The Mini-CEX in anaesthesia has strengths and weaknesses. Strengths include: its perceived very positive educational impact and its relative feasibility. Variable assessor stringency means that large numbers of assessors are required to produce reliable scores.

Supervisors' judgements on trainee independence with a case, based on the need for direct or more distant supervision, can generate reliable scores of trainee ability without the need for an onerous number of assessments, identify trainees performing below expectations, and track trainee progress towards independent specialist practice.

T he value of workplace-based assessments, such as the miniclinical evaluation exercise and clinicians' confidence and engagement in the process, has been limited by low reliability and capacity to identify underperforming trainees. It was proposed that changing the way supervisors make judgments about trainees would improve the reliability of the score and the identification of underperformers. Anesthetists regularly make decisions about the level of trainee independence with a case, based on how closely they require supervision. This was used as the basis for a new scoring system. Three hundred thirty-eight mini-clinical evaluation exercises, in which supervisors scored trainees using the conventional system and also scored trainee independence based on the need for direct and more distant supervision, were compared with the actual trainee independence score and the expected trainee independence score obtained externally. Compared with the conventional scoring system used in earlier studies, reliability was greatly improved using a system based on a trainee's level of independence with a case. Reliability further improved when this score was corrected for the difficulty of the case. Furthermore, the new scoring system overcame the previously identified problem of assessor leniency and identified a number of trainees performing below expectations. Judgments of supervisors on the trainee independence in a case, based on the need for direct or more distant supervision, can produce reliable scores of trainee ability without the need for an onerous number of assessments, identify trainees performing below expectations, and evaluate trainee progress toward independent specialist practice. COMMENTThese investigators from Australia and New Zealand evaluated a new scoring system for clinical assessment of trainees that combined traditional assessments with the addition of case difficulty and the level of supervision required. This new scoring method appears reliable and affords improved identification of poor performance.The authors readily acknowledge the limitations of their innovation. The extent to which the scoring system is generalizable to medical areas beyond anesthesia is questionable. The context for supervision and the manner in which supervisors arrive at judgments concerning their trainees may be dissimilar. Moreover, the extent to which well-defined, explicit criteria for case difficulty are available to enable creation of an external standard is uncertain. Comment by Kathryn E. McGoldrick, MD, FCAI(Hon) Disclosure: The author declares no conflict of interest.E ach year 200,000 to 400,000 patient deaths occur as a result of preventable medical errors. Communication failures are a major cause of these errors, and poor-quality handoffs are associated with adverse events. Transfers of care have been a focus of attention for national regulatory agencies. This study was undertaken to evaluate a simple checklist to improve communication during intraoperative transfer of patient care.The authors developed and int...