![]() ![]() Step 4: Position yourself non-obtrusively such that you can adequately observe the resident and the patient without interfering with the doctor-patient space. Step 3: Ask the resident to inform the patient and obtain his/her permission for your presence. ![]() This adds structure, transparency, and can help to decrease the anxiety, even if just a little. Step 2: Let the resident know when DO will be occurring, describe the purpose, inform that you will be a “fly on the wall”-except on the floor and larger and with only two feet. ![]() ![]() We use our own tool developed from patient interviewing textbooks and experience. The residents should have access to the feedback/evaluation tool: a good tool will help the learner learn as well as the evaluator evaluate. Have the skills to be observed segregated by competency. This provides baseline standardization among observers. Step 1: Use a structured tool to guide observation and feedback. Also, senior residents do DO on interns providing inpatient care. For us, each resident’s advisor and the behavioral science faculty do most of the DO. More can be done for residents about whom there are questions, concerns, uncertainty, or signs of educational difficulty. Start small with one to two DO per resident per year, or one/6 months. Some stay that way, but over time most acclimate to or at least accept or expect it as part of the program’s landscape. If DO is so valuable, why is it not used more often? It is time intensive, and time is money. While a physician is in the best position to globally assess all of the competencies simultaneously, other medical professionals can readily observe and describe specific skills, eg, behavioral scientists, clinical pharmacists, nurses, senior residents. For those in osteopathic training, DO is particularly effective for assessing OMM (osteopathic manual manipulation) skills. Indirectly, but also readily assessable, are the competencies of medical knowledge and system-based practice. 5 Further, teachers become aware of what actually happened instead of just hearing a filtered report from the learner.ĭO readily allows direct assessment of key ACGME core competencies in real-time, under actual circumstances: patient care, interpersonal and communication skills, practice-based learning and Improvement, and professionalism. Observable skills include history taking, physical examination, and procedural skills.ĭO has been shown to have advantages and positive effects for teachers and learners: identification of otherwise unrecognized deficiencies, which can allow for remediation where needed, 1, 2 needs assessment before implementing a curriculum, 3 more reliable for formative feedback than self-assessment,4 and increased learner confidence. The encounter may be with either a real or simulated patient we prefer real. This article describes and discusses DO, then makes suggestions on how to effectively perform it.ĭO involves carefully and purposefully watching and listening to a resident work through a patient encounter. Though resource intensive, Direct Observation (DO) is a terrific tool for formative and summative feedback that is part of the Accreditation Council for Graduate Medical Education (ACGME) toolbox for evaluation. The purpose of residency education is to train physicians to care effectively for patients. Stephen Wilson, MD, MPH, and Gretchen Shelesky, MD, MS, University of Pittsburgh Medical Center St Margaret Family Medicine Residency Direct Observation: What It Is and How to Effectively Perform It ![]()
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