title: The mini-clinical evaluation exercise during medical clerkships: are learning needs and learning goals aligned?
abstract: OBJECTIVE
  The generation of learning goals (LGs) that are aligned with learning needs (LNs) is one of the main purposes of formative workplace-based assessment. In this study, we aimed to analyse how often trainer-student pairs identified corresponding LNs in mini-clinical evaluation exercise (mini-CEX) encounters and to what degree these LNs aligned with recorded LGs, taking into account the social environment (e.g. clinic size) in which the mini-CEX was conducted.
  
  
  METHODS
  Retrospective analyses of adapted mini-CEX forms (trainers' and students' assessments) completed by all Year 4 medical students during clerkships were performed. Learning needs were defined by the lowest score(s) assigned to one or more of the mini-CEX domains. Learning goals were categorised qualitatively according to their correspondence with the six mini-CEX domains (e.g. history taking, professionalism). Following descriptive analyses of LNs and LGs, multi-level logistic regression models were used to predict LGs by identified LNs and social context variables.
  
  
  RESULTS
  A total of 512 trainers and 165 students conducted 1783 mini-CEXs (98% completion rate). Concordantly, trainer-student pairs most often identified LNs in the domains of 'clinical reasoning' (23% of 1167 complete forms), 'organisation/efficiency' (20%) and 'physical examination' (20%). At least one 'defined' LG was noted on 313 student forms (18% of 1710). Of the 446 LGs noted in total, the most frequently noted were 'physical examination' (49%) and 'history taking' (21%). Corresponding LNs as well as social context factors (e.g. clinic size) were found to be predictors of these LGs.
  
  
  CONCLUSIONS
  Although trainer-student pairs often agreed in the LNs they identified, many assessments did not result in aligned LGs. The sparseness of LGs, their dependency on social context and their partial non-alignment with students' LNs raise questions about how the full potential of the mini-CEX as not only a 'diagnostic' but also an 'educational' tool can be exploited.
authors.affiliation: Institute of Medical Education, Faculty of Medicine, University of Bern, Bern, Switzerland.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Montagne
authors.forename: Anja
authors.initials: A
authors.lastname: Rogausch
authors.forename: Armin
authors.initials: A
authors.lastname: Gemperli
authors.forename: Christoph
authors.initials: C
authors.lastname: Berendonk
authors.forename: Patrick
authors.initials: P
authors.lastname: Jucker-Kupper
authors.forename: Christine
authors.initials: C
authors.lastname: Beyeler
mesh_terms: D000328:Adult; D002982:Clinical Clerkship / Q000458:organization & administration*; D002983:Clinical Competence; D004501:Education, Medical / Q000458:organization & administration*; D004521:Educational Measurement / Q000379:methods*; D005260:Female; D006040:Goals; D006801:Humans; D007858:Learning; D008297:Male; D020380:Needs Assessment / Q000458:organization & administration*; D009937:Organizational Objectives; D012189:Retrospective Studies; D013557:Switzerland; D055815:Young Adult