The educational impact of Mini-Clinical Evaluation Exercise (Mini-CEX) and Direct Observation of Procedural Skills (DOPS) and its association with implementation: A systematic review and meta-analysis

Abstract

IntroductionMini Clinical Evaluation Exercise (Mini-CEX) and Direct Observation of Procedural Skills (DOPS) are used as formative assessments worldwide. Since an up-to-date comprehensive synthesis of the educational impact of Mini-CEX and DOPS is lacking, we performed a systematic review. Moreover, as the educational impact might be influenced by characteristics of the setting in which Mini-CEX and DOPS take place or their implementation status, we additionally investigated these potential influences.MethodsWe searched Scopus, Web of Science, and Ovid, including All Ovid Journals, Embase, ERIC, Ovid MEDLINE(R), and PsycINFO, for original research articles investigating the educational impact of Mini-CEX and DOPS on undergraduate and postgraduate trainees from all health professions, published in English or German from 1995 to 2016. Educational impact was operationalized and classified using Barr’s adaptation of Kirkpatrick’s four-level model. Where applicable, outcomes were pooled in meta-analyses, separately for Mini-CEX and DOPS. To examine potential influences, we used Fisher’s exact test for count data.ResultsWe identified 26 articles demonstrating heterogeneous effects of Mini-CEX and DOPS on learners’ reactions (Kirkpatrick Level 1) and positive effects of Mini-CEX and DOPS on trainees’ performance (Kirkpatrick Level 2b; Mini-CEX: standardized mean difference (SMD) = 0.26, p = 0.014; DOPS: SMD = 3.33, p<0.001). No studies were found on higher Kirkpatrick levels. Regarding potential influences, we found two implementation characteristics, “quality” and “participant responsiveness”, to be associated with the educational impact.ConclusionsDespite the limited evidence, the meta-analyses demonstrated positive effects of Mini-CEX and DOPS on trainee performance. Additionally, we revealed implementation characteristics to be associated with the educational impact. Hence, we assume that considering implementation characteristics could increase the educational impact of Mini-CEX and DOPS.

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“…In another study, undergraduate students have found Mini-CEX as feasible and satisfactory tool [61]. A systematic review and meta-analysis done also suggested positive effect of Mini-CEX application on trainee's performance [64]. One third of students were satisfied of learning medical interview skills and two third were more than satisfied with same which is similar to results of a study in which 96% students were satisfied with communicative skills [65].…”

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“…During the CCs, supervising (teaching) doctors of each department evaluate the clinical skills of students using an evaluation sheet based on the mini-CEX and Direct Observation of Procedural Skills (DOPS) [11] [12]. Accomplishment consists of 5-point evaluation sheet for 16 parts (80%), subjective evaluation by the organizer of each department (10%), and written report (10%) (Fig 2).…”

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“…Instead, the time should be used to provide a more meaningful and detailed feedback, which should be pointed out in the assessors' workshop. On the other hand, several previous studies have reported negative experiences with the mini-CEX, according to non-constructive attitudes or lack of time [28][29][30][31]. The lack of time and the additional workload in clinical settings might be a general disadvantage forTA B L E 1 Braun and Clarke's (2006) phases of thematic analysis Familiarising yourself with your data Transcribing data (if necessary), reading and rereading the data and taking notes 2 General initial codes Coding interesting features across the entire data set 3 Searching for themes Collating codes into potential themes and gathering all data relevant to each potential theme 4 Reviewing themes Generate a thematic "map" of the analysis and check the themes' relevance into the coded extracts and the entire data set 5 Defining and naming themes Ongoing analysis to refine the specifics of each theme and the overall story the analysis tells, and generating clear definitions and names for each theme 6Producing the report The final opportunity for analysis: selection of vivid, compelling extract examples, final analysis of selected extracts, relating back of the analysis to the research question and literature, and producing a scholarly report of the analysis The mean duration of the assessment was significantly decreased (P < .0001) The mean duration of the feedback was significantly decreased (P < .0001) F I G U R E 5 A, Box plot comparing the results of the mini-CEX of the assessment of the upper jaw made by the faculty members.…”