Direct Observation and Feedback on the Internal Medicine Clinical Teaching Unit

Main Article Content

Michael Ke Wang
Daniel Brandt Vegas


direct observation, feedback, internal medicine, survey, medical education


Background: Direct observation is an invaluable tool for assessing clinical skills. However, it is unclear whether trainees are regularly observed on internal medicine clinical teaching units (CTUs).

Methods: A web-based survey was distributed to medical students and residents completing rotations on inpatient internal medicine CTUs. Participants recorded the frequency of direct observation and observational feedback received over the past week.

Results: Of the 189 survey respondents, 76% reported receiving direct observation at least once. On average, six skill-specific observations were reported by each learner, with an average of two different skills being observed. Bedside clinical decision-making and physical examination skills were observed most frequently. Feedback was least often provided after the direct observation of physical examination and communication skills.
Conclusions: A quarter of trainees were not regularly observed at the internal medicine CTUs. The optimal frequency of direct observation requires further study.


Contexte: L’observation directe est un outil précieux d’évaluation des compétences cliniques. On ne sait pas si les stagiaires sont observés régulièrement dans les unités d’enseignement clinique (UEC) de médecine interne. Méthodologie: Un sondage en ligne a été transmis à des étudiants en médecine et à des résidents qui font des stages dans des UEC de médecine interne en milieu hospitalier. Les participants ont consigné la fréquence des observations directes et des rétroactions d’observations reçues au cours de la semaine précédente.

Résultats: Sur les 189 répondants au sondage, 76 % ont déclaré avoir reçu une observation directe au moins une fois. En moyenne, six observations sur une compétence particulière ont été déclarées par chaque apprenant, le nombre moyen decompétences différences qui ont été observées étant de deux. Les compétences relatives à la prise de décision clinique au chevet du patient et à l’examen physique ont fait le plus souvent l’objet d’une observation. Une rétroaction est survenue le moins souvent après l’observation directe de l’examen physique et de l’aptitude à communiquer.

Conclusions: Le quart des stagiaires n’ont pas été observés régulièrement à l’UEC de médecine interne. La fréquence optimale de l’observation directe doit faire l’objet d’une étude approfondie.

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