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PhD student in Medical Education Journal Club Atefe Zabihi Zazoly PhD student in Medical Education 2018 2

Factors influencing the educational impact of Mini- Title: Factors influencing the educational impact of Mini- CEX and DOPS: A qualitative synthesis Med Teach. 2018 Apr;40(4):414-420 3 zabihi1823@gmail.com-Autumn 97

Authors Andrea C. Lörwalda Felicitas-Maria Lahnera Robert Greifb Christoph Berendonka John Norcinic Sören Huwendieka a Department of Assessment and Evaluation, Institute of Medical Education, University of Bern, Bern, Switzerland b Anaesthesiology and Pain Medicine, Bern University Hospital, Bern, Switzerland c Foundation for Avancement of International Medical Education and Research (FAIMER), Philadelphia, PA, USA 4

zabihi1823@gmail.com-Autumn 97 Table of Contents Abstract Introduction Objective Method Result Discussion Conclusion 5 zabihi1823@gmail.com-Autumn 97

zabihi1823@gmail.com-Autumn 97 Abstract There is no existing comprehensive analysis and synthesis of factors influencing the educational impact of Mini-CEX and DOPS. The authors chose a two-step approach. (a systematic literature review & a qualitative synthesis) They offered a model consisting of four themes and nine subthemes as influencing factors. 6 zabihi1823@gmail.com-Autumn 97

zabihi1823@gmail.com-Autumn 97 Introduction Mini-CEX & DOPS: The two most commonly forms of workplace-based assessment Effects on the: Learner’s reaction Modification of attitudes and perceptions Acquisition of knowledge and skills Change in behavior Change in organizational practice Benefits to clients or patients 7 zabihi1823@gmail.com-Autumn 97

Supervisors' knowledge Introduction Many factors might influence the educational impact of Mini-CEX and DOPS. Feedback Purpose Supervisors' interest Trainees' mindsets Supervisors' knowledge 8 zabihi1823@gmail.com-Autumn 97

zabihi1823@gmail.com-Autumn 97 Objective To synthesize factors influencing the educational impact of Mini-CEX and DOPS into a model based on a systematic review of the literature. 9 zabihi1823@gmail.com-Autumn 97

zabihi1823@gmail.com-Autumn 97 Methods Systematic literature review and study selection Qualitative synthesis of influencing factors 10 zabihi1823@gmail.com-Autumn 97

Method: Systematic literature review The electronic databases: Scopus, Web of Science (all databases), and Ovid including All Ovid Journals (Full Text & Abstracts), Embase, ERIC, Ovid MEDLINE(R), and PsycINFO The individual online journals. Between the first description of Mini-CEX in 1995/the first description of DOPS in 2003 and December 2016 Key words: “mini-CEX”, “mini clinical evaluation exercise”, “direct observation of procedural skills”, “work based assessment”, “workplace based assessment”, “supervised learning event”, and “supervised learning events” combined with OR 11 zabihi1823@gmail.com-Autumn 97

Method: Systematic literature review Inclusion criteria: Only original research articles Only English- or German-language articles Only undergraduate and postgraduate medical trainees Only articles investigating Mini-CEX or DOPS conducted by medical experts in actual clinical encounters Only articles describing the educational impact of Mini-CEX or DOPS, operationalized using Barr’s adaptation of Kirkpatrick’s four-level model Only articles describing influencing factors on the educational impact of Mini-CEX or DOPS 12 zabihi1823@gmail.com-Autumn 97

Method: Qualitative synthesis Authors chose an integrative approach and performed a thematic analysis. AL and FL independently reviewed the unaltered texts of the results sections of the included studies. Identified factors were iteratively revised, reclassified, and then coded into subthemes. Subthemes were grouped into theme. 13 zabihi1823@gmail.com-Autumn 97

zabihi1823@gmail.com-Autumn 97 Results Twelve articles reported factors influencing. 14 zabihi1823@gmail.com-Autumn 97

zabihi1823@gmail.com-Autumn 97 Result The qualitative synthesis revealed four themes and nine subthemes. Context Users Implementation Outcome 15 zabihi1823@gmail.com-Autumn 97

zabihi1823@gmail.com-Autumn 97 Result 16 zabihi1823@gmail.com-Autumn 97

zabihi1823@gmail.com-Autumn 97 Result: Context Subthemes: Time for Mini-CEX/DOPS (nine studies): Whether trainees and supervisors have sufficient time to incorporate Mini-CEX and DOPS into their daily routine Usability of the tools (three studies): Describes the user-friendliness of the tools’ design 17 zabihi1823@gmail.com-Autumn 97

zabihi1823@gmail.com-Autumn 97 Result: users Subthemes: Supervisors’ knowledge about how to use Mini-CEX/DOPS (seven studies) Supervisors’ attitude to Mini-CEX/DOPS (Five studies) Trainees’ knowledge about Mini-CEX/DOPS (four studies) Trainees’ perception of Mini-CEX/DOPS (six studies) 18 zabihi1823@gmail.com-Autumn 97

Result: implementation Subthemes: Observation (four studies): Whether direct observation takes place, and if so, whether the trainees’ performance during observation reflects their actual clinical performance. Feedback (five studies): Whether feedback was provided, and if so, its quality, including ratings and elaboration of feedback. 19 zabihi1823@gmail.com-Autumn 97

zabihi1823@gmail.com-Autumn 97 Result: Outcome Subthemes: Trainees’ appraisal of feedback (five studies): The trainees’ perceptions and appraisal of the feedback received in Mini-CEX/DOPS. Educational impact: Whether the use of these tools actually shapes and supports trainees’ learning. 20 zabihi1823@gmail.com-Autumn 97

zabihi1823@gmail.com-Autumn 97 Discussion Three influencing factors were described as dichotomous. These dichotomous influencing factors appear to act as prerequisites. Direct observation and feedback constitute the main components of the tools. Taking only part of the influencing factors into account would be inadequate. There may be even more factors influencing the educational impact of Mini-CEX and DOPS. 21 zabihi1823@gmail.com-Autumn 97

Limitation & Strengths Due to the limited data base, the model might be incomplete. This model should be seen as preliminary in nature. This is the first systematic synthesis. A model which can serve as a starting point to enhance the educational impact of Mini-CEX and DOPS 22 zabihi1823@gmail.com-Autumn 97

zabihi1823@gmail.com-Autumn 97 Conclusion This model could be useful for medical educators interested in implementing Mini-CEX and DOPS or in improving the educational impact of existing programs. Future studies could either search for further influences or validate the model. 23 zabihi1823@gmail.com-Autumn 97

zabihi1823@gmail.com-Autumn 97 Notable points Educational impact Workplace based assessment & Reliability High emphasis on Mini-CEX !!! DOPS??? Date of publication Impact OR Effect 24 zabihi1823@gmail.com-Autumn 97

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