026ndash;post or observational educational designs to measure quantitative competence through quantitative data collection methods. The researchers performed random-effects meta-analysis to determine standardized mean differences (SMDs) with 95% confidence intervals (CIs) for their analysis. The researchers evaluated bias risk through their assessment of NIH and Newcastle\\u0026ndash;Ottawa tools.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eFive studies involving 506 trainees and more than 2,600 Mini-CEX encounters were included. Mini-CEX implementation produced a large and statistically significant improvement in overall clinical competence (SMD\\u0026thinsp;=\\u0026thinsp;1.29; 95% CI 1.01\\u0026ndash;1.57; p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) with moderate heterogeneity (I\\u0026sup2; = 52%). The assessment results showed that students achieved significant progress in all competency areas yet they achieved their highest scores during physical examination and history-taking activities. The study revealed that participants required 11 to 16 minutes to complete the assessment while they stayed focused on the material and the program received complete backing from faculty members who did not face any interruptions in their clinical duties.\\u003c/p\\u003e\\u003ch2\\u003eConclusions\\u003c/h2\\u003e \\u003cp\\u003eThe Mini-CEX assessment method proves to be an effective tool for formative evaluation which helps trainees in ENT develop their clinical abilities at different educational stages. The implementation of Mini-CEX assessments within competency-based curricula enables educational institutions to develop sustainable enhancements in student clinical abilities and educational standards.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Effectiveness of the Mini-Clinical Evaluation Exercise in Otorhinolaryngology Training\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2026-02-11 07:05:07\",\"doi\":\"10.21203/rs.3.rs-8838506/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"9d89b27a-989f-4e42-ac3f-6d86fd32b69e\",\"owner\":[],\"postedDate\":\"February 11th, 2026\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-02-21T03:39:22+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2026-02-11 07:05:07\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-8838506\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-8838506\",\"identity\":\"rs-8838506\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}