Year 5 Mini Case Record (MCR)

Based on the American Board of Internal Medicine’s MiniCEX Framework

Student to retain the completed MCR form in their own records
THIS FORM SHOULD BE COMPLETED IN BLACK INK

Student’s Name: Student’s Number: _______________________

Rater’s Name: Position:

Site  Alfred  Angliss  Bairnsdale  Bendigo  Box Hill  Casey

 Caulfield  Dandenong  Epworth  Frankston  Johor Bahru  Kingston
 Maroondah  Mildura  MMC  Peter James  Sale  Sandringham
 Traralgon  Wantirna  Warragul  Wonthaggi  Other (please state)
Rotation:___________________________Module title:_________________________________

Patient details: Sex M/F __________________________ Age __________________

Instructions:
1. Each MCR should be of 15 – 20 minutes of observed patient interaction.
2. Students are to be rated on at least two of the four items.
3. MCR’s should ideally be completed by assessors who have completed an MCR ASSESSMENT WORKSHOP.
4. In the event that formal MCR training has not taken place, doctors who have completed specialist training or
registrars are eligible to conduct the MCR.
5. The assessor (NOT THE STUDENT) must select the patient to be assessed.
6. Students must be marked according to the stated criteria not by comparing to other year 5 students.
7. MCR forms can be downloaded from BLACKBOARD.
8. It is the responsibility of each student to bring the MCR rating form on the day of the assessment.
9. Each completed MCR form must be retained by the student in their own records.
10. Clear instructions about the nature of each MCR are provided in the Rotation Guides.

11. Student’s strengths and areas for improvement MUST be completed for each MCR.

MCR Items Unsatisfactory Borderline Satisfactory Excellent NA

1. Patient assessment – history and/or

1 2 3 4 5 6 7 8 
examination skills

2. Clinical reasoning – ability to discuss

patient assessment and/or an appropriate 1 2 3 4 5 6 7 8 
management plan with MCR examiner

3. Medical Interview: Information giving -

Ability to discuss patient assessment 1 2 3 4 5 6 7 8 
and/or management plan with the patient

4. Professional/Ethical behaviour 1 2 3 4 

Student’s strengths:

_______________________________________________________________________________________________
_______________________________________________________________________________________________
Area(s) for improvement:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________

Date ____/____/2010 Assessor’ Signature Student’s Signature

 Guide to MCR Ratings
(To view the full criteria, please visit the Year 5 Website at http://www.med.monash.edu.au/medical/year-five/ Click on MED5091/2 then Assessment (MCR)
MCR item 1–2 3–4
Unsatisfactory Borderline
Performs an assessment that has
frequent incomplete and
1. Patient
inaccurate elements; Assessment
Assessment Very inadequate, is conducted in an unstructured
falls short of the manner. Student is unsure and/or
(history and
required standard uncoordinated in examination
examination) techniques and demonstrates a
lack of sensitivity to patient’s
comfort and dignity.
Formulates some simple
diagnostic hypotheses but
neglects important data; Unable
2. Clinical Very inadequate,
to accurately estimate severity of
falls short of the
Reasoning illness; Superficial discussion of
required standard
relevant investigative tests;
Management plans are poorly
developed.
Provides some inaccurate
information that is not always
3. Medical
presented in a logical order;
Interview – Very inadequate, Information of the management
falls short of the plan is mostly unclear and not
Information
required standard easily understood by the patient;
giving Does not always check the
patient’s understanding of the
information.
Occasionally lacks discretion and
neglects patients needs of
confidentiality, comfort and
4. Professional Very inadequate,
respect; At times behaves
unprofessionally in front of or in
/ Ethical falls short of the
the hearing of patients and/or
required standard
Behaviour relatives; Allows own views to
impact on the consultation; Not
able to fully grasp the ethical
issues quickly.
5 6
Pass
Mostly demonstrates a
coherent, accurate and
structured approach to
assessment in which most of
the important elements are
covered; Examination
techniques are reasonably
coordinated; Is aware of the
need to demonstrate sensitivity
to patient’s comfort and dignity
Formulates a list of common
simple diagnostic hypotheses.
Synthesises important data and
can estimate severity of illness.
Can determine and justify
appropriate investigative tests.
Able to develop a suitable
management plans.
Gives mostly accurate
information in a logical order;
Instructs the patient on the main
aspects of the management
plan and presents information
that enables patient
understanding; Emphasises
important points and attempts
to check patients
understanding.
Demonstrates discretion and
pays attention to patient’s
needs of confidentiality,
comfort, and respect;
Demonstrates a safe grasp of
ethical issues, Student is non-
judgemental and has some
insight into own clinical ability.
7–8
Satisfactory Excellent
A coherent, comprehensive,
accurate and structured approach to
Exceeds the assessment; Examination
required techniques are well coordinated.
standard but Assessment is appropriate to the
there is clinical problem, facilitates patient’s
room for telling of the story, effectively uses
improvement appropriate questions, and is
sensitive to patient’s comfort and
dignity.
Formulates a complete list of
all/almost all diagnostic hypotheses;
Exceeds the Identifies all of important patient
required problems and estimates severity of
standard but illness; Able to discuss and justify
there is investigative tests cognisant of
room for differential diagnosis and individual
improvement patient factors; Able to develop well
formulated management plans and
consider risks: benefits.
Gives accurate information in a
logical order; Explores patients
perspective; Clearly instructs the
Exceeds the patient about the management
required plan/therapy; Uses jargon free,
standard but open, honest and explicit language
there is and terms that are easily
room for understood; Checks the patient’s
improvement understanding of the information and
if the patient has any questions or
concerns; Uses active listening
during the patient encounter.
Student shows respect, compassion,
empathy and is always discrete; Is
Exceeds the fully aware of patients needs for
required confidentiality, comfort and respect.
standard but Behaves in an ethical manner and
there is has a well developed understanding
room for of ethical issues; Student is non-
improvement judgemental, is aware of limitations
and uses a professional approach at
all times.