Silvan (00:00)
Hi everyone and welcome to the Silvates podcast.

So the content today will be specific to a certain audience and it's geared towards clinic tutors at an osteopathic university. So some of this might not be relevant for everybody, but if you're interested, please sit down and enjoy. So I've got three people joining me. I've got Sarah Jane Marshall, I've got Phil Bright, and I've got Marianne Dangard Jensen joining me. So thank you all for making the time and doing this.

Dr Philip Bright (00:27)
Thanks

Hello, everyone.

Sarah-Jane (00:31)
Bye everyone.

Bye.

Marianne Damgaard Jensen (00:33)
Hello

everyone.

Silvan (00:35)
So we're going to be talking about mini clinical evaluation exercises. Now you're all the experts on this. So I want to sort of dive straight in and ask what a mini CEX is.

Dr Philip Bright (00:49)
Yeah, I'll come in on that one. mean, the Mini-CEX has been developed as kind of a structured workplace-based assessment. And it's kind of ideal for getting a snapshot of various aspects of clinical practice, whether it be history taking, physical examination, patient management. And it's kind of, I suppose, been derived out of the Viber process. So where individuals

that seem to be engaging in clinical practice in the actual setting as opposed to simulated setting. The beauty of these types of assessment is it captures a small snapshot of that. And from a student point of view, because it's not following that kind of extended pathway of your being seen with the patient literally from the point of picking them up in the reception all the way through from case-based history taking through to examination through to treatment and follow up.

It's just providing a small kind of snapshot within one of those scenarios. So from that point of view, you know, it could be argued to be more student friendly and but gives because you can capture over a broad breadth of those kind of interventions. It gives a nice opportunity to capture them at many intervals.

Sarah-Jane (02:09)
Yeah, and the beauty of them also is that they get immediate feedback as well. So they love that to help their learning as well.

Marianne Damgaard Jensen (02:17)
And then in the previous vivas, it used to be one examiner. So by having lots of little snapshots, the assessments actually have greater reliability by having different examiners involved.

Silvan (02:36)
Yeah, that's really interesting and I suppose I'm wondering what the primary purpose of it is.

Dr Philip Bright (02:44)
think following on from Maryanne's comment there, it's really to give the students the opportunity to get a direct feedback on their performance. And with the way the format of the CEX is structured, it's kind of a key indication from a scoring point of view how they have performed.

but also it gives an opportunity for more qualitative based feedback so that the assessor can actually write a quick line of what was done well, where there could be room for improvement and the areas that the student should perhaps take on board in relation to developing an action plan for areas of improvement that have been suggested to them.

Silvan (03:35)
Yeah, anything to add, Sarah Jane or Marianne?

Sarah-Jane (03:39)
Yes, it does do that and it's also with their final exams coming up which is very clinically based it gives them an opportunity to get a bit of adrenaline going under a little bit of pressure to just sort of get an idea of what the larger exam in June with the CCA is like as well.

Marianne Damgaard Jensen (03:57)
Yeah, so I think it's obviously got high kind of validity in that they're actually doing what they're going to be doing in clinical life, but also as Sarah-Jane says, they're preparing for what they're going to be doing in their final exam without taking on the whole thing in one big chunk.

Dr Philip Bright (04:14)
And I think as well because that validity comes from the point of view that the CEX has been established for use across a variety of disciplines. think what it provides for osteopaths, particularly student osteopaths, is that ability to understand how they rate against other clinicians in other areas. There's a very broad base to the use of the mini CEX from anesthetists, radiologists,

Chiro practors, interestingly enough. And the utility of it as well is that it's been developed and used in other countries. So for anybody who is intending to perhaps go and practice in New Zealand or Australia, it's widely used there. So a practitioner there who wanted to take on a graduate, if they saw the CEX scores, would be able to really place them in the right context, which I think gives a really broad use for it.

Silvan (05:10)
Yeah, that sounds really useful. I suppose I'm thinking about who would conduct the CES.

Dr Philip Bright (05:20)
think from a point of view of a general setting, it's normally the person closely aligned to managing the clinical intern if we were looking at it quite broadly. you know, from our osteopathic context, it would be the clinic tutor directly who have responsibility for that student during a set piece of time.

Marianne Damgaard Jensen (05:42)
Yeah, that's how they're done throughout the BCNO group and we aim to have actually over the assessments what we do is to have a wide variety of assessors so that they get as much input as possible.

Silvan (06:01)
Yeah, and are there any sort of key areas or sort of things that are being assessed?

Dr Philip Bright (06:08)
Yeah, I think from the point of view of the the CEX capturing that kind of patient practitioner intervention in the teaching clinics, first and foremost, you're kind of looking at history taking skills. Then we move into the physical examination process and how the communication skills link within that. That's obviously then kind of leading nicely into clinical judgment, because those processes prior to that set up the adoption of clinical judgment.

And then overriding that, you've kind of got professionalism issues which are being captured, which also then informs organization and efficiency within how the process is being conducted from the point of view of the assessor looking at that practitioner and how they've dealt with that particular patient and the scenario that's being captured at that point.

Marianne Damgaard Jensen (07:01)
Just to add to that, sort of head of clinical education, Sarah, Jane and I kind of ensure that all those areas have been covered for each student so that there's not a snapshot on the case history the whole time. But we kind of look at that and also that they are exposed to both returning patients and a new patient in these minutes.

Sarah-Jane (07:25)
Yeah, because

the beauty of it is that because it's a snapshot, you might not have to see all the competences in one. And by having the three or the six, we can make sure that that is seen across six. So so that they are seen in each competence, as Marianne says.

Silvan (07:41)
Yeah, because I can imagine not everything is going to be seen in the one session. And so how do you sort of account for that?

Marianne Damgaard Jensen (07:50)
So as you said, basically we keep an eye on it because we have all the scores for each student, all the forms. the students get, you should take a photo of it or have it emailed to them or whatever. But we also keep an eye and ensure that each student has all the areas assessed basically.

Silvan (08:18)
And how long would like a mini CEX last for? How long could they expect to be doing this for?

Marianne Damgaard Jensen (08:27)
So each min-CX is usually 10 to 20 minutes.

Sarah-Jane (08:33)
Yeah, and that might be that you might do a couple of minutes on one area, then you might pop out. So it might not all be at the same time. But it's trying to really just work with them as a colleague, really just popping in, see how they're doing so that it's not too stressful. But still, as I said before, think putting a little bit of emphasis on an assessment. So yeah.

10 to 20 minutes, Mary Ann says, maybe a little bit longer with the new patient than the returning patient, because the new patient session just lasts longer than the returning patient.

Silvan (09:05)
Yeah, and Phil, mentioned earlier, sort of, it gives the student an opportunity to get a bit more sort of qualitative feedback. What kind of sort of feedback would would they be getting in this kind of instance that they can then take away with them?

Dr Philip Bright (09:19)
I think in relation to conditions, so if a patient is presenting with a particular condition, then there's scope for the tutor and the patient themselves to ask questions around that. And how the student practitioner deals with that is a really good developmental process for them to go on in initial stages.

they may struggle to recall the information, they may get confused signals and as they progress through that process, what I think the CEX kind of gives the opportunity for is positive steps in the right direction, which is what the feedback will be built on in relation to that. And I think when you look at that in relation to the dynamic between the practitioner, the student, as it were, the patient,

and the tutor, they're all going to be kind of involved in that process. And I think, you know, being able to provide feedback around that, not only commenting on how the practitioner has dealt with the condition, but also how they've got the information correctly over to the patient to, you know, persuade them that the right direction is being managed, they're given confidence that they can proceed and recover.

And all those soft skills, that's I think where the key feedback can be provided through this process, which is more than just a tick in a box.

Sarah-Jane (10:50)
And they have criteria as well that we do look at to help enhance that feedback as well and that feedback criteria is linked to the osteopathic practice standards which they need to be assessed against to go and graduate so that we do have some standards as well to help with that feedback and it helps them again for that CCA exam because the criteria are the same for the CCA as well.

Marianne Damgaard Jensen (11:15)
Yeah, just to echo that, what Sarah-Jane said, so it doesn't, it's not all about knowledge, it's about anything within the osteopathic practice standards really, so it could be communication and consent, shared decision making, it could be how they handle their own posture, so the feedback could be in a wide variety of things, it could also be about, so, you

we're not particularly disease focused in how we handle conditions. So it's actually about how they can see that personal context for that patient, know, taking aboard their wishes as well as, you know, putting it into the context of their findings, examination findings when they put the plan together.

Dr Philip Bright (11:59)
And I think what's really good about that process as well is what the form offers is obviously feedback directly to the examiner. So it's a two-way process and there's very few assessment tools out there that actually allow for that dialogue to take place. And I'm not saying it's perfect, you know, because the rating, the relationship between the tutor and the student, you know, for various different reasons may be an issue, but...

Silvan (11:59)
Yes.

Dr Philip Bright (12:25)
what it still allows is for the student to go actually, you how did I feel during that assessment process? How satisfied was I with the process and the outcome? And I think that's really good at heading off issues around mismanagement and conduct within assessments because the student has got that direct feedback route to follow on.

Marianne Damgaard Jensen (12:51)
but maybe not quite clear for when we don't have a visual of the form here, but the qualitative feedback on the back has kind of errors that are done well, errors from improvement. And then the last book is like a reflective box for the student to fill in, both about the action plan, but also, as Phil said, kind of feedback on how they felt, time taken, things like this.

Silvan (13:17)
Yeah, and you've sort of alluded to some of the challenges in a way of doing these. I wonder if there are any other challenges that you can foresee or have encountered when you've done them.

Dr Philip Bright (13:29)
Yeah, I think one of the kind of common criticisms around it, certainly from the context of use in osteopathy, that I think concerns have always been raised about, how does it capture the kind of osteopathic element? And actually, if you look at it as a totality, the kind of the fact that it's being done within the setting,

is the osteopathic element. We are capturing what's going on in terms of the process and in terms of the thought behind the way that the person as a patient is being managed. So the osteopathy is implicit. It doesn't have to be kind of rubber stamped on it as this is osteopathic. Because if the students are embodying the concepts that people recognise as being osteopathic, then that will come out within the context of the assessment.

Sarah-Jane (14:24)
And also the assessor reliability is one area that you need to be aware of. And that's why by having, as Marianne spoke about earlier, up to six, they show that the reliability and validity is much better. And also with training. So we're hoping that this will help. then observation of peers, supervision, constant revisiting.

And that's something that we've done over a long period of time. And, you know, when people come into the role, we make sure that they're ready to start that assessment as well. But that's one area which students are always talking about, you know, somebody's going to mark me higher than somebody else. And actually, we had a few years ago with a student who was excellent at spreadsheets much better than myself. And he ended up by helping me with a spreadsheet. We inputted all the assessor marks and he said, OK, they are.

they are across the board, know, good range for all of them. the training is important.

Marianne Damgaard Jensen (15:21)
So, yeah,

agree. about, it's about examiners really understanding that, you know, it's been shown to be reliable by having, you know, numerous snapshots. And it also helps that, you know, you can have a bad day on one section and it's not the end of the world, you know, because it is this kind of lots of snapshots. So the main problems we've had is where tutors sort of want to be thorough to do it for longer.

Dr Philip Bright (15:36)
you

Marianne Damgaard Jensen (15:50)
But that's not really the point. The point is that it's snapshot and therefore it's not too stressful, as we said. And it's a very specific point where you can feed back to feed forwards because a small feedback can lead to a very specific actionable point that doesn't lead the student into overwhelm. They can actually tackle something there and then they get the feedback and they can action it straight away.

Silvan (16:14)
Yeah, and can imagine that sort of, talked about training the clinical tutors and I imagine that's to create the standard across everybody's sort of competence and knowing how to deliver it, I can imagine.

Sarah-Jane (16:27)
Yes.

Silvan (16:31)
I mean.

Dr Philip Bright (16:32)
There's enough formative opportunities as well. I think you kind of look at the formative process as being formative not only for the student but for the tutor as well and people are finding their feet. Particularly when you've got new students in year three and you may have a new tutor, there's that real opportunity to kind of find the happy medium which you wouldn't necessarily get if it was straight into summative approach.

Sarah-Jane (16:59)
Yeah, absolutely.

Silvan (17:00)
Yeah.

And I imagine that framework also gives them a bit of structure in a way.

Dr Philip Bright (17:07)
Yeah, I think that Sarah-Jane said, although the details of the form aren't specific to the OPS, the OPS are embodied within the elements of it. So I think in terms of meeting the needs of the regulator, that aspect is quite well covered.

Marianne Damgaard Jensen (17:26)
and we have marking criteria relating to this as well.

Silvan (17:30)
Yeah. And I'm wondering how, you know, talked about sort of giving students feedback. I'm wondering how sort of that feedback is delivered doing that sort of mini CEX.

Sarah-Jane (17:44)
Yeah, so the students, so once it's completed, the tutor will find a time that as soon after the assessment as possible to sit down with a student and go through areas. Ideally, how do you think it went? So that it's a dialogue between the two and then going through and then using examples for any feedback that they have asked the student to reflect on that and then devise their own action plans.

So it's an immediate feedback, the research which Phil I'm sure will be able to tell me the most recent research on immediate feedback, how valid that is for learning within assessment and for the learner. And yeah, that's how it's done. And then with the students, we can either input it and it goes into a centralised sheet, which as Marianne was saying, that gives us an opportunity to look at all the categories, what may have been covered in one assessment to make sure they're covered in another one. And we ask them to screenshot it as well so they've got an immediate

record of it for their own use as well. So they may have time to reflect after the exam, maybe an hour or even a day or a week later rather than immediate because things can change slightly after the immediate feedback I think.

Dr Philip Bright (18:55)
Yeah, it's an interesting point because I think, you know, even the satisfaction scores from the students and the assessors as to how well the assessment process has gone are reflexive in that, you know, it's literally an immediate response and scoring that they're providing. And, you know, one of the challenges within that is, you know, all well and good if you've done really well, but if you haven't done so well.

there's kind of a de-escalation needed within that process and sometimes I think, know, it's a case of, okay, here's the feedback, you've got a copy of it, you may not have enjoyed the assessment as much as the other ones where you got maybe, you know, a really good score but go away, reflect on it and then we can come back and talk about it after. But I think, you know, in some instances, some of that immediate feedback could be really, really highly warranted, you know, if we were seeing instances where there was particular

potential for unsafe practice, if there was a particular issue around patient handling that had to be managed, it's putting in a way the patient at the heart of that process so you can get that feedback to say this is what you need to avoid because it's not right for the patients, it doesn't fit the OPS and ultimately you you're directing that student to avoid potential issues when they're in practice on their own.

Silvan (20:21)
Yeah, and Marianne, you sort of talked about some of the marking criteria earlier. I wonder if you can talk a little bit about how it's scored, for example.

Marianne Damgaard Jensen (20:30)
Yeah,

so it can be scored with a Likert scale, but it can be scored in any kind of banding. And obviously ours has to be fitting in with the Plymouth banding scale for level six. So that's what we've mapped it out with. And then, you know, we've got the various areas that we look at. So case history taking, clinical reasoning, physical examination, working diagnosis, and then

prognosis and treatment and lastly consent and shared decision making. So we've got like six areas that we look at and so we make sure that all those six areas are covered by our assessments and then the criteria is based on the Plymouth scale for level six.

Dr Philip Bright (21:17)
Within that as well, if you look at the kind of wider utility of the Mini-CEX, there's been many ways adopted in terms of scoring the process, all the way from kind of extended scales that have gone from kind of one to nine on a performance rating to pass-fail, where one individual would perhaps assess in terms of if somebody is competent or not.

But it does depend on kind of requirements around the final degree classification and so that will have an impact on how those scales are contrived to certain extent. if anyone wants to come forward and go, so what, know, I've looked in the literature of this and I've seen that radiologists are just pass fail or the anesthetist has got this massive nine point scale and they all do really well on it. It's like, well, yeah, but part of that's because

that's based on the requirements for their profession and part of it's probably based on the requirements for the validator that's approving the degree and it's horses for courses so you have to appreciate why this has been set in such a way for use of osteopaths.

Silvan (22:31)
Yeah, and it sounds like you've really sort of taken the time to sort of take sort of a model and really apply it in its true sense to make it relevant.

Dr Philip Bright (22:40)
Yeah, mean, you look at, you know, in a way, osteopathy has been probably a little bit of a ground breaker in this area because I think we're looking at now heading into kind of 10 years plus of use of the CEX within the profession, both here and internationally. And there's very few opportunities where you can kind of celebrate that kind of level of involvement and

in a way cross pollination. So, you know, looking at that in terms of what it relates to in relation to practice in Australia and New Zealand and how we can kind of look at that as a context for our own practice in the UK. It'll be interesting to see how it's kind of extended into the European area as well. You know, perhaps from an international point of view, that could be something that the BCNO group could pick up and see how well that would translate over to our European partners.

Silvan (23:40)
And if you have someone who's sort of never conducted the CEX before, sort of where would they start? What would you recommend?

Dr Philip Bright (23:49)
From a research point of view, I would say have a look at the work of Brett Vaughan, who his PhD was all around clinical assessment and management within teaching clinics and osteopathy, but Australian based. But I think it would be useful for a start point because you get to see the differences between programs, between countries. So Australia run a five year program, believe it or not.

Here we are in the UK talking about condensing programs and they're really trying to get their money's worth out of the process. Probably if could get the students into six years, they'd be up to that as well. It's interesting because when you look at the results that Brett reported, you start to see how you spread more thinly in a way the outcomes from the CEX.

difference in terms of transition between the levels that we have between say year three and four when they're going year three, three, four, five and six as it were, there's a very long drawn out process within that. So, you know, maybe that does support a better argument for condensed programs, but we could spend another podcast on that one.

Sarah-Jane (25:07)
And I think Phil's right. I think understanding the concept of the assessment is really important. So directing them in it, it's really good. And then, you know, when you get the, once they've got the understanding is explaining where it fits into the program. And then it comes down to training and practice. And as Phil said earlier about the formative opportunities, you can go and do it anytime. And then quite often what we'll do with, with tutors is, get them to watch somebody do one. So we just have people watching them.

Marianne Damgaard Jensen (25:27)
Yeah.

Sarah-Jane (25:34)
and then they do it themselves. And it's good practice for the students because it doesn't go anywhere. It gives them feedback immediately, which they love because it's centred on them for a period of time as well. So there's plenty of opportunities. And then what we do is only when somebody feels comfortable, you know, and taking that on for a summative assessment. And then what we will do is myself and or Marianne may observe them in practice to make sure that they're comfortable with it. And so it's training on the job, really.

as well as making sure they've got the understanding of the background of what the CEX is trying to achieve.

Marianne Damgaard Jensen (26:09)
And I think as Sarah-Jane said before, I think it lends itself really well as an assessment to prepare them for the FCC because we've had a lot of trouble in the past at that level six prior to the FCC of trying to, so that's generally third year in the current model, of having assessment that really have high reliability. And I think this one here has the benefits of

higher reliability than most of the other assessments that institutions have been doing before at level six. And then also better feedback to feed forwards because there's lots of bits to it. So it's not just this one exam, it's lots of bits. So whilst one assessment doesn't cover everything, it covers something actionable. And I think in this time of tendency to overwhelm too much information, I think it fills a really good gap there.

to allow students to action something definite and feel that they can improve something quite particular. And as Phil said as well, also cap to something that might be potentially dangerous or save the student handling in a way that's going to damage them or whatever. So it has a lot of potential in that way.

Dr Philip Bright (27:24)
And also because it's freely kind of available and the processes and the forms underpin it are shared quite readily amongst the kind of learning resources. The students can assess each other with it. It's a case of if they were doing an observation, put yourselves in the role of an assessor and see how you would apply the criteria. And that I think is really useful in terms of not only kind of the simulated aspect of it.

but also the fact that they start to appreciate what assessors will be looking for. And you can't necessarily do that with an FCCA because of the length and the time of it and everything else. But something like this, which gives you that small snapshot opportunity is ideal.

Marianne Damgaard Jensen (28:12)
Yeah, we use that throughout the BCNO group with peer assessment and encourage that all the time. And I think, as you said, Phil, it's really helpful. think in days gone by, you know, they've had really the wrong idea about what we're trying to assess, you know, and they don't realise that the processes that we're looking for, they think we're sort of a world championship in finding the right diagnosis, which there's no such a thing, of course, osteopathy. There can be many truths, many, many truths, depending on which...

Silvan (28:12)
music.

Sarah-Jane (28:38)
another talk.

Marianne Damgaard Jensen (28:42)
which lens you look through.

Silvan (28:46)
Yeah, and as you said earlier, Sarah Jenny can be used as both a formative and a summative type of assessment. I'm wondering how often they can be used.

Sarah-Jane (28:56)
Well, as Maryanne was just saying, anytime they like. So we do like an official, if you like, formative so that they all at least understand what the process is like. And I think quite often with a lot of assessments, it is all about process and the understanding of it. And once they get an understanding of how it works, it's a bit less scary the next time and the next time and the next time. And as Maryanne says, if they can take those forms anytime, practice anytime they like, they can complete them online so that they can actually go onto the spreadsheet. We can give them a

copy of that they can take their own copy if they want to do it it's in written form as well so it's not in printed out form so yeah that anytime they like it's I to be honest I would say that they don't use it as much as they could use it but it is there as a tool anytime they like they can go and grab a form from reception area.

Dr Philip Bright (29:49)
There's even potential that you could use it as a patient feedback process as well. know, somewhere down the line, would be like, you know, with a patient after the process of their consultation and treatment, it would be like, okay, using this criteria, how would you rate that element of your treatment? So, the utility of it is pretty wide.

Sarah-Jane (30:11)
Yeah.

Silvan (30:12)
That sounds quite novel and quite interesting actually to be using it from a patient perspective. imagine that'd be quite interesting. I'm wondering if there are any best practices to implementing the Mini-CEX.

Dr Philip Bright (30:29)
lead on that one. think we've kind of looked at the elements around it, I think in some of our previous kind of responses, but part of this process is trying to get the evaluators engaged and thinking curiously, I think, about how best to apply the use of the examination tool. The beauty of it is that with these types of resources and with what's available on the Moodle

learning platform. There is guidance, there's structure, there's always an open dialogue between the students and the tutors and the tutors and the clinical staff. So I think that's really, really helpful. Probably, you know, for you guys, the biggest issue is probably scheduling. You might like more assessments, you might like less assessments, but overall, you know, you've always got to kind of a

appeal to the wider sensibilities of the university and the regulations around that. So you could be caught between a rock and a hard place where that's concerned.

Sarah-Jane (31:39)
Yeah, it's been challenging. ended up with a new programme, the year 3s, to get the reliability and we do three over a month period and to get all of those in with the students is quite full on quite busy and the admin staff have been absolutely amazing in the clinic reception areas to facilitate that. So it's almost come, I think the students...

again, it's become a bit more natural rather than so much pressure, you know, that they've got that opportunity. as Phil was saying, that if they have done not so great in one, they've got almost an immediate opportunity to pick themselves up again and reflect. So, yes, it is a challenge administratively, but seems to have gone well to be honest with the first lot gone through.

Marianne Damgaard Jensen (32:27)
Yeah.

Yeah, definitely the administrative challenge, but I think again, yeah, really big praise to the admin staff in London as well. yeah, I think we have slightly less trained examiners and we're getting a few help from Kent this time. so, yeah, because we ran slightly over by a week and a half to get them all in. Over the time, we sort of, you know, aim to get them in. But yeah, I think it's...

Sarah-Jane (32:36)
you

Marianne Damgaard Jensen (32:59)
It's an administrative, but I totally agree with Sarah Jane. think the students really normalised in terms of the pressure of having somebody assessing them, understood what it was about over the three and had this feeling of each time it was feeding forwards and each time they had another chance to demonstrate and they got more more understanding about it as we went along. And obviously we started as Sarah Jane said, with formatives as well.

Dr Philip Bright (33:25)
Yeah, I think when we looked at the kind of profile of grades over a couple of years as a research piece, this was a few years back, we did see a nice kind of linear increase from those initial kind formative developmental assessments through to their kind of final year assessment. you know, sometimes we just expect that and we kind of think, you know, well, that's what we hope to see. But it's nice to be able to have something that does

reinforce that evidence. And I think, you know, particularly from a student point of view, if you are able to see that progression in real terms, ultimately as well, I think what's good about is that, you know, there's good students who achieve the good grades, they still haven't necessarily started off with the top grade in the assessment, but they progress to it. But overall, you know, the grade profile is so good that it contributes to that kind of final good degree classification.

And even if there's a little dip in there, know, overall it's the consistency and the fact that we're able to provide these assessments on so many opportunities that gives the good students the opportunities to build that strong grade profile. So, you know, I think it's much better than that kind of, you know, one shot captures all. And if you miss that opportunity, you're kind of sunk. It's really helpful for the developmental side of things.

Silvan (34:46)
I think this has been a really interesting and valuable sort of opportunity to learn about what the Mini CEX is. Because I think even as staff members, sometimes we're not aware of sort of some of the developments and even the reasoning behind them. Sometimes it can be often, you know,

there's a new thing to have to implement and there can be some resistance. I'm really hoping this will provide some staff members and students as well as that into a bit of an insight about why we do this and what it really is.

Dr Philip Bright (35:19)
Yeah, that's great. Thank you, Sylvain. I think the other thing as well to just to mention with that is that, know, initial rounds when we went through the developmental side of this was done with kind of complete consultation when it was first brought in in Kent. So, you know, I think winning the hearts and minds and bringing people on board from the start of those types of changes is absolutely vital.

Sarah-Jane (35:41)
Yeah, I absolutely agree.

Marianne Damgaard Jensen (35:42)
Yeah,

I agree with that. So thank you very much and in helping with that process by providing this platform for informing everyone about the MiniCX.

Sarah-Jane (35:53)
Yes, thank you.

Dr Philip Bright (35:54)
Yeah, thanks, Sylvan.

Silvan (35:55)
Thanks, everyone.