Direct Observation and Feedback on the Internal Medicine Clinical Teaching Unit
Main Article Content
Keywords
direct observation, feedback, internal medicine, survey, medical education
Abstract
Abstract
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.
Résumé
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.
References
1. Gonzalo JD, Heist BS, Duffy BL, Dyrbye L, Fagan MJ, Ferenchick G, et al. The art of bedside rounds: a multi-center qualitative study of strategies used by experienced bedside teachers. J Gen Intern Med. 2013;28(3):412–420. https://doi.org/10.1007/s11606-012-2259-2
2. Kogan JR, Conforti LN, Bernabeo EC, Durning SJ, Hauer KE, Holmboe ES. Faculty staff perceptions of feedback to residents after direct observation of clinical skills. Med Educ. 2012;46(2):201–215. https://doi.org/10.1111/j.1365-2923.2011.04137.x
3. Kogan JR, Hauer KE. Brief report: Use of the mini-clinical evaluation exercise in internal medicine core clerkships. J Gen Intern Med. 2006;21(5):501–512. https://doi.org/10.1111/j.1525-1497.2006.00436.x
4. Lorwald AC, Lahner FM, Nouns ZM, Berendonk C, Norcini J, Greif R, et al. The educational impact of Mini-Clinical Evaluation Exercise (Mini-CEX) and Direct Observation of Procedural Skills (DOPS) and its association with implementation: A systematic review and meta-analysis. PLoS One 2018;13(6):e0198009. https://doi.org/10.1371/journal.pone.0198009
5. Hauer KE, Oza SK, Kogan JR, Stankiewicz CA, Stenfors-Hayes T, Cate OT, et al. How clinical supervisors develop trust in their trainees: A qualitative study. Med Educ. 2015;49(8):783–795. https://doi.org/10.1111/medu.12745
6. Kogan JR, Hatala R, Hauer KE, Holmboe E. Guidelines: The do's, don'ts and don't knows of direct observation of clinical skills in medical education. Perspect Med Educ. 2017;6(5):286–305. https://doi.org/10.1007/s40037-017-0376-7
7. Association of American Medical Colleges. Canadian Medical School Graduation Questionnaire—All Schools Summary, 2009. Washington, DC: AAMC; 2009.
8. Association of American Medical Colleges. Medical School Graduation Questionnaire, 2019. Washington, DC: AAMC; 2019
9. Howley LD, Wilson WG. Direct observation of students during clerkship rotations: A multiyear descriptive study. Acad Med. 2004;79(3):276–280. https://doi.org/10.1097/00001888-200403000-00017
10. Schopper H, Rosenbaum M, Axelson R. 'I wish someone watched me interview:' Medical student insight into observation and feedback as a method for teaching communication skills during the clinical years. BMC Med Educ. 2016;16(1):286. https://doi.org/10.1186/s12909-016-0813-z
11. Watling C, LaDonna KA, Lingard L, Voyer S, Hatala R. 'Sometimes the work just needs to be done': Socio-cultural influences on direct observation in medical training. Med Educ. 2016;50(10):1054–1064. https://doi.org/10.1111/medu.13062
12. Artino AR, Jr., La Rochelle JS, Dezee KJ, Gehlbach H. Developing questionnaires for educational research: AMEE Guide No. 87. Med Teach. 2014;36(6):463–474. https://doi.org/10.3109/0142159X.2014.889814
13. Kogan JR, Holmboe ES, Hauer KE. Tools for direct observation and assessment of clinical skills of medical trainees: A systematic review. JAMA. 2009;302(12):1316–1326. https://doi.org/10.1001/jama.2009.1365
14. Bates J, Konkin J, Suddards C, Dobson S, Pratt D. Student perceptions of assessment and feedback in longitudinal integrated clerkships. Med Educ. 2013;47(4):362–374. https://doi.org/10.1111/medu.12087
15. LaDonna KA, Hatala R, Lingard L, Voyer S, Watling C. Staging a performance: Learners' perceptions about direct observation during residency. Med Educ. 2017;51(5):498–510. https://doi.org/10.1111/medu.13232
16. Ten Cate O, Hart D, Ankel F, Busari J, Englander R, Glasgow N, et al. Entrustment decision-making in clinical training. Acad Med. 2016;91(2):191–198. https://doi.org/10.1097/ACM.0000000000001044
17. Chaiyachati KH, Shea JA, Asch DA, Liu M, Bellini LM, Dine CJ, et al. Assessment of inpatient time allocation among first-year internal medicine residents using time-motion observations. JAMA Int Med. 2019;179(6):760. https://doi.org/10.1001/jamainternmed.2019.0095
18. Daniels MD. How to maximize bedside teaching in our busy world. Can J Gen Intern Med. 2015;10(3):29. https://doi.org/10.10.22374/cjgim.v10i3.57
19. Hampton JR, Harrison MJ, Mitchell JR, Prichard JS, Seymour C. Relative contributions of history-taking, physical examination, and laboratory investigation to diagnosis and management of medical outpatients. Br Med J. 1975;2(5969):486–489. https://doi.org/10.1136/bmj.2.5969.486
20. Peterson MC, Holbrook JH, Von Hales D, Smith NL, Staker LV. Contributions of the history, physical examination, and laboratory investigation in making medical diagnoses. West J Med. 1992;156(2):163–165. https://doi.org/10.1097/00006254-199210000-00013
21. Kirch W, Schafii C. Misdiagnosis at a university hospital in 4 medical eras. Medicine (Baltimore). 1996;75(1):29–40. https://doi.org/10.1097/00005792-199601000-00004
22. Kalet A, Earp JA, Kowlowitz V. How well do faculty evaluate the interviewing skills of medical students? J Gen Intern Med. 1992;7(5):499–505. https://doi.org/10.1007/BF02599452
23. Gonzalo JD, Masters PA, Simons RJ, Chuang CH. Attending rounds and bedside case presentations: Medical student and medicine resident experiences and attitudes. Teach Learn Med. 2009;21(2):105–110. https://doi.org/10.1080/10401330902791156
24. Boissy A, Windover AK, Bokar D, Karafa M, Neuendorf K, Frankel RM, et al. Communication skills training for physicians improves patient satisfaction. J Gen Intern Med. 2016;31(7):755–761. https://doi.org/10.1007/s11606-016-3597-2
25. Franks P, Fiscella K, Shields CG, Meldrum SC, Duberstein P, Jerant AF, et al. Are patients' ratings of their physicians related to health outcomes? Ann Fam Med. 2005;3(3):229–234.
26. Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM. Physician–patient communication. The relationship with malpractice claims among primary care physicians and surgeons. JAMA 1997;277(7):553–559. https://doi.org/10.1001/jama.277.7.553
https://doi.org/10.1001/jama.1997.03540310051034
27. Chen W, Liao SC, Tsai CH, Huang CC, Lin CC, Tsai CH. Clinical skills in final-year medical students: The relationship between self-reported confidence and direct observation by faculty or residents. Ann Acad Med (Singapore). 2008;37(1):3–8.
28. Pfeiffer C, Madray H, Ardolino A, Willms J. The rise and fall of students' skill in obtaining a medical history. Med Educ. 1998;32(3):283–288. https://doi.org/10.1046/j.1365-2923.1998.00222.x
29. Smith J, Jacobs E, Li Z, Vogelman B, Zhao Y, Feldstein D. Successful implementation of a direct observation program in an ambulatory block rotation. J Grad Med Educ. 2017;9(1):113–117. https://doi.org/10.4300/JGME-D-16-00167.1
30. Graddy R, Reynolds SS, Wright SM. Coaching residents in the ambulatory setting: Faculty direct observation and resident reflection. J Grad Med Educ. 2018;10(4):449–454. https://doi.org/10.4300/JGME-17-00788.1
31. Evans C. Making sense of assessment feedback in higher education. Rev Educ Res. 2013;83(1):70–120. https://doi.org/10.3102/0034654312474350
32. Gauthier S, Melvin L, Mylopoulos M, Abdullah N. Resident and attending perceptions of direct observation in internal medicine: A qualitative study. Med Educ. 2018;52(12):1249–1258. https://doi.org/10.1111/medu.13680
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Articles are published under a Creative Commons Attribution - Non Commercial 4.0 International License. Authors and users are free to copy and redistribute the material in any medium or format, with proper attribution, for non-commercial purposes. Authors retain copyright to their article.
Michael Ke Wang, McMaster University, Hamilton, Canada
Department of Medicine, McMaster University, Hamilton, ON, Canada
Population Health Research Institute, McMaster University, Hamilton, ON, Canada;
Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
Daniel Brandt Vegas, McMaster University, Hamilton, Canada
Department of Medicine, McMaster University, Hamilton, ON, Canada
McMaster Education Research Innovation and Theory Program, McMaster University, Hamilton, ON, Canada