Factors influencing the educational impact of Mini-CEX and DOPS: A qualitative synthesis

Abstract

Introduction: The educational impact of Mini-CEX and DOPS varies greatly and can be influenced by several factors. However, there is no comprehensive analysis and synthesis of the described influencing factors.

Methods: To fill this gap, we chose a two-step approach. First, we performed a systematic literature review and selected articles describing influencing factors on the educational impact of Mini-CEX and DOPS. Second, we performed a qualitative synthesis of these factors.

Results: Twelve articles were included, which revealed a model consisting of four themes and nine subthemes as influencing factors. The theme context comprises “time for Mini-CEX/DOPS” and “usability of the tools”, and influences the users. The theme users comprises “supervisors’ knowledge about how to use Mini-CEX/DOPS”, “supervisors’ attitude to Mini-CEX/DOPS”, “trainees’ knowledge about Mini-CEX/DOPS”, and “trainees’ perception of Mini-CEX/DOPS”. These influence the implementation of Mini-CEX and DOPS, including “observation” and “feedback”. The theme implementation directly influences the theme outcome, which, in addition to the educational impact, encompasses “trainees’ appraisal of feedback”.

Conclusions: Our model of influencing factors might help to further improve the use of Mini-CEX and DOPS and serve as basis for future research.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Glossary

Workplace-Based Assessment (WPBA): Refers to the assessment of trainees’ performance in the workplace. Commonly used forms of WPBA are Mini-Clinical Evaluation Exercise (Mini-CEX), Direct Observation of Procedural Skills (DOPS), Case-based Discussion (CbD), and Multi-Source Feedback (MSF). WPBAs can be used in a summative or formative manner. The information gained within the assessments can be discussed separately or can be summarized in portfolios, making a trainee’s individual progress visible.

Norcini J, Burch V. 2007. Workplace-based assessment as an educational tool: AMEE Guide No. 31. Medical Teacher. 29:855–871.

Swanwick T, Chana N. 2013. Workplace-based assessment. Clinical teaching made easy: a practical guide to teaching and learning in clinical settings. 103–112.

Mini-Clinical Evaluation Exercise (Mini-CEX): Is a form of workplace-based assessment, which is commonly used in undergraduate and postgraduate medical education. It was developed by John Norcini and colleagues in 1995, by splitting the much longer CEX (clinical evaluation exercise) into many short events, the Mini-CEX. The Mini-CEX consists of two parts: first, a direct observation of a trainee performing in the workplace; and second, a feedback conversation, in which the observed performance is discussed and feedback for further improvement can be provided. Emphasizing the feedback conversation, Mini-CEX is being increasingly used in a formative manner, with the aim of shaping and supporting trainees’ learning.

Norcini JJ, Blank LL, Arnold GK, Kimball HR. 1995. The mini-CEX (clinical evaluation exercise): a preliminary investigation. Annals of Internal Medicine. 123:795–799.

Norcini J, Burch V. 2007. Workplace-based assessment as an educational tool: AMEE Guide No. 31. Medical Teacher. 29:855–871.

Qualitative Synthesis: Is a process that can be used to pool qualitative research data. Since it is regularly used within systematic reviews, it is also referred to as qualitative systematic review. There are different methodologies to perform a qualitative synthesis, ranging from an integrative to an interpretative approach. To integrate or summarize qualitative data, thematic analysis can be used. To interpret qualitative data in seeking to develop new concepts and theories, meta-ethnography or realist synthesis could be suitable.

Bearman M, Dawson P. 2013. Qualitative synthesis and systematic review in health professions education. Medical Education. 47:252–260.

Seers K. 2012. What is a qualitative synthesis? Evidence Based Nursing. 15:101–101.

Additional information

Notes on contributors

Andrea C. Lörwald

Andrea C. Lörwald is a PhD candidate at the Institute of Medical Education in Bern, Switzerland. Her research focuses on workplace-based assessment, feedback and learning in the workplace.

Felicitas-Maria Lahner

Felicitas-Maria Lahner, MSc, is a PhD candidate at the Institute of Medical Education in Bern, Switzerland. She has expertise in qualitative and quantitative methods. Her main interest is in medical education assessment.

Robert Greif

Robert Greif, MD, MME, FERC, is professor of Anesthesiology and director of the medical education programs at the Department of Anesthesiology and Pain Therapy, Bern University Hospital and University of Bern, Bern, Switzerland. His research focuses on airway management, resuscitation, simulation, and faculty development.

Christoph Berendonk

Christoph Berendonk, MD, MME, is deputy head of the Department of Assessment and Evaluation at the Institute of Medical Education in Bern, Switzerland. His research focuses on performance assessment in the simulated and the workplace setting.

John Norcini

John Norcini, PhD, is President and CEO, Foundation of Advancement of International Medical Education and Research, Philadelphia, USA. His principal academic interest is in the area of the assessment of physician performance.

Sören Huwendiek

Sören Huwendiek, MD, PhD, MME, is Head of the Department of Assessment and Evaluation at the Institute of Medical Education in Bern, Switzerland. He is a pediatrician. His research focuses on formative assessment (incl. Virtual Patients and workplace-based assessments), summative assessment, blended learning, problem-based learning, and medical educators.