711 Paediatric Mini-Clinical Evaluation Exercises (Mini-Cex), Case based Discussions (CbD) and Directly Observed Procedural Skills (DOPS): Tick-box or educational tool?

• Published in: Archives of disease in childhood Vol. 107; no. Suppl 2; p. A388
• Main Author: Jefferies, Kimberley
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 17.08.2022; BMJ Publishing Group LTD
• Subjects: Abstracts; Child Health; Computers; Data collection; Educational Benefits; Grounded Theory; Interviews; Learning; Literature reviews; Medical Education; Nomenclature; Pediatrics; Rating Scales; Semi Structured Interviews; Teaching Methods; Trainees; Training
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2022-rcpch.630

AimsIn response to Modernising Medical Careers, workplace-based assessments (WBAs), including Mini-Cex, CbDs and DOPS were incorporated into paediatric training from 2007 to standardise training and assessment nationally.A literature review identified only two previous UK studies that had evaluated paediatric trainees (ST1-5) perspectives on using WBAs. Since these studies, the Royal College of Paediatrics and Child Health (RCPCH) has increased the emphasis on the formative purpose of WBAs and changed the assessment schedule and nomenclature. This study built on existing knowledge and explored the views of both paediatric trainers and trainees (ST1-8) to determine whether these changes had altered stakeholder opinions.MethodsUsing a Constructivist Grounded Theory approach, qualitative semi-structured interviews, lasting 25-40 minutes, were conducted via video link, between June 2020 to January 2021. Interviews were audio-recorded and transcribed verbatim. Data collection and analysis were conducted iteratively using constant comparison until theoretical sufficiency was achieved. Memo writing ensured reflexivity and member checking minimised bias. Ethical approval was granted by SMED-REC(Number 20/30).ResultsAcross five hospital sites, fifteen trainees (ST1-8) and four consultants or equivalent participated.Many found WBAs useful because they promoted trainee-trainer interaction, facilitated observation and provided a unique, personalised learning opportunity. Good preparation, selection of a complex or challenging case and timely constructive feedback contributed to their educational value.Junior trainees preferred Mini-Cexs and DOPS, especially when learning new or advanced procedures; whilst senior trainees valued CbDs and used them to reflect, debrief and discuss difficult cases.‘DOPS…where you’re pushing your competency, I’ve found them really useful’(P16)‘The more senior I get, the more decisions I`m making, the more useful CbDs are…’(P6)Changes in assessment requirements, increased emphasis on their formative purpose, a shift from quantity to quality assessments, re-branding to supervised learning events (SLEs), and the replacement of rating scales with free-text comment boxes, has helped most trainees appreciate their value as an educational tool.‘It’s good the RCPCH reduced the numbers….the problem with numbers is that people then do them as a tick-box exercise.…not necessarily as a learning situation’(P1)Despite these changes, some trainees still described WBAs as a ‘hassle’, ‘chore’, or ‘tick-box’ completed solely to fulfil their ARCP requirements. Some trainees preferred using reflective notes or skills log entries to document their learning.Assessors recognised the reciprocal value of WBAs. They prompted them to look things up, refresh their memory and consolidate their own learning. Trainers also found them useful to structure their teaching, make suggestions for change and document concerns about a trainee in difficulty, which facilitated the provision of additional support.ConclusionPaediatric WBAs are being increasingly recognised as valuable educational tools following e-portfolio updates and changes to assessment requirements. However, heavy workloads, limited consultant availability, lack of training, and a shortage of reliable computers continue to threaten their educational potential. Three key targets to avoid a ‘tick-box’ exercise include increasing time, improving training and optimising technology.