Abstract
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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-015-0490-3) contains supplementary material, which is available to authorized users.
Highlights
In contrast to objective structured clinical examinations (OSCEs), mini-clinical evaluation exercises take place at the clinical workplace
Students were randomly assigned to two equivalent OSCE tracks on two subsequent days, comprising comparable clinical tasks related to historytaking and physical examination
One student with extremely low mini-CEX scores had been excluded from further statistical analyses, because we wanted to avoid over- or underestimation of the association between mini-CEX and OSCE scores
Summary
In contrast to objective structured clinical examinations (OSCEs), mini-clinical evaluation exercises (mini-CEXs) take place at the clinical workplace. Rogausch et al BMC Medical Education (2015) 15:208 in daily clinical practice Both in OSCEs and mini-CEXs, multiple scores averaged across these different encounters/stations and including different cases, patients and raters, should represent a valid picture of a learner’s clinical skills [3]. In everyday clinical applications of WBAs, the assessment quality depends on the raters who are using the tool, and potentially on context characteristics which influence the raters’ information processing [18,19,20,21]. These context characteristics are summarized in the model of the performance assessment process, developed by DeNisi and adapted by Govaerts [18, 22]. It comprises cues related to (1) the learners’ performance, (2) the raters, (3) the assessment design and (4) the organizational environment which all influence trainers’ ratings in a certain way [18, 22]
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