Repeated Mini-CEX encounters as a workplace-based learning tool for final-year dental students: a convergent mixed-methods study

Abstract Background Workplace-based assessment is increasingly emphasized in competency-based health professions education because it allows direct observation of learners in authentic clinical settings. The Mini-Clinical Evaluation Exercise (Mini-CEX) is widely used in medical education, but its use in undergraduate dental education, particularly in Pakistan, remains limited. This study explored changes associated with repeated Mini-CEX encounters among final-year dental students and examined students’ reflective experiences related to feedback, confidence, and learning. Methods A convergent parallel mixed-methods study was conducted among final-year Bachelor of Dental Surgery students at Karachi Medical and Dental College, Karachi, Pakistan. Forty-one students completed two Mini-CEX encounters approximately two months apart. Quantitative data included Mini-CEX domain scores, student satisfaction scores, observation time, and feedback time. Paired differences were assessed using Wilcoxon signed-rank tests, with paired-samples t-tests performed as sensitivity analyses. Qualitative data were collected through reflective essays after the second encounter and analyzed using inductive thematic analysis. Quantitative and qualitative findings were integrated through triangulation. Results Student satisfaction increased significantly from 5.56 ± 0.63 to 7.24 ± 0.73 ( p < 0.001). Observation time decreased from 21.71 ± 2.40 min to 7.33 ± 0.94 min, and feedback time decreased from 14.39 ± 2.55 min to 3.48 ± 0.73 min (both p < 0.001). Humanistic qualities/professionalism improved significantly from 4.49 ± 1.40 to 5.07 ± 0.69 (Wilcoxon p = 0.019). Medical interviewing scores showed a possible modest improvement from 4.54 ± 1.38 to 4.93 ± 0.52 (Wilcoxon p = 0.047), although the difference was not statistically significant in the paired-samples t-test sensitivity analysis. Overall clinical competence increased descriptively from 4.61 ± 1.39 to 5.00 ± 0.63, but did not reach statistical significance. Qualitative analysis generated five themes: emotional tension as a gateway to learning, feedback as a catalyst for clinical confidence, experiential learning as a bridge between theory and practice, perceived faculty attitudes shaping student engagement, and professional growth and identity formation. Conclusion Repeated Mini-CEX encounters were associated with improved student satisfaction, reduced observation and feedback time, significant improvement in professionalism, and a possible modest improvement in medical interviewing scores. However, no statistically significant improvement was observed in overall clinical competence or in several other competency domains, including physical examination, clinical judgment, counseling skills, and organization/efficiency. The reduction in feedback time should not be interpreted as evidence of improved feedback quality. These findings suggest that repeated Mini-CEX encounters may support selected aspects of clinical learning, feedback uptake, reflective practice, and perceived professional growth, but they do not demonstrate broad improvement in overall clinical competence. Mini-CEX may be a useful formative workplace-based assessment strategy in undergraduate dental education when implemented with structured feedback, trained assessors, and appropriate monitoring of feedback quality.