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Patterns of direct observation and their impact during residency: general practice supervisors’ views
Author(s) -
Rietmeijer Chris B T,
Huisman Daniëlle,
Blankenstein Annette H,
Vries Henk,
Scheele Fedde,
Kramer Anneke W M,
Teunissen Pim W
Publication year - 2018
Publication title -
medical education
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.776
H-Index - 138
eISSN - 1365-2923
pISSN - 0308-0110
DOI - 10.1111/medu.13631
Subject(s) - supervisor , data collection , medical education , focus group , psychology , post hoc analysis , medicine , political science , sociology , social science , anthropology , law
Context Direct observation ( DO ) of residents’ performance, despite the importance that is ascribed to it, does not readily fit in with the practice of postgraduate medical education ( PGME ); it is infrequent and the quality of observation may be poor in spite of ongoing efforts towards improvement. In recent literature, DO is mostly portrayed as a means to gather information on the performance of residents for purposes of feedback and assessment. The role of DO in PGME is likely to be more complex and poorly understood in the era of outcome‐based education. By exploring the possible complexity of DO in workplace learning, our research aims to contribute to a better use of DO in the practice of PGME . Methods Constructivist grounded theory informed our data collection and analysis. Data collection involved focus group sessions with supervisors in Dutch general practice who were invited to discuss the manifestations, meanings and effects of DO of technical skills. Theoretical sufficiency was achieved after four focus groups, with a total of 28 participants being included. Results We found four patterns of DO of technical skills: initial planned DO sessions; resident‐initiated ad hoc DO ; supervisor‐initiated ad hoc DO , and continued planned DO sessions. Different patterns of DO related to varying meanings, such as checking or trusting, and effects, such as learning a new skill or experiencing emotional discomfort, all of them concerning the training relationship, patient safety or residents’ learning. Conclusions Direct observation, to supervisors, means much more than gathering information for purposes of feedback and assessment. Planned DO sessions are an important routine during the initiation phase of a training relationship. Continued planned bidirectional DO sessions, although infrequently practised, potentially combine most benefits with least side‐effects of DO . Ad hoc DO , although much relied upon, is often hampered by internal tensions in supervisors, residents or both.