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Meta-Analysis
. 2018 Jun 4;13(6):e0198009.
doi: 10.1371/journal.pone.0198009. eCollection 2018.

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

Andrea C Lörwald  1 , Felicitas-Maria Lahner  1 , Zineb M Nouns  1 , Christoph Berendonk  1 , John Norcini  2 , Robert Greif  3 , Sören Huwendiek  1
Affiliations
Meta-Analysis

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

Andrea C Lörwald et al. PLoS One. .

Abstract

Introduction: Mini 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.

Methods: We 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.

Results: We 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.

Conclusions: Despite 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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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram of search results according to the PRISMA statement.
From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Iterns for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7): e1000097. doi:10.1371/journal.pmed1000097. For more information, visit www.prisma-statement.org.
Fig 2
Fig 2. Random-effects meta-analyses on the effects of Mini-CEX or DOPS compared with no intervention on trainee performance.
Positive numbers favor Mini-CEX/DOPS. Abbreviation used: SMD (standardized mean difference).
See this image and copyright information in PMC

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