The influence of students' prior clinical skills and context characteristics on mini-CEX scores in clerkships - a multilevel analysis.

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. CONCLUSION 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.

Breaking Points: Mutiny in the Continental Army

The mutinies of the Continental Army during the American Revolution threatened both the integrity of the army and the viability of the Revolution itself. They were complex phenomena, stemming from numerous underlying physical and psychological causes. Having slowly developed over the course of the war, the problems confronting the Continental Army eventually brought it to the breaking point. No less than four major mutinies, involving soldiers or officers, occurred between 1780-1783. This essay focuses on the reasons for the mutinies and how the participants justified their actions. It also examines responses from General Washington and other senior officers, and what effects these actions had on the army. Finally, this essay addresses the question of why so few major mutinies occurred given the miserable state of the Continental Army.

Ueber Juden

[Heinrich Friedrich Diez]

L' esprit des esprits, ou pensées choisies : pour servir de suite aux Maximes de la Rochefoucault

Vorlageform des Erscheinungsvermerks: A Londres, & se trouve à Hambourg chez Virchaux, Imprimeur-libraire

Vorstellung der Execution, welche an den beyden Wallachischen Rebellen, Horia und Klotska, zu Karlsburg vollzogen worden

I. D. D. [d.i. wahrscheinl. Johann David Donnhäuser]

Etwas über den Kempelischen Schachspieler : eine Gruppe philosophischer Grillen

[Johann Philipp Ostertag]

Quinti Horatii Flacci Opera : Ad Optimas Editiones Collata

Praemittitur Notitia Literaria Studiis Societatis Bipontinae

Ms. lat. qu. 43 - Tractatus asceticus iuxta usus et constitutiones sacri et exempti ordinis Cisterciensis

Vorbesitzer: Georg Kloß

Ms. lat. oct. 60 - Directorium Moguntinum ad usum ecclesiae S. Bartholomaei Francfordensis

Die tatsächliche Blattzahl weicht von den Angaben des Kataloges ab.