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Resident and attending perceptions of direct observation in internal medicine: a qualitative study
Author(s) -
Gauthier Stephen,
Melvin Lindsay,
Mylopoulos Maria,
Abdullah Nadine
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.13680
Subject(s) - cognitive reframing , perception , grounded theory , medical education , qualitative research , psychology , medicine , social psychology , social science , neuroscience , sociology
Objectives Direct observation is the foundation of assessment and learning in competency‐based medical education ( CBME ). Despite its importance, there is significant uncertainty about how to effectively implement frequent and high‐quality direct observation. This is particularly true in specialties where observation of non‐procedural skills is highly valued and presents unique challenges. It is therefore important to understand perceptions of direct observation to ensure successful acceptance and implementation. In this study, we explored perceptions of direct observation in internal medicine. Methods We interviewed internal medicine attending physicians ( n = 9) and residents ( n = 8) at the University of Toronto, purposively sampled for diversity. Using a constructivist grounded theory approach, constant comparative analysis was performed to develop a framework to understand perceptions of direct observation on the clinical teaching units. Results Participants articulated a narrow perception of what constitutes direct observation, in contrast to their own descriptions of skills that were observed. This resulted in the perception that certain valuable skills that participants felt were routinely observed were nonetheless not ‘directly observable’, such as clinical reasoning, observed through case presentations and patient care discussions. Differentiating direct observation from informal observation led to overestimation of the time and resource requirements needed to enhance direct observation, which contributed to scepticism and lack of engagement related to CBME implementation. Conclusions In an internal medicine training programme, perceptions of what constitutes direct observation can lead to under‐recognition and hinder acceptance in workplace‐based assessment and learning. Our results suggest a reframing of ‘direct observation’ for residents and attending physicians, by explicitly identifying desired skills in non‐procedurally‐based specialties. These findings may help CBME ‐based training programmes improve the process of direct observation, leading to enhanced assessment and learning.