Systematic Direct Observation of Clinical Skills in the Clinical Year

Abstract

Abstract Introduction Direct observation of clinical skills is vital to medical student development. However, direct observation of medical students by faculty is often sporadic, undocumented, and unstandardized. We sought to increase feedback to students and help students recognize they are receiving feedback. The purpose of this resource was to teach intentional, systematic feedback on clinical skills that is standardized within all required clinical clerkships. Methods This resource provides the direct observation curriculum and the observation forms used in the required clerkships, including surgery, internal medicine, psychiatry, neurology, pediatrics, obstetrics and gynecology, family medicine, and emergency medicine. For the purpose of direct observation, the clerkships developed and adopted an assessment checklist for a problem-focused history (e.g., abdominal pain), organ-specific physical examination (e.g., abdominal exam), and an advanced communication skill (e.g., information sharing). Results Before the implementation of systematic direct observation, 71% of students reported direct observation of history examination and 82% direct observation of physical examination (average across all required clerkships). After implementation, 92% reported direct observation of history and 96% for physical examination. Discussion Implementation of a systematic program for direct observation of clinical skills can effectively increase direct observation of clinical skills. Furthermore, at the end of the clinical year, we can ensure that the major patient problems and the key portions of the physical examination have been observed and formative feedback provided by faculty.

Keywords

• Feedback
• Medical Students
• Clerkship
• Clinical Skills
• Observation
• Direct Observation