title: The influence of students' prior clinical skills and context characteristics on mini-CEX scores in clerkships--a multilevel analysis.
abstract: BACKGROUND
  In contrast to objective structured clinical examinations (OSCEs), mini-clinical evaluation exercises (mini-CEXs) take place at the clinical workplace. As both mini-CEXs and OSCEs assess clinical skills, but within different contexts, this study aims at analyzing to which degree students' mini-CEX scores can be predicted by their recent OSCE scores and/or context characteristics.
  
  
  METHODS
  Medical students participated in an end of Year 3 OSCE and in 11 mini-CEXs during 5 different clerkships of Year 4. The students' mean scores of 9 clinical skills OSCE stations and mean 'overall' and 'domain' mini-CEX scores, averaged over all mini-CEXs of each student were computed. Linear regression analyses including random effects were used to predict mini-CEX scores by OSCE performance and characteristics of clinics, trainers, students and assessments.
  
  
  RESULTS
  A total of 512 trainers in 45 clinics provided 1783 mini-CEX ratings for 165 students; OSCE results were available for 144 students (87%). Most influential for the prediction of 'overall' mini-CEX scores was the trainers' clinical position with a regression coefficient of 0.55 (95%-CI: 0.26-0.84; p < .001) for residents compared to heads of department. Highly complex tasks and assessments taking place in large clinics significantly enhanced 'overall' mini-CEX scores, too. In contrast, high OSCE performance did not significantly increase 'overall' mini-CEX scores.
  
  
  CONCLUSIONS
  In our study, Mini-CEX scores depended rather on context characteristics than on students' clinical skills as demonstrated in an OSCE. Ways are discussed which focus on either to enhance the scores' validity or to use narrative comments only.
authors.affiliation: Department of Assessment and Evaluation, Institute of Medical Education, University of Bern, Bern, Switzerland. anja.rogausch@iml.unibe.ch.|Clinic Sonnenhalde, Riehen, Switzerland. anja.rogausch@iml.unibe.ch.
authors.forename: Anja
authors.initials: A
authors.lastname: Rogausch
authors.affiliation: Department of Assessment and Evaluation, Institute of Medical Education, University of Bern, Bern, Switzerland. christine.beyeler@iml.unibe.ch.
authors.forename: Christine
authors.initials: C
authors.lastname: Beyeler
authors.affiliation: Department of Assessment and Evaluation, Institute of Medical Education, University of Bern, Bern, Switzerland. stephanie.montagne@iml.unibe.ch.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Montagne
authors.affiliation: Department of Assessment and Evaluation, Institute of Medical Education, University of Bern, Bern, Switzerland. patrick.jucker@iml.unibe.ch.
authors.forename: Patrick
authors.initials: P
authors.lastname: Jucker-Kupper
authors.affiliation: Department of Assessment and Evaluation, Institute of Medical Education, University of Bern, Bern, Switzerland. christoph.berendonk@iml.unibe.ch.
authors.forename: Christoph
authors.initials: C
authors.lastname: Berendonk
authors.affiliation: Department of Assessment and Evaluation, Institute of Medical Education, University of Bern, Bern, Switzerland. soeren.huwendiek@iml.unibe.ch.
authors.forename: Sören
authors.initials: S
authors.lastname: Huwendiek
authors.affiliation: Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland. armin.gemperli@unilu.ch.|Swiss Paraplegic Research Nottwil, Nottwil, Switzerland. armin.gemperli@unilu.ch.
authors.forename: Armin
authors.initials: A
authors.lastname: Gemperli
authors.affiliation: Department of General Practice, University Medical Center, Göttingen, Germany. whimmel@gwdg.de.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Himmel
mesh_terms: D002982:Clinical Clerkship / Q000379:methods / Q000592:standards*; D002983:Clinical Competence / Q000592:standards*; D004504:Education, Medical, Undergraduate / Q000379:methods / Q000592:standards*; D004521:Educational Measurement / Q000379:methods / Q000592:standards*; D006801:Humans; D055361:Multilevel Analysis; D013337:Students, Medical; D013557:Switzerland