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Introduction: The mini-CEX is a direct observation of care delivery that provides feedback to the medical resident; and previous studies have confirmed its validity, reliability, feasibility and user satisfaction. Its application in the paediatric emergency care setting is scarce., Objective: To assess trends in the acquisition of emergency care skills in paediatrics residents through the mini-CEX and determine the satisfaction of participants after its implementation., Material and Methods: Inclusion criteria: paediatrics residents in the first (MIR1) and second (MIR2) year of residency., Setting: emergency department., Study Period: 4 years (May 2019-May 2023). Evaluated competencies: anamnesis, physical examination, professionalism, clinical judgment, communication, organization-efficiency and global assessment. Number of evaluations: maximum of 6 per resident per year; each evaluation assessed 2-3 competencies (each competency could be evaluated twice per year). The evaluators were adjunct physicians in the emergency department; medical residents were assessed for training purposes. Satisfaction was rated on a scale from 1 to 9., Results: A total of 217 evaluations were performed on 54 residents (1-9 per resident). The median observation time was 16 min per visit (IQR, 14-25) and the feedback time was 10 min per visit (IQR, 7-15). The median anamnesis, physical examination, clinical judgment, organization-efficacy and global scores were 7 for MR1 and 8 for MRI2 residents (P = .015; P = .001, P = .076, P = .009 and P = .010, respectively). We did not find significant differences in the remaining competencies. The average satisfaction score was 9 for both evaluators and residents., Conclusions: The acquisition of skills was high; with favourable outcomes observed in MRI2 relative to MRI1. The implementation of the mini-CEX was well accepted among the involved professionals., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2024 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.)