gms | German Medical Science

Questions: During postgraduate training, trainees often suffer from a lack of feedback and structured supervision. Tools for Workplace Based Assessment (WPBA) – like the Mini Clinical Evaluation Exercise (Mini-CEX) and Direct Observation of Procedural Skills (DOPS) – might help to enhance the quality in clinical education. These assessments require a teacher to observe a trainee performing a clinical task (~ 15 min.) and to provide structured feedback using a checklist (~ 5 min.). In order to level the way for broader implementation of Mini-CEXand DOPS in Switzerland, a feasibility study based on pilot clinics was conducted to answer the following questions:

1.

Which aspects facilitate the application of Mini-CEX and DOPS in clinical routine?

2.

Which barriers have to be considered?

Methods: In 13 volunteering hospitals from different specialties (4 internal medicine, 4 surgery, 2 ENT, 2 gynaecology, 1 psychiatry) the staff was trained to perform Mini-CEX and/or DOPS (interactive workshops and written instructions). It was recommended to complete 4 Mini-CEX/DOPS per trainee/year. An accompanying online-survey among participants was conducted. Physicians from pilot clinics were asked to anonymously describe barriers and possible ways to enhance feasibility of WPBA in daily clinical routine. Quantitative data were analysed descriptively, qualitative data were interpreted according to the model of inductive category development (Mayring, 2005).

Results:Twelve clinics returned WPBA-forms (220 Mini-CEX, 95 DOPS), involving 160 trainees and 84 trainers. Only 4% of the trainees reached a number of ≥ 4 Mini-CEX or DOPS per year. On average, the participants were more satisfied with DOPS compared to Mini-CEX (trainees 6.7 ± 1.8 SD for Mini-CEX, 7.6 ± 1.8 for DOPS; teachers 6.8 ± 1.7 for Mini-CEX, 7.7 ± 1.4 for DOPS; 1 = very low, 10 = highest satisfaction). Participants in the survey (21 trainees, 16 trainers) mentioned specific barriers regarding the integration of WPBA, which can be classified to three different levels:

1.

The perception of the assessment itself (e.g. trainees’ test anxiety, trainers’ view of WPBA as an additional task);

2.

the perception of the learning environment (e.g. work overload; little time for teaching) and

3.

the trainee-trainer relationship (e.g. role confusion).

They proposed a more structured planning of assessments(e.g. clear responsibility for making appointments; reserved time slots) as a possible solution.

Conclusions: While WPBA was feasible and appreciated by participants in clinics from varying specialties, the assessment frequency was relatively low. This might be traced back to specific barriers as indicated in the survey. A more structured approach to organise the assessments and to integrate WPBA into further educational activities (e.g. logbook, regular performance reviews) might support its positive impact on postgraduate training and facilitate implementation.