Development of a Geriatric Nursing-Specific Mini-CEX and Evaluation of the Professional Competence of Nursing Students: A Novel Approach to Clinical Evaluation in Implementing Case Study


Case study
Geriatric competencies
Mini-CEX, Nursing students
Professional competence

How to Cite

Mohajer, S., Tang , L. Y., Chong , M. C. ., Danaee, M. ., Mazlum, S. R. ., & Bagheri , N. (2022). Development of a Geriatric Nursing-Specific Mini-CEX and Evaluation of the Professional Competence of Nursing Students: A Novel Approach to Clinical Evaluation in Implementing Case Study. Iranian Red Crescent Medical Journal, 24(5).


Background: Geriatric nursing is professional holistic care that requires special attention and the development of professional competence. No valid and reliable tool exists to evaluate professional geriatric competencies (PGC) of nursing students in professional practice which remains a debatable issue in nursing education. Therefore, the present study was conducted to fill data scarcity.

Objectives: The present study aimed to develop a Geriatric Nursing-Specific Mini-CEX (GN-Specific Mini-CEX) tool to evaluate the professional geriatric competencies of internship nursing students.

Methods: The present study is descriptive observational quantitative with a cross-sectional design. The Geriatric Nursing-Specific Mini-CEX tool was developed in seven skill domains and 40 items based on the core competencies of geriatric nursing, published literature, and expert opinions. Delphi method was applied to evaluate the face and content validity, and reliability was determined using Cronbach's alpha test through a pilot test. The modified tool was scored between 1 to 9 in each item of skill domains with a total score of 40 to 360. Higher scores indicate a higher professional geriatric competence for nursing students. Then, 160 internship undergraduate nursing students were selected by convenience sampling from Mashhad University of Medical Sciences (MUMS) as one of the major medical sciences universities of Iran ,in January 2020. One-day workshop of evaluators was held in two sessions and the professional geriatric competencies of students were evaluated by implementing case studies. The results were analyzed with inter-rater reliability and descriptive statistics.

Results: ICC values for seven components of geriatric nursing-specific Mini-CEX ranged from 0.639 to 0.919, indicating an acceptable level of reliability for this scale. The mean score of overall geriatric competence was (M= 6.12, SD=.33), which indicated that the geriatric competencies of students enrolled in the study were at a satisfactory moderate level. The highest and the lowest mean scores were observed in history taking /communication (M= 6.71, SD=.71) and physical examination skills (M= 4.99, SD=.67), respectively.

Conclusion: The results of this study indicate the feasibility of using new developed geriatric nursing-specific Mini-CEX tool to evaluate the professional geriatric competencies of nursing students through implementing case studies in professional clinical settings. The data obtained from the present study could be useful for nursing education to evaluate and redesign a curriculum for integrative core geriatric competencies as a process of quality improvement.


Canadian Gerontological Nursing Association. Gerontological nursing competencies and standards of practice 2010. Compétences de base normes de pratique pour infirmières et infirmiers en gérontologie Vancouver: CGNA, Canadian Gerontological Nursing Association. 2010.

Eskandari N, Golaghaie F, Aghabarary M, Dinmohammadi M, Koohestani H, Didehdar M, et al. Explaining the relationship between moral intelligence and professional self-concept with the competence of nursing students in providing spiritual care to promote nursing education. J Educ

Health Promot. 2019;8:230. doi: 10.4103/jehp.jehp_105_19. [PubMed: 31867394].

Mohajer S, Tang LY, Chong MC, Danaee M, Mazlum SR, Bagheri N. Evaluation of Professional Self-Concepts And its Relationship Factors: A study Among Nursing Students in Mashhad univercity of medical sciences, Iran. Iran. Red Crescent Med J. 2021;23(12):e1638. doi: 10.32592/ircmj.2021.23.12.1638.

Wei CJ, Lu TH, Chien SC, Huang WT, Liu YP, Chan CY, et al. The development and use of a pharmacist-specific Mini-CEX for postgraduate year trainees in Taiwan. BMC Med Educ. 2019;19(1):165. doi: 10.1186/s12909-019-1602-2. [PubMed: 31118004].

Fukada M. Nursing competence: Definition, structure and development. Yonago Acta Medica. 2018;61(1):1-7. doi: 10.33160/yam.2018.03.001. [PubMed: 29599616].

Liu YP, Jensen D, Chan CY, Wei CJ, Chang Y, Wu CH, et al. Development of a nursing-specific Mini-CEX and evaluation of the core competencies of new nurses in postgraduate year training programs in Taiwan. Comparative Study. 2019;19(1):270. doi: 10.1186/s12909-019-1705-9. [PubMed: 31319845].

Namazi Nia M, Mohajer S, Ghahramanzadeh M, Mazlom R. Effect of laughter yoga on mental well-being of Cancer patients undergoing chemotherapy. Evid Based Care J. 2019;9(3):7-14. doi: 10.22038/EBCJ.2019.39928.2050.

Ghasemi A, Karimi Moonaghi H, Mohajer S, Mazlom R, Shoeibi N. Effect of self-management educational program

on vision-related quality of life among elderly with visual impairment. Evid Based Care J. 2018;8(1):35-44. doi: 10.22038/EBCJ.2018.28999.1717.

Bagheri S, Valizadeh Zare N, Mazlom R, Mohajer S, Soltani M. Effect of Implementing Family-Centered Empowerment Model on Burden of Care in Caregivers of the Elderly with Parkinson's Disease. Evid Based Care J. 2019;9(3):41-8. doi: 10.22038/EBCJ.2019.14043.

Nojabaee A, Salehmoghaddam AR, Mazlom R, Asgharipour N, Mohajer S. Effect of flourishing promotion program on social health in the elderly. Evid Based Care J. 2018;8(2):39-48. doi: 10.22038/EBCJ.2018.30277.1749.

Bahrami M, Purfarzad Z, Keshvari M, Rafiei M. The components

of nursing competence in caring for older people in Iranian hospitals: A qualitative study. Iran J Nurs Midwifery

Res. 2019;24(2):124–30. doi: 10.4103/ijnmr.IJNMR_83_18. [PubMed: 30820224].

Wu S, Jackson N, Larson S, Ward KT. Teaching geriatrics and transitions of care to internal medicine resident physicians. Geriatrics. 2020;5(4):72. doi: 10.3390/geriatrics5040072. [PubMed: 33050060].

Yazdanpanah Y, Saleh Moghadam AR, Mazlom R, Haji Ali Beigloo R, Mohajer S. Effect of an educational program based on health belief model on medication adherence in elderly patients with hypertension. Evid Based Care J. 2019;9(1):52-62. doi: 10.22038/EBCJ.2019.35215.1895.

Kajander-Unkuri S, Meretoja R, Katajisto J, Saarikoski M, Salminen L, Suhonen R, et al. Self-assessed level

of competence of graduating nursing students and factors related to it. Nurse Edu Today. 2014;34(5):795-801. doi: 10.1016/j.nedt.2013.08.009. [PubMed: 24018358].

Nursalam N, Sukartini T, Hidayah DA. Competence Development for Managing Patient with Mechanical Ventilators based on Caring. Int J Psychosoc. 2020;24(7):4113-4128. doi: 10.37200/IJPR/V24I7/PR270408.

Norris M, Gimber P. Developing nursing students' metacognitive skills using social technology. Teach Learn Nurs. 2013;8(1):17-21. doi: 10.1016/j.teln.2012.09.003.

Sahebalzamani M, Farahani H, Pouryani A. Assessing the Reliability and Validity of the Mini-Clinical Evaluation Exercise (Mini-CEX) for Nursing Student. J Appl Environ Biol Sci. 2013;3(9):78-82.

Bing‐Jonsson PC, Bjørk IT, Hofoss D, Kirkevold M, Foss CJIjoopn. Competence in advanced older people nursing: development of nursing older people–competence evaluation tool. Int J Older People Nurs. 2015;10(1):59-72. doi: 10.1111/opn.12057. [PubMed: 24863394].

Schneider J, O’Hara K, Munro I. Using continuing professional development with portfolio in a pharmaceutics course. Pharmacy. 2016;4(4):36. doi: 10.3390/pharmacy4040036. [PubMed: 28970409].

Norcini JJ, Blank LL, Duffy FD, Fortna GS. The mini-CEX: a method for assessing clinical skills. Ann Intern Med. 2003;138(6):476-81. doi: 10.7326/0003-4819-138-6-200303180-00012. [PubMed: 12639081].

Djuria SA, Afandi M. Development of measurement tool mini-CEX (mini clinical evaluation exercise) as an evaluation tool of nursing students in teaching hospital of Universitas Muhammadiyah Yogyakarta. JNHC. 2013;1(1):127-33.

Bahreini M, Ahmadi F, Shahamat S, Behzadi S. The Impact of Professional Portfolio on Nurses' Clinical Competence. SDME. 2011;8(2):107-14.

Meresh E, Daniels D, Sharma A, Rao M, Mehta K, Schilling D. Review of mini-clinical evaluation exercise (mini-CEX) in a psychiatry clerkship. Adv Med Educ Pract. 2018;9:279-283. doi: 10.2147/AMEP.S160997. [PubMed: 29750064].

Farshi MR, Vahidi M, Jabraeili M. Relationship between emotional intelligence and clinical competencies of nursing students in Tabriz Nursing and Midwifery School. Res Dev Med Educ. 2014;4(1):91-5. doi: 10.15171/rdme.2015.015.

Himmah Z, Wong LP, Chong MC, Al Raimi AM, Al Ajeel LY, Mohajer S. Quality of Communication Between Cancer Patients And Doctors. Iran Red Crescent Med J. 2021;23(12):e1452. doi: 10.32592/ircmj.2021.23.12.1452.

Charokar K, Kapoor A. Introduction of Mini-clinical Evaluation Exercise for the Formative Assessment of Postgraduates in the General Surgery Discipline. J clin diagn res. 2020;14(9):1-5. doi: 10.7860/JCDR/2020/45606.13976.

Wong LP, Alias H, Danaee M, Ziaee M, Abedi F, Ziaee A, et al. Uncovering psychobehavioural implications of SARS‐CoV‐2 infection in Iran. Transbound Emerg Dis. 2020;67(6):2892-900. doi: 10.1111/tbed.13662. [PubMed: 32512635].