Effectiveness of a Multidimensional Formative Assessment Model Integrating Mini-CEX and DOPS on Enhancing Clinical Competency of Medical Imaging Interns
Journal: Journal of Higher Education Research DOI: 10.32629/jher.v7i2.5154
Abstract
Objective: To investigate the effectiveness of an integrated Mini-CEX/DOPS formative assessment model in enhancing clinical competency of medical imaging interns. Methods: A quasi-experimental study enrolled 96 interns into an experimental group (n=48, integrated model) and control group (n=48, traditional assessment) from January 2024 to December 2025. Outcomes included competency scores, OSCE pass rates, and satisfaction. Results: The experimental group showed significantly higher scores in all six competency domains (P<0.05), higher OSCE pass rate (95.83% vs. 79.17%, P=0.014), and greater satisfaction (93.75%). Conclusion: The integrated model effectively enhances clinical competency through structured continuous feedback and self-directed learning.
Keywords
Mini-CEX; DOPS; formative assessment; medical imaging; clinical competency
Full Text
PDF - Viewed/Downloaded: 0 TimesReferences
[1]Rawekar A, Choudhari SG, Mishra V, et al. Formative assessment in practical for Indian postgraduates in health professions education. J Family Med Prim Care. 2020;9(7):3399-3404.
[2]Gupta SK, Agrawal S, et al. Assessment in undergraduate competency-based medical education: a systematic review. Cureus. 2024;16(4):e58073.
[3]Epstein RM. Assessment in medical education. N Engl J Med. 2007;356(4):387-396.
[4]Norcini JJ, Blank LL, Arnold GK, et al. The Mini-CEX: a preliminary investigation. Ann Intern Med. 1995;123(10):795-799.
[5]Gruppen LD, Frank JR, Lockyer J, et al. Toward a research agenda for competency-based medical education. Med Teach. 2017;39(6):623-630.
[6]Krishnappa S, Das S, Raju K, Chaudhary N, Bevinakatti SH. Outcome-Based Medical Education Implication and Opportunities for Competency-Based Medical Education in Undergraduate Pathology. Cureus. 2023;15(8):e42801.
[7]Frank JR, Snell LS, Cate OT, et al. Competency-based medical education: theory to practice. Med Teach. 2010;32(8):638-645.
[8]Norcini J, Burch V. Workplace-based assessment as an educational tool: AMEE Guide No. 31. Med Teach. 2007;29(9):855-871.
[9]Lörwald AC, Lahner FM, Nouns ZM, et al. 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. PLoS One. 2018;13(6):e0198009.
[10]Kogan JR, Holmboe ES, Hauer KE. Tools for direct observation and assessment of clinical skills. JAMA. 2009;302(12):1316-1326.
[11]Sharma R, Rana AK, Verma M, et al. Implementing mini-clinical evaluation exercise (mini-CEX) and its efficacy as a formative assessment tool in the otorhinolaryngology (ORL) undergraduate medical program. Indian J Otolaryngol Head Neck Surg. 2025;77(12):5412-5417.
[12]Bindal T, Wall D, Goodyear HM. Trainee doctors’ views on workplace-based assessments. Med Teach. 2011;33(12):919-927.
[13]Lörwald AC, Lahner FM, Greif R, et al. Factors influencing the educational impact of Mini-CEX and DOPS. Med Teach. 2018;40(4):414-420.
[14]Wang Y, Chen G, et al. Application of Mini-CEX combined with DOPS in standardized training of community outpatient residents. BMC Med Educ. 2024;24:780.
[15]Sivaraman G, Lakshmanan J, et al. Use of Mini-CEX as formative assessment tool in undergraduate medical students in ENT. Indian J Otolaryngol Head Neck Surg. 2024;76:2698-2703.
[16]Gupta SK, Agrawal S, et al. Assessment in undergraduate competency-based medical education: a systematic review. Cureus. 2024;16(4):e58073.
[17]Lee GB, Chiu AM. Assessment and feedback methods in competency-based medical education. Ann Allergy Asthma Immunol. 2022;128(3):256-262.
[18]Höhne E, Recker F, et al. Assessment methods in medical ultrasound education. Front Med. 2022;9:871957.
[19]Jasemi M, Ahangarzadeh Rezaie S, Hemmati Maslakpak M, Parizad N. Are workplace-based assessment methods (DOPS and Mini-CEX) effective in nursing students' clinical skills? A single-blind randomized, parallel group, controlled trial. Contemp Nurse. 2019;55(6):565-575.
[20]Ritchie KC, Sjaus A, Munro A, George RB. An interpretive phenomenological analysis of formative feedback in anesthesia training: the residents' perspective. BMC Med Educ. 2020;20(1):493.
[21]Barros CCCS, et al. Using portfolio in medical education: a systematic review. FASEB J. 2022;36(S1):R6267.
[22]Weissenbacher A, Bolz R, Zimmermann A, Donaubauer B, Stehr SN, Hempel G. Mentoring und arbeitsplatzbasierte Prüfungen im Praktischen Jahr : Ein effektiver Weg zur Steigerung von Zufriedenheit und Kompetenz? [Mentoring and workplace-based assessments for final year medical students : An effective way to increase satisfaction and competence?]. Anaesthesist. 2021;70(6):486-496.
[23]Chen G, Wang H, Zhou L, Yang J, Xu L, Liang Y. Development and applications of graduate outcome-based curriculum for basic medical education. Front Med (Lausanne). 2024;11:1400811.
[24]Höhne E, Recker F, et al. Assessment methods in medical ultrasound education. Front Med. 2022;9:871957.
[25]H’ng MWC, et al. Workplace-based assessments in the Singapore radiology residency programme. Singapore Med J. 2021;62(3):149-152.
[26]Tay YX, Lau DS, Chow HC, et al. Workplace-based assessment - Moving from participation to engagement using direct observation of procedural skills (DOPS). J Med Imaging Radiat Sci. 2023;54(2):229-234.
[27]Branfield Day L, Miles A, Ginsburg S, Melvin L. Resident Perceptions of Assessment and Feedback in Competency-Based Medical Education: A Focus Group Study of One Internal Medicine Residency Program. Acad Med. 2020;95(11):1712-1717.
[28]Agarwal G, Maroo K, Zomorodian P, et al. Radiology AI training and assessment-challenges, innovations, and a path forward. BJR Open. 2025;7(1):tzaf026.
[29]Emke AR, Torre D, Aagaard EM. Competency-Based Education and Programmatic Assessment in Undergraduate Medical Education: Describing the Gateway Experience of Successful Design and Implementation. Acad Med. 2025;100(11):1268-1271.
[30]Goldhamer MEJ, Martinez-Lage M, Black-Schaffer WS, et al. Reimagining the Clinical Competency Committee to Enhance Education and Prepare for Competency-Based Time-Variable Advancement. J Gen Intern Med. 2022;37(9):2280-2290.
[2]Gupta SK, Agrawal S, et al. Assessment in undergraduate competency-based medical education: a systematic review. Cureus. 2024;16(4):e58073.
[3]Epstein RM. Assessment in medical education. N Engl J Med. 2007;356(4):387-396.
[4]Norcini JJ, Blank LL, Arnold GK, et al. The Mini-CEX: a preliminary investigation. Ann Intern Med. 1995;123(10):795-799.
[5]Gruppen LD, Frank JR, Lockyer J, et al. Toward a research agenda for competency-based medical education. Med Teach. 2017;39(6):623-630.
[6]Krishnappa S, Das S, Raju K, Chaudhary N, Bevinakatti SH. Outcome-Based Medical Education Implication and Opportunities for Competency-Based Medical Education in Undergraduate Pathology. Cureus. 2023;15(8):e42801.
[7]Frank JR, Snell LS, Cate OT, et al. Competency-based medical education: theory to practice. Med Teach. 2010;32(8):638-645.
[8]Norcini J, Burch V. Workplace-based assessment as an educational tool: AMEE Guide No. 31. Med Teach. 2007;29(9):855-871.
[9]Lörwald AC, Lahner FM, Nouns ZM, et al. 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. PLoS One. 2018;13(6):e0198009.
[10]Kogan JR, Holmboe ES, Hauer KE. Tools for direct observation and assessment of clinical skills. JAMA. 2009;302(12):1316-1326.
[11]Sharma R, Rana AK, Verma M, et al. Implementing mini-clinical evaluation exercise (mini-CEX) and its efficacy as a formative assessment tool in the otorhinolaryngology (ORL) undergraduate medical program. Indian J Otolaryngol Head Neck Surg. 2025;77(12):5412-5417.
[12]Bindal T, Wall D, Goodyear HM. Trainee doctors’ views on workplace-based assessments. Med Teach. 2011;33(12):919-927.
[13]Lörwald AC, Lahner FM, Greif R, et al. Factors influencing the educational impact of Mini-CEX and DOPS. Med Teach. 2018;40(4):414-420.
[14]Wang Y, Chen G, et al. Application of Mini-CEX combined with DOPS in standardized training of community outpatient residents. BMC Med Educ. 2024;24:780.
[15]Sivaraman G, Lakshmanan J, et al. Use of Mini-CEX as formative assessment tool in undergraduate medical students in ENT. Indian J Otolaryngol Head Neck Surg. 2024;76:2698-2703.
[16]Gupta SK, Agrawal S, et al. Assessment in undergraduate competency-based medical education: a systematic review. Cureus. 2024;16(4):e58073.
[17]Lee GB, Chiu AM. Assessment and feedback methods in competency-based medical education. Ann Allergy Asthma Immunol. 2022;128(3):256-262.
[18]Höhne E, Recker F, et al. Assessment methods in medical ultrasound education. Front Med. 2022;9:871957.
[19]Jasemi M, Ahangarzadeh Rezaie S, Hemmati Maslakpak M, Parizad N. Are workplace-based assessment methods (DOPS and Mini-CEX) effective in nursing students' clinical skills? A single-blind randomized, parallel group, controlled trial. Contemp Nurse. 2019;55(6):565-575.
[20]Ritchie KC, Sjaus A, Munro A, George RB. An interpretive phenomenological analysis of formative feedback in anesthesia training: the residents' perspective. BMC Med Educ. 2020;20(1):493.
[21]Barros CCCS, et al. Using portfolio in medical education: a systematic review. FASEB J. 2022;36(S1):R6267.
[22]Weissenbacher A, Bolz R, Zimmermann A, Donaubauer B, Stehr SN, Hempel G. Mentoring und arbeitsplatzbasierte Prüfungen im Praktischen Jahr : Ein effektiver Weg zur Steigerung von Zufriedenheit und Kompetenz? [Mentoring and workplace-based assessments for final year medical students : An effective way to increase satisfaction and competence?]. Anaesthesist. 2021;70(6):486-496.
[23]Chen G, Wang H, Zhou L, Yang J, Xu L, Liang Y. Development and applications of graduate outcome-based curriculum for basic medical education. Front Med (Lausanne). 2024;11:1400811.
[24]Höhne E, Recker F, et al. Assessment methods in medical ultrasound education. Front Med. 2022;9:871957.
[25]H’ng MWC, et al. Workplace-based assessments in the Singapore radiology residency programme. Singapore Med J. 2021;62(3):149-152.
[26]Tay YX, Lau DS, Chow HC, et al. Workplace-based assessment - Moving from participation to engagement using direct observation of procedural skills (DOPS). J Med Imaging Radiat Sci. 2023;54(2):229-234.
[27]Branfield Day L, Miles A, Ginsburg S, Melvin L. Resident Perceptions of Assessment and Feedback in Competency-Based Medical Education: A Focus Group Study of One Internal Medicine Residency Program. Acad Med. 2020;95(11):1712-1717.
[28]Agarwal G, Maroo K, Zomorodian P, et al. Radiology AI training and assessment-challenges, innovations, and a path forward. BJR Open. 2025;7(1):tzaf026.
[29]Emke AR, Torre D, Aagaard EM. Competency-Based Education and Programmatic Assessment in Undergraduate Medical Education: Describing the Gateway Experience of Successful Design and Implementation. Acad Med. 2025;100(11):1268-1271.
[30]Goldhamer MEJ, Martinez-Lage M, Black-Schaffer WS, et al. Reimagining the Clinical Competency Committee to Enhance Education and Prepare for Competency-Based Time-Variable Advancement. J Gen Intern Med. 2022;37(9):2280-2290.
Copyright © 2026 Lianjie Bai, Xinping Wang, Yang Liu, Hui Li, Xiaoqiu Jin
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License