Institut für Medizinische Lehre Mini-CEX and DOPS: Why and How? Christoph Berendonk MD MME [email protected] Content Why How • Principles of the two instruments • Thoughts on implementation www.vaxd.com Institut für Medizinische Lehre Mini-CEX / DOPS Resident-Patient-Interaction Mini-CEX DOPS Mini-Clinical Evaluation Exercise Direct Observation of Procedures History taking, counseling, physical examination Institut für Medizinische Lehre Technical interventions Why Mini-CEX / DOPS • Extrinsic effect „we learn what is tested“ assessment drives learning • Intrinsic effect „what is being tested is better stored“ test-enhanced learning Institut für Medizinische Lehre Test enhanced learning 100 % p< 0 .0 0 1 ES= 0 .9 3 • 5th year medical students • ACLS course • 30 min theory • 3 h practice • Experiment • Control: 30 min further practice • Intervention: 30 min test 82.8 75 73.3 4 h course 3.5 h Kurs + h course 30 3.5 Min Test + 0.5 h test 50 Posttest 14 d nach Kurs 14 days later Kromann. Med Educ 2009 Institut für Medizinische Lehre 4 h Kurs Why Mini-CEX / DOPS Medical Expert Communicator Collaborator Health Advocate Manager Scholar Professional 1. Written Tests (MCQ, SAQ) +++ + ++ ++ + ++ + 2. Essays ++ + + +++ + + + 3. Oral Exam +++ + + + - - + 4. Mini-CEX / DOPS +++ +++ +++ +++ +++ +++ +++ 5. OSCE / SP +++ +++ +++ ++ - - + 6. Multi-source Feedback ++ +++ +++ +++ +++ ++ +++ 7. Portfolio ++ ++ + +++ ++ +++ +++ 8. Simulations +++ + +++ - ++ - ++ adapted from John Norcini, Workshop „Research in Medical Educations“, Heidelberg 2009 Institut für Medizinische Lehre Mini-CEX / DOPS Observation Institut für Medizinische Lehre Documentation Feedback Mini-CEX / DOPS Observation • “We have learned many surprising things about our residents‘ skills and deficiencies not evident at morning report, rounds, or via standardized tests” • “We also learned that the skills that cause a resident to shine on rounds, such as verbal case presentations and transmission of didactic material, do not necessarily correlate with clinical skills “ 10-15 Min ABIM Institut für Medizinische Lehre Mini-CEX / DOPS Documentation Institut für Medizinische Lehre Mini-CEX / DOPS Feedback 5 Min motor-talk.de Institut für Medizinische Lehre Feedback Effects • 3rd year medical students • surgical knot tying course • 30 min theory • pre-test • practical exercise • Control: unspecific feedback • Intervention: specific feedback • post-test 30 p p re = 0 . 8 2 25 22 p po st = 0 . 0 0 8 20 17 1 5 .4 1 5 .9 15 10 5 0 Unspe z. Fe e dback Control Konstr uk iv e s Fe edba ck Intervention Boehler. Med Educ 2006 Institut für Medizinische Lehre Pr e te st Postte st Feedback • • • • • • is planed and expected includes a self-assessment addresses points of improvement and strengths is specific and describes focuses on modifiable behaviour includes a jointly developed learning goal adapted from Institut für Medizinische Lehre Ende. Jama 1983 Thoughts on implementation Mini-CEX / DOPS • No stand alone • Part of an educational program ‘Blockpraktika’ Master of Medicine, Bern University • • • • • • • Institut für Medizinische Lehre 5 clinical rotations each lasting one month Bed side teaching Case based discussions Patient retinue … One Mini-CEX / DOPS per student per week Final evaluation at the end of each rotation Thoughts on implementation Mini-CEX / DOPS ‘Blockpraktika’ Master of Medicine, Bern University • • Institut für Medizinische Lehre Students get regular and systematic feedback about their performance Early identification of students ‘with problems’ Mini-CEX / DOPS Institut für Medizinische Lehre Thoughts on implementation Mini-CEX / DOPS • • Inform all stakeholders about purpose Giving feedback is a skill Institut für Medizinische Lehre ‘Blockpraktika’ Master of Medicine, Bern University • Information: • face to face • leaflet • www • Teach the teacher workshops • Hands on practical experience Results of cohort 2010 • Feasibility • • 2115 Mini-CEX / DOPS with 141 students • Number of Mini-CEX / DOPS per student: 15 mean (SD +/- 2.5) • Response rate: 94% Narrative comments • About 60% of the assessment forms contained information about strengths and weaknesses • About 40% included specific learning goals Institut für Medizinische Lehre Conclusions • Mini-CEX / DOPS contribute to the educational quality of medical programs • Adapt the tool for your needs • Giving and receiving feedback is a skill Institut für Medizinische Lehre
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