Introduction

Competency-based education (CBE) is an educational model that prioritizes the acquisition and demonstration of clearly defined competencies [1]. In the health profession, this has led to a paradigm shift from traditional time-based training to a model that prioritizes the achievement of defined clinical competencies [2]. In traditional models, learners progress through fixed timeframes, with an emphasis on curriculum delivery, often measured by attendance, examination performance, and procedural counts. In contrast, CBE emphasizes mastery of a range of key domains such as cognitive (knowledge and thinking skills), psychomotor (practical and procedural skills), and affective (professional attitudes, interpersonal skills, and ethics), rather than commencing with a rigid curriculum that focuses on what and how learners are taught [2,3]. By aligning educational outcomes with the current demands of clinical practice, CBE ensures that graduates are well-prepared for the complexities of contemporary healthcare by equipping them with a skill set that goes beyond academic knowledge to embrace holistic patient care [4]. Each competency outlined in the CBE curriculum serves as a reference point for the design of learning outcomes, instructional methods, and assessment strategies [5].

Successful CBE implementation in health-profession education requires robust assessment methods that can accurately evaluate student competencies in clinical settings [6]. This ensures that the learners meet the standards required for safe and effective patient care. In healthcare systems, workplace-based assessments (WBAs) have emerged as effective and popular tools for health-professional education. WBAs are conducted in a clinical context, allowing teachers to observe how learners interact with patients in the real world and to assess their professional, interpersonal, and clinical skills in real-life scenarios. These assessments can be used to evaluate clinical competence and professional behavior among learners in ways that written assessments or simulated stations cannot [7]. For instance, a national study on surgical education found that the use of WBAs significantly improved the quality of feedback, supervision, and assessment of relational competencies, such as communication and collaboration among surgical trainees and trainers [8].

One example of a WBA is the mini-clinical evaluation exercise (mini-CEX). It was initially developed by the American Board of Internal Medicine and has now been widely used in medical education to capture authentic interactions and clinical procedures as both formative and summative assessment tools [9]. Its flexible and structured approach enables real-time evaluation of clinical skills, professionalism, and decision-making abilities among learners [10]. A mini-CEX typically takes approximately 20 minutes, during which a learner performs a focused clinical task, such as patient history taking and physical examination, while being observed by a teacher. After discussing the diagnosis and management plan, the teacher assesses the learner and provides structured feedback to encourage reflective learning and ongoing improvement [11]. Compared to other commonly used assessment methods such as written examinations and Objective Structured Clinical Examinations (OSCEs), the mini-CEX offers several advantages. Written assessments predominantly measure cognitive knowledge, whereas OSCEs assess clinical skills in simulated environments under standardized conditions [12]. Unlike these traditional assessments, the mini-CEX supports learners by bridging the gap between classroom instruction and clinical performance, and by fostering both professional development and learner confidence [10,13]. This aligns with the philosophy of CBE in which progression is based on skill acquisition rather than training time [1].

Despite several published works highlighting the benefits of using the mini-CEX in medical education [9, 10], there remains a limited understanding of its widespread impact and adoption, specifically in nursing and dental education. This has resulted in a knowledge gap regarding how nursing and dental programs employ this assessment tool to enhance clinical training outcomes. These two professions were selected because of their hands-on clinical nature and increasing adoption of CBE, which makes them particularly suited for exploring the use of WBAs, such as the mini-CEX. Hence, a bibliometric analysis can provide a comprehensive quantitative overview of the scholarly landscape of mini-CEX in dental and nursing education. By analyzing publication numbers, authors, citation counts, and keywords, this study aimed to identify trends in the use of the mini-CEX assessment tool for future research. Such insights are important for educators and policymakers to understand the current utilization of mini-CEX, especially in nursing and dental education.

Methods

Ethics statement: This study was exempted from ethical review by the Institutional Review Board of the International Islamic University Malaysia, as it involved analysis of publicly available secondary data and posed no risk to human participants.

1. Study design

This study employed a descriptive bibliometric analysis using both performance analysis and science mapping techniques guided by the methodological framework proposed by Öztürk et al. [14]. This approach provides quantitative insights into publication trends and research impact in this field.

2. Research questions

The bibliometric analysis aimed to address the following questions: (1) What are the publication trends and citation patterns in research related to the mini-CEX in nursing and dental education? (2) Who are the key contributors (authors, institutions, and countries) to this research field? (3) What types of publications and scholarly linkages within the scientific literature pertain to the use of mini-CEX in nursing and dental education? (4) What are the potential research gaps in the current literature related to mini-CEX in nursing and dental education?

3. Eligibility criteria

Articles were included if they met the following criteria: (1) focused on the use of mini-CEX within the context of nursing or dental education; (2) involved relevant participants, including students, learners, trainees, clinical educators, and academic faculty; (3) published in English; and (4) indexed in the Web of Science Core Collection. Both empirical studies and systematic or narrative review articles were included if they directly discussed the use of mini-CEX in nursing or dental education and met all other criteria.

Articles were excluded if they met any of the following: (1) focused on other types of WBAs (e.g., direct observation of procedural skills and OSCEs) without specifically mentioning the mini-CEX; (2) investigated the mini-CEX in disciplines outside nursing or dentistry (e.g., medicine and pharmacy), unless nursing or dental education-related data could be extracted and analyzed separately; (3) were conference abstracts, commentaries, editorials, letters to the editor, or opinion pieces; (4) did not explicitly involve learners (students and trainees) or educators (teachers and clinical supervisors); and (5) were non-English-language publications.

4. Data sources and search strategy

A comprehensive search was conducted on the Web of Science database on July 1, 2025. The search strategy was developed using a combination of free-text keywords and controlled vocabulary terms (including medical subject headings, where applicable) linked by Boolean operators to maximize sensitivity and specificity. The final search string was: (“mini-CEX” OR “mini clinical evaluation exercise”) AND (“nursing” OR “nurse” OR “dental” OR “dentistry”). The search was limited to publications from 2002 onwards, as the mini-CEX was first introduced in that year [9]. All the retrieved references were exported to Microsoft Excel (Microsoft Corp., Redmond, WA, USA) for management and screening.

5. Study selection

The selection process comprised two main stages. First, the titles and abstracts of the retrieved articles were independently screened by two investigators (GSSL and AYYS). Duplicates were then identified and removed. The articles that passed the initial screening were subjected to a full-text review to confirm their eligibility based on the inclusion and exclusion criteria. Discrepancies were resolved by consensus among all investigators. Only articles that met all eligibility criteria were included in the final dataset for bibliometric analysis.

6. Data extraction

Standardized data extraction in Microsoft Excel was used to collect the following variables from each included article: bibliographic information (first author, full author list, title, year of publication, journal name, and publisher), study context (country of origin, institutional affiliation, and funding agency), study characteristics (discipline and study design), impact indicators (total number of citations, journal indexing, and quartile rankings according to Journal Citation Reports), keyword analysis (author-assigned keywords and keyword co-occurrences), and Sustainable Development Goals (SDGs) classification, if applicable.

7. Data analysis

Microsoft Excel and IBM SPSS version 24.0 (IBM Corp., Armonk, NY, USA) were used for descriptive analyses. A Mann-Whitney U test was used to compare citation counts between the two periods (2012–2019 vs. 2020–2025), given the non-normal distribution of citation data. Spearman rank-order correlation was used to examine the association between publication year and total citations. The significance level was set at p=0.05. VOSviewer software (ver. 1.6.20; Centre for Science and Technology Studies, Leiden University, The Netherlands) was used to examine the authors’ collaboration networks and keywords.

Results

Our initial database search yielded 51 articles. After removing non-eligible publication types, such as abstracts, proceedings, and editorials, and applying a language filter to include only English-language publications, 45 articles were retained for further screening. Subsequent title and abstract screening excluded three articles, leaving 42 articles for full-text review. Based on the eligibility criteria, 37 articles were included in the final bibliometric analysis. Five articles were excluded after full-text assessment because they did not primarily focus on the mini-CEX, did not have nursing or dental education context, or lacked extractable data relevant to these professions.

1. Citation performance, indexing status, and Sustainable Development Goal classification

The citation performance of the included articles is summarized in Table 1, where publications are ranked in descending order of citation counts. In cases in which multiple articles shared the same citation count, the journal impact factor score was used as a secondary criterion to determine their relative ranking, with articles published in journals with higher impact factors ranked higher. If both the citation count and impact factor were the same, the year of publication was considered, with earlier publications ranked higher.

The total number of citations across all the included articles was 229 (202 excluding self-citations), indicating a strong level of external referencing. This yielded an average of 6.19 citations per item. The articles were cited by 206 citing documents, of which 187 were not self-cited. The h-index of the included dataset was nine, indicating that nine articles had been cited at least nine times, reflecting a solid citation impact in the field of mini-CEX research in nursing and dental education. The most frequently cited article received 34 citations [15], whereas eight articles received 10 or more citations, placing them in the top 22% of all the included publications. In contrast, eight articles had no recorded citations at the time of data collection.

Of the 37 included articles, 25 (67.6%) were indexed in either the Science Citation Index Expanded (SCIE) or Social Sciences Citation Index (SSCI), and the remaining 12 (32.4%) were indexed in the Emerging Sources Citation Index (ESCI). In terms of alignment with SDGs, most of the included studies (n=28) were classified under SDG 04, Quality Education. An additional six articles were aligned with SDG 03, Good Health and Well-Being, while one article lacked a clear SDG classification [16]. Notably, two articles contributed to both SDG 03 and SDG 04, reflecting their dual relevance to healthcare outcomes and educational quality [15,17].

2. Article types, authorship patterns, and collaboration network

Of the 37 articles included, 22 focused on nursing education, 14 on dental education, and one addressed both disciplines. Regarding document type, the Web of Science database classified one article as a review and the remaining 36 were categorized as original research articles. A total of 36 scholars contributed as first authors, with Samira Mohajer listed as the first author of two articles (Fig. 1A). Six authors contributed at least two articles (Fig. 1B). The number of authors per article ranged from two to eight, with a mean of 4.81 and a median of five (Fig. 1C). Based on the distribution of authorship across articles, the most common number of authors was six (21.6%), followed by five (16.2%) and four (16.2%).

A co-authorship collaboration network was generated based on the authors who contributed to the selected set of publications (Fig. 2). The minimum threshold was set to include authors with at least one publication, which resulted in 172 authors meeting this criterion. However, not all these authors were interconnected; therefore, only the largest connected component, consisting of eight authors, was visualized and analyzed. In the network visualization, each node represents an individual author, the size of the node corresponds to the number of publications by that author, and the links between nodes reflect co-authorship ties, with thicker or more numerous lines representing stronger collaborative relationships.

3. Journals, publication trends, and impact factor rankings (Science Citation Index Expanded and Social Sciences Citation Index)

The distribution of journals in which the included articles were published is presented in Table 2, which is arranged in descending order based on publication frequency. BMC Medical Education emerged as the most prominent journal, publishing six articles, followed by Nurse Education in Practice, with three articles. In addition, five journals, the European Journal of Dental Education, GMS Journal for Medical Education, Journal of Clinical Nursing, Journal of Dental Education, and Journal of Family Medicine and Primary Care, each published two articles.

Among the 25 articles indexed in SCIE, SSCI, or both, 15 (42.9%) were published in Quartile 1 (Q1) journals, followed by three (8.6%) in Q2, four (11.4%) in Q3, and one (2.9%) in Q4 journals. The remaining 12 articles, indexed in the ESCI, were not assigned a quartile ranking and are thus classified as “Others” (Fig. 3A).

Table 3 and Fig. 3B illustrate that the highest number of publications occurred in 2022 (seven articles), whereas 2024 recorded the highest number of citations (58 citations). Both the number of publications and total citations were significantly higher from 2020 to 2025 than from 2012 to 2019 (p=0.001 for both publications and citations; Mann-Whitney U test). Furthermore, a strong and statistically significant positive correlation was observed between the number of publications and total citations (r=0.775, p=0.001; Spearman rank-order correlation).

4. Country contributions, publishers, institutional affiliations, funding, and keywords

As shown in Fig. 4A, most of the authors were from Iran (10 articles), followed by China (nine articles), Australia (four articles), Germany (four articles), Taiwan (three articles), the United States (three articles), India (two articles), Pakistan (two articles), and Malaysia (two articles). The remaining countries (Brazil, Chile, England, Indonesia, and Ireland) contributed one article each. The largest contributing publishers were Elsevier, Springer Nature, and Wiley, each contributing seven articles (Fig. 4B). This was followed by Wolters Kluwer Medknow Publications (two articles) and German Medical Science-GMS (two articles). The remaining publishers contributed one article each. Fig. 4C shows that both Golestan University of Medical Sciences and Mashhad University of Medical Sciences funded two articles (5.4% each). By contrast, 14 articles (37.84%) did not contain data on the financial agencies that supported the study.

Only nine universities were identified as having published two or more articles on the use of mini-CEX in either nursing or dental education. Among them, Shahid Beheshti University of Medical Sciences had the highest number of publications, contributing three articles (8.1%). This was followed by eight institutions: Australian National University, Friedrich Schiller University of Jena, Mashhad University of Medical Sciences, National Taiwan University, National Taiwan University Hospital, Universiti Malaya, University of Canberra, and University of Göttingen, each contributing two articles (5.4%). Supplementary Material 1 provides a complete list of all contributing institutions, including those with a single publication.

A total of 203 keywords were identified, with 46 distinct keywords meeting the threshold of at least two occurrences (Fig. 5). The keyword network revealed five main clusters, with “skills” (green), “mini-CEX” (red), “clinical competence” (yellow), “competence” (blue), and “impact” (purple) emerging as the most prominent terms. Other frequently co-occurring keywords included “assessment,” “formative assessment,” “workplace-based assessment,” “evaluation,” “nursing,” “OSCE,” “procedural skills,” and “medical education.”

Discussion

This bibliometric analysis offers an overview of the global research landscape concerning the use of mini-CEX in nursing and dental education. The Web of Science Core Collection was selected as the sole data source because of its comprehensive citation coverage, standardized indexing practices, and high-quality metadata within the selected fields, making it particularly suitable for bibliometric and citation analyses [18]. These findings provide important insights into publication patterns, research productivity, scholarly impact, and collaborative networks. The citation metrics of the included studies indicate a moderate but meaningful academic impact of mini-CEX research within the chosen fields of nursing and dentistry. The high proportion of citations (excluding self-citations) also suggests that these works were acknowledged and referenced by external researchers, reinforcing their relevance beyond immediate author networks [19]. The ranking method used in this study, which prioritized citation count, followed by journal impact factor and publication year, provided a transparent and structured method to differentiate the scholarly influence of closely matched articles [20].

A notable observation from the dataset is the higher representation of nursing-focused mini-CEX publications compared to those from dental education. This may reflect the broader and earlier integration of structured WBAs within nursing curricula, where clinical placements are often longer and more embedded across training years [21,22]. In contrast, dental education may rely more heavily on procedural checklists and competency logs [23,24], which are easier to implement and provide a straightforward way to document student progress. In addition, the one-on-one nature of dental procedures, where a single dental student or practitioner works directly with one patient at a time, and the tighter clinical schedules within dental curricula may limit opportunities for structured, observation-based assessments, such as the mini-CEX [25]. These contextual constraints may explain its more widespread adoption in nursing than in dental education.

The strong alignment with SDG 04 (Quality Education) demonstrates that mini-CEX research is often situated within broader efforts to improve teaching and learning in healthcare professions. This finding is consistent with literature from other disciplines, particularly medicine [9,10], where the mini-CEX has been increasingly adopted to support CBE, real-time feedback, and reflective practice. Meanwhile, a smaller proportion of articles aligned with SDG 03 (Good Health and Well-being), reflecting an indirect link between patient outcomes and healthcare quality through improved professional training [10]. Collectively, this dual alignment underscores the mini-CEX’s potential not only as a pedagogical tool for advancing quality education in health professions (SDG 04) but also as a strategic contributor to strengthening healthcare systems and achieving better patient outcomes globally (SDG 03).

The analysis of authorship and publication types revealed that nearly all the included articles were original research studies, with only one classified as a review. Such a pattern is consistent with trends observed in other healthcare research domains [26,27]. This suggests that the field is still in a development phase, where empirical investigations dominate, and comprehensive syntheses or theoretical frameworks are limited. Furthermore, the co-authorship network exhibited a fragmented structure, with most authors working in relatively isolated groups. Only a small subset of researchers formed an interconnected cluster, suggesting that collaborative ties across institutions or regions remain limited. This fragmented landscape may be attributed to the niche nature of mini-CEX research in nursing and dental education or the tendency for such studies to be institution-specific. Promoting cross-institutional or interprofessional collaboration could enhance both the visibility and methodological rigor of future studies in this domain.

The dominance of certain countries in publication output may reflect a growing institutional and national emphasis on enhancing the quality of health-profession education. The increasing contributions from countries such as Iran and China align with broader, well-documented trends in global scientific productivity within the healthcare domain [28,29]. By contrast, the relatively low representation in other countries may be due to mini-CEX research in nursing and dentistry being underreported or dispersed across broader health education or interprofessional journals that were not indexed in this analysis. It is also worth noting that many of the top contributing institutions are medical universities with integrated faculties of health sciences, which may offer a more supportive infrastructure for educational research and promote cross-disciplinary collaboration, particularly in settings where interprofessional education is actively encouraged [30]. To address regional disparities and broaden the evidence base, future efforts should focus on supporting publication visibility in underrepresented regions and strengthening cross-border collaboration.

The prominence of journals such as BMC Medical Education and Nurse Education in Practice was not unexpected. These journals are known for their global reach and inclusive editorial scope, making them the preferred outlets for health-profession educators worldwide. Moreover, bibliometric evidence shows that several low- and middle-income countries, such as Iran, India, and Malaysia, were actively involved in publishing research on mini-CEXs in nursing and dental education, reflecting the journal’s commitment to broader representation [31]. The high percentage of publications in Q1 journals reflects the growing recognition of educational research in clinical training and the credibility of mini-CEX as a valuable assessment tool. In contrast, several articles appeared in journals indexed under the ESCI, which typically includes journals in the early stages of establishing their impact factor quartile rankings. The ESCI serves as a platform for a diverse range of journals and provides emerging authors with opportunities to contribute to scholarly discourse [32,33]. The presence of mini-CEX studies in ESCI journals may reflect both growing interest in this specialized topic and the efforts of newer contributors to gain visibility within the academic publishing landscape.

The finding that articles published from 2020 onward received significantly more citations than earlier publications aligned with two interrelated phenomena. First, the global shift toward competency-based learning in recent years led to a surge in educational research [1,34], including studies exploring assessment adaptations in clinical training. Second, newer articles tend to benefit from increased digital discoverability, especially with the expansion of open access [35]. The strong positive correlation between the number of publications and citation counts suggests a growing academic interest in this area, which is likely to continue as health-profession education increasingly prioritizes clinical competence, real-time feedback, and student-centered learning [1,36]. However, uneven citation distribution is not uncommon in bibliometric studies as it may reflect variability in methodological quality, practical relevance, or visibility. It also highlights the ongoing need for greater dissemination and cross-disciplinary engagement with educational research involving mini-CEX.

The keyword analysis revealed that while terms like “skills,” “competence,” and “assessment” were consistently used, discipline-specific terms such as “nursing” appeared more frequently than “dentistry.” This further supports the observation that the mini-CEX has gained relatively greater traction in nursing education literature. Moreover, the prominence of keywords such as “formative assessment,” “evaluation,” and “multisource feedback” indicates an ongoing interest in leveraging the mini-CEX for continuous improvements rather than high-stakes decision-making. Interestingly, terms like “OSCE” and “procedural skills” also appeared, suggesting that researchers compare or complement mini-CEX with other assessment tools [37-39]. This highlights the potential for future integrative studies comparing effectiveness, feasibility, and learner perceptions of various WBAs in diverse contexts.

The combination of performance analysis and science mapping techniques in this bibliometric study allowed for both the quantitative measurement and visualization of scholarly impact, research networks, and thematic keyword evolution. Moreover, the inclusion of SDG classification provides a novel lens through which to assess the global relevance and societal contributions of mini-CEX research in nursing and dental education. Focusing on nursing and dental education, this study offers a discipline-specific perspective that has been underexplored in previous bibliometric reviews of WBAs.

Although this bibliometric analysis offered valuable insights, it had several limitations that must be acknowledged. First, the study relied solely on the Web of Science Core Collection and may have excluded relevant articles published in regional or discipline-specific databases, such as PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Second, only peer-reviewed English-language articles were included, potentially omitting valuable research published in other languages. Third, citation-based metrics are inherently time sensitive; newer articles may not have had sufficient time to accumulate citations, which could underestimate their long-term impact. In addition, as data collection for 2025 was limited to publications indexed up to June 30, 2025, the publication and citation counts for 2025 may increase in the latter half of the year, which could influence the temporal trend analyses.

In conclusion, the bibliometric findings revealed a steady increase in mini-CEX publications within nursing and dental education since 2020, with nursing education contributing a slightly larger share of the research output. Despite moderate citation metrics, the high proportion of Q1 journal publications and their alignment with key SDGs highlight the growing credibility and relevance of the mini-CEX in CBE. However, the fragmented authorship network and underrepresentation of certain regions highlight the need for enhanced collaboration and visibility in this field. Moving forward, integrating diverse methodological approaches and expanding interprofessional engagement can further advance the adoption and impact of mini-CEX as a valuable WBA tool in health-profession education.

Supplementary materials

Article information

Conflicts of interest

No potential conflict of interest relevant to this article was reported.

Funding

None.

Author contributions

Conceptualization: GSSL, AYYS; Data curation, Project administration, Visualization, Software: GSSL; Formal analysis: GSSL, GUJ; Investigation, Validation: AYYS; Methodology: GSSL, AYYS, EAS; Writing-original draft: GSSL; Writing-review & editing: AYYS, EAS, GUJ.

Fig. 1.

(A) Scholars contributed as the first author. (B) Authors who contributed at least two articles. (C) Total number of authorships in the selected articles.

Fig. 2.

Graphical mapping of co-authorships using the VOSviewer software (ver. 1.6.20; Centre for Science and Technology Studies, Leiden University, The Netherlands).

Fig. 3.

(A) Classification of the selected articles based on impact factor in quartiles (Q). (B) Number of articles and total citation counts concerning the year of publication.

Fig. 4.

(A) Publishers involved in the article’s publication. (B) Countries where articles were produced. (C) Funding agencies contributed to the selected published articles.

Fig. 5.

Graphical mapping of keywords using VOSviewer software (ver. 1.6.20; Centre for Science and Technology Studies, Leiden University, The Netherlands) with co-occurrence of at least two documents. Five main clusters emerged: “skills” (green), “mini-CEX” (red), “clinical competence” (yellow), “competence” (blue), and “impact” (purple).

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