# Student Perceptions of Assessment for Workplace Learning and Summative Decisions Using Frequent Mini-CEXs

## TL;DR

This study explores how frequent mini-CEX assessments during medical clerkships affect student learning and perceptions of summative evaluations.

## Contribution

It identifies student perceptions of frequent low-stakes mini-CEXs as both formative learning tools and contributors to summative decisions.

## Key findings

- Frequent mini-CEXs provide guided practice opportunities with low anxiety.
- Effective faculty feedback is crucial for maximizing learning from mini-CEXs.
- Students perceive mini-CEXs as formative with summative impact.

## Abstract

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Introduction: Direct observation assessments that provide both formative feedback and data for summative decisions can be difficult to achieve. The mini-clinical evaluation exercise (mini-CEX) is a widely used tool of direct observation that provides opportunities for feedback. We introduced a direct observation system with frequent mini-CEXs to increase clerkship student learning opportunities and to improve competency-based summative decisions. However, students may express resistance to assessments for learning with any summative impact as they may perceive the assessments as purely a series of summative evaluations.

Aims: We explored how frequent low-stakes mini-CEXs affect clerkship students’ perception of learning and to understand student perceptions of these assessments supporting their end-of-rotation summative clinical performance evaluations.

Methods: This qualitative study used a purposive sampling strategy of focus groups with students who completed multiple mini-CEXs during their four-week neurology clerkship at one of three sites. All eleven students chose to participate. Eight students completed eight mini-CEXs, two students completed seven, and one student completed four. Investigator triangulation was used with interpretation comparisons that included independent content analysis. The emerging themes were discussed and final theme consensus was reached.

Results: Three major themes arose: perceived effects of frequent mini-CEXs for clerkship student learning by facilitating multiple opportunities for guided practice under low assessment anxiety; the importance of consistent, effective faculty feedback and engagement to maximize mini-CEXs for learning; and support for summative impact of frequent, mainly formative, low stakes mini-CEXs.

Conclusions: Students perceived that frequent mini-CEXs are mainly formative assessments for learning while having summative impact. However, variable perceived faculty affinity and engagement with the mini-CEX are important considerations to maximize the assessments for learning. These findings support a shift towards workplace-based assessment programs for learning that promote frequent direct observation and feedback, while also improving the trustworthiness of summative decisions.