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
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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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Tools like rubrics, checklists, or rating scales, such as the Mini-CEX, provide structured criteria for performance evaluation.
“Tools like rubrics, checklists, or rating scales, such as the Mini-Clinical Evaluation Exercise (Mini-CEX), provide structured criteria for performance evaluation [53][54][55].”
From Formative assessment and feedback in medical education: A practical guide: AMEE Guide No. 189 (2026) · cites this paper as [53]
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- Authors
- Lörwald, A. C., Lahner, F.-M., Nouns, Z. M., Berendonk, C., Norcini, J., Greif, R., & Huwendiek, S.
- Affiliations
- University of Bern (CH)
- Foundation for Advancement of International Medical Education and Research (US)
- Corresponding author
- Lörwald, Andrea C.
- ORCID
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2018-06-04
- Volume
- 13
- Issue
- 6
- Pages
- e0198009
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC5986126
- OpenAlex
- W2807114631
- Cited by
- 117
- References
- 58
- Citations by year
- 2026: 9 · 2025: 14 · 2024: 19 · 2023: 15 · 2022: 18 · 2021: 17 · 2020: 18 · 2019: 5 · 2018: 2
- FWCI
- 1.90
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- BORIS (University Library Bern) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Open Access CRIS of the University of Bern
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Medicine › Rehabilitation › Musculoskeletal Disorders and Rehabilitation
- Keywords
- Mini-CEX, Direct Observation of Procedural Skills, formative assessment, clinical skills assessment, Kirkpatrick model, implementation characteristics, trainee performance, undergraduate medical education, graduate education, participant responsiveness, assessment quality
- MeSH terms
- Clinical Competence, Education, Medical, Educational Measurement, Humans, Outcome Assessment, Health Care
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