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Falls Clinical Evaluation Exercise (Mini-CEX)

According to the 2010 AGS/BGS clinical practice guidelinea multi-factorial fall risk assessment should be performed when a community-living older person reports 2 or more fall in the last year, difficulty with gait or balance or presents with an acute fall.

Evaluator: Date:

Trainee: ______circle: Fellow Resident Other: ______

Patient: Age: ______Gender: ______New: _____ Follow-up_____

Instructions for Completion:

Please rate each of the three skills areas (medical interviewing, physical examination, counseling) and the overall clinical competence using the 1-9 scale below. Use the check list shown for each skill to help you determine your overall numerical rating.

Unsatisfactory / Satisfactory / Superior
1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9

Medical Interviewing/Data Gathering

Score: _____

The trainee collected this information: (if not applicable, write N/A) / YES / NO
frequency of falls, circumstances of last fall (loss of consciousness, tripped/stumbled, lightheadedness, palpitations, unable to get up within 5 minutes, needed assistance to get up) and injuries from falls
mobility and use of assistive device
alcohol use
medications the patient is taking

Physical Examination

Score: _____

The trainee assessed...: (if not applicable, write N/A) / YES / NO
orthostatic vital signs
visual acuity (if not done within 3 months or no eye exam in the previous year)
cognition
heart rate and rhythm
quad strength (raise from chair without using arms)
gait
balance
rigidity, bradykinesia, tremor, sensory exam
proper fit of assistive device
feet and footware

Counseling

Score: _____

The trainee…: (if not applicable, write N/A) / YES / NO
discusseda plan for visual impairment, orthostatic hypotension, heart rate and rhythm impairment, foot &footware problems if present
discussed the need to minimize medications (esp. sedative hypnotics, anxiolytics, antidepressants, antipsychotics) as appropriate
discussed the importance of vitamin D supplementation
offered a structured or supervised exercise program (such as tai-chi or physical therapy) if the patients has problems with gait, balance, strength or endurance
providededucation and written information on falls
arranged for a home hazard evaluation and/or give a home safety checklist
assessed the patient/family’s understanding of the plan

Overall Clinical Competence in performing a multi-factorial fall assessment:

Overall Score: _____

Additional Comments:

  1. What did you observe the trainee doing well?
  1. What could the trainee do better?

Fall Mini-CEX Time:Observing min.Providing Feedback min.

Trainee satisfaction with Mini-CEX:

Unsatisfactory
One of the least useful teaching exercises / Satisfactory
About average for teaching exercises / Superior
Compares with best teaching exercises
1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9

Evaluator satisfaction with Mini-CEX:

Unsatisfactory
One of the least useful teaching exercises / Satisfactory
About average for teaching exercises / Superior
Compares with best teaching exercises
1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9
Evaluator Signature / Trainee Signature
Date: / Date:

References

  1. Chang JT, Ganz DA: Quality Indicators for Falls and Mobility Problems in Vulnerable Elders. J Am Geriatr Soc. 2007;55;S327-S334
  2. Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society. Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons.J Am Geriatr Soc. 2011;59(1):148-57.

Developed by Angela Gentili VCU/McGuireVAMC 2011