Stephanie Montagne

The influence of students’ prior clinical skills and context characteristics on mini-CEX scores in clerkships – a multilevel analysis

BackgroundIn contrast to objective structured clinical examinations (OSCEs), mini-clinical evaluation exercises (mini-CEXs) take place at the clinical workplace. As both mini-CEXs and OSCEs assess clinical skills, but within different contexts, this study aims at analyzing to which degree students’ mini-CEX scores can be predicted by their recent OSCE scores and/or context characteristics.MethodsMedical students participated in an end of Year 3 OSCE and in 11 mini-CEXs during 5 different clerkships of Year 4. The students’ mean scores of 9 clinical skills OSCE stations and mean ‘overall’ and ‘domain’ mini-CEX scores, averaged over all mini-CEXs of each student were computed. Linear regression analyses including random effects were used to predict mini-CEX scores by OSCE performance and characteristics of clinics, trainers, students and assessments.ResultsA total of 512 trainers in 45 clinics provided 1783 mini-CEX ratings for 165 students; OSCE results were available for 144 students (87 %). Most influential for the prediction of ‘overall’ mini-CEX scores was the trainers’ clinical position with a regression coefficient of 0.55 (95 %-CI: 0.26–0.84; p < .001) for residents compared to heads of department. Highly complex tasks and assessments taking place in large clinics significantly enhanced ‘overall’ mini-CEX scores, too. In contrast, high OSCE performance did not significantly increase ‘overall’ mini-CEX scores.ConclusionIn our study, Mini-CEX scores depended rather on context characteristics than on students’ clinical skills as demonstrated in an OSCE. Ways are discussed which focus on either to enhance the scores’ validity or to use narrative comments only.

The mini-clinical evaluation exercise during medical clerkships: are learning needs and learning goals aligned?

The generation of learning goals (LGs) that are aligned with learning needs (LNs) is one of the main purposes of formative workplace‐based assessment. In this study, we aimed to analyse how often trainer–student pairs identified corresponding LNs in mini‐clinical evaluation exercise (mini‐CEX) encounters and to what degree these LNs aligned with recorded LGs, taking into account the social environment (e.g. clinic size) in which the mini‐CEX was conducted.

Facharztprüfungen in der Schweiz: Eine Bestandsaufnahme der verwendeten Prüfungsmethoden

Fragestellung/Zielsetzung: Die Prüfungsmethode hat einen Einfluss auf das Lernen und die Qualitätssicherung [1]. International finden bei Facharztprüfungen verschiedene Methoden Anwendung. In der Schweiz existieren landesweite Facharztprüfungen (http://www.fmh.ch/files/pdf17/art_fap_2016_d.pdf), allerdings fehlt bisher eine umfassende Übersicht zu den verwendeten Prüfungsmethoden in den einzelnen Fachgebieten. Deshalb untersuchten wir diesen Aspekt in der vorliegenden Studie.

Losing connectivity when using EHRs: a technological or an educational problem?

In this issue, the article ‘The impact of adopting EHRs: how losing connectivity affects clinical reasoning’, by Varpio et al., investigates how clinicians experienced the move from a paper-based health record to an electronic health record (EHR) and how this affected clinical reasoning. They found that previously chronological and interconnected data were replaced by data points that were ‘largely chronologically and contextually isolated’. The study participants experienced this as a loss of clinical reasoning support mechanisms. They no longer knew the patients’ evolving status and reported an increased cognitive workload. In their extensive constructivist grounded theory study, the authors found that the negative effect on clinical reasoning could be attributed to a loss of connectivity when using the EHR.

Alignment between learning needs and learning goals of Mini-CEX in clerkships

Background: Defining learning goals (LG) in alignment with learning needs (LN) is one of the key purposes of formative workplace-based assessment, but studies about this topic are scarce. Summary of Work: We analysed quantitatively and qualitatively how often trainer-student pairs identified the same LN during Mini Clinical Evaluation Exercises (Mini-CEX) in clerkships and to what degree those LNs were in line with the recorded LGs. Multilevel logistic regression models were used to predict LGs by identified LNs, controlling for context variables. Summary of Results: 512 trainers and 165 students conducted 1783 Mini-CEX (98% completion rate). Concordantly, trainer-student pairs most often identified LNs in the domains ‘clinical reasoning’ (23% of 1167 complete forms), ‘organisation / efficiency’ (20%) and ‘physical examination’ (20%). At least one ‘defined’ LG was noted on 313 student forms (18% of 1710), with a total of 446 LGs. Of these, the most frequent LGs were ‘physical examination’ (49% of 446 LGs) and ‘history taking’ (21%); corresponding LNs as well as context variables (e.g. clinic size) were found to be predictors of these LGs. Discussion and Conclusions: Although trainer-student pairs often agreed in their identified LNs, many assessments did not result in an aligned LG or a LG at all. Interventions are needed to enhance the proportion of (aligned) LGs in Mini-CEX in order to tap into its full potential not only as a ‘diagnostic’ but also as an ‘educational tool’. Take-home messages: The sparseness of LGs, their dependency on context variables and their partial non-alignment with students’ LNs raise the question of how the effectiveness of Mini-CEX can be further enhanced.