Influences on the implementation of Mini-CEX and DOPS for postgraduate medical trainees’ learning: A grounded theory study

Abstract

Introduction: In order for Mini-Clinical Evaluation Exercise (Mini-CEX) and Direct Observation of Procedural Skills (DOPS) to actually have a positive effect on trainees’ learning, the way in which the tools are implemented is of key importance. However, there are many factors influencing their implementation. In this study, we aim to develop a comprehensive model of such factors.

Methods: Using a constructivist grounded theory approach, we performed eight focus groups. Participants were postgraduate trainees and supervisors from three different specialties; all were experienced with Mini-CEX and/or DOPS. Data were analyzed for recurring themes, underlying concepts and their interactions using constant comparison.

Results: We developed a model demonstrating how the implementation of Mini-CEX and DOPS for trainees’ learning is influenced by 13 factors relating to four categories: organizational culture (e.g. value of teaching and feedback), work structure (e.g. time for Mini-CEX and DOPS, faculty development), instruments (e.g. content of assessment), and users (e.g. relationship between trainees and supervisors), and their interaction.

Conclusions: We developed a complex model of influencing factors relating to four categories. Consideration of this model might support successful implementation and trainees’ learning with Mini-CEX and DOPS.

Acknowledgments

The authors thank the focus group participants for sharing their experiences and thoughts, Sabine Nabecker for her support in organizing the focus groups within the Department of Anaesthesiology and Pain Therapy, Lorelei Lingard and Christoph Berendonk for their valuable input on an earlier version of this manuscript, and Sarah Mannion de Hernandez for correcting the English manuscript.

Disclosure statement

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

Glossary

Constructivist Grounded Theory: Is a methodology that can be used for exploratory research, especially to explore social processes. Performing a grounded theory study is an iterative process, including theoretical sampling, data collection, and analysis. Using a constructivist approach means that both data gathering and data analysis are seen as created from shared experiences and relationships with participants. Researcher reflexivity is thus important. Using a constructivist approach also implies that the whole process, from developing the research question to analyzing the data, is informed by existing literature.

Watling CJ, Lingard L. 2012. Grounded theory in medical education research: AMEE Guide No. 70. Med Teach. 34:850–861.

Charmaz K. 2006. Constructing grounded theory: a practical guide through qualitative analysis. Thousand Oaks (CA): Sage.

Additional information

Notes on contributors

Andrea C. Lörwald

Andrea Carolin Lörwald, PhD, is a research associate 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

Bettina Mooser is a Master of Science in Psychology. She joined this research project during her internship at the Institute of Medical Education in Bern, Switzerland. Her main interest is in health psychology.

Bettina Mooser

Felicitas-Maria Lahner, PhD, is a research associate 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.

Martin Perrig

Martin Perrig, MD, MME, is a chief physician at the Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland.

Matthias K. Widmer

Matthias K. Widmer, MD, MME, is a physician at the Department of Cardiovascular Surgery and is responsible for trainees’ specialist training at Bern University Hospital, Bern, Switzerland.

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, Bern, Switzerland. His research focuses on airway management, resuscitation, simulation, and faculty development.

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 (including Virtual Patients and workplace-based assessments), summative assessment, blended learning, problem-based learning, and medical educators.