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Perceptions of scheduled vs. unscheduled directly observed visits in an internal medicine residency outpatient clinic

INTRODUCTION: Learners may subconsciously change their behavior once they know they are being observed, and this Hawthorne effect should be considered when designing assessments of learner behavior. While there is a growing body of literature to suggest direct observation is the ideal standard for f...

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Autores principales: Rea, Joanna, Stephenson, Christopher, Leasure, Emily, Vaa, Brianna, Halvorsen, Andrew, Huber, Jill, Bonnes, Sara, Hafdahl, Luke, Post, Jason, Wingo, Majken
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7057513/
https://www.ncbi.nlm.nih.gov/pubmed/32131806
http://dx.doi.org/10.1186/s12909-020-1968-1
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author Rea, Joanna
Stephenson, Christopher
Leasure, Emily
Vaa, Brianna
Halvorsen, Andrew
Huber, Jill
Bonnes, Sara
Hafdahl, Luke
Post, Jason
Wingo, Majken
author_facet Rea, Joanna
Stephenson, Christopher
Leasure, Emily
Vaa, Brianna
Halvorsen, Andrew
Huber, Jill
Bonnes, Sara
Hafdahl, Luke
Post, Jason
Wingo, Majken
author_sort Rea, Joanna
collection PubMed
description INTRODUCTION: Learners may subconsciously change their behavior once they know they are being observed, and this Hawthorne effect should be considered when designing assessments of learner behavior. While there is a growing body of literature to suggest direct observation is the ideal standard for formative assessment, the best method to directly observe learners is unknown. We explored scheduled and unscheduled methods of direct observation among internal medicine residents in the outpatient continuity clinic to advance the understanding of both observation methods. METHODS: We conducted a thematic analysis of faculty and internal medicine residents in an outpatient clinic setting. A semi-structured interview guide for focus group sessions was created. Focus groups were used to explore the internal medicine resident and core teaching faculty perceptions of the scheduled and unscheduled direct observation methods in the outpatient clinc. An experienced qualitative research interviewer external to the internal medicine residency was moderating the sessions. Eight peer focus groups were held. Abstraction of themes from focus group transcripts identified resident and faculty perceptions of the different observation methods. RESULTS: Focus groups had 14 resident participants and 14 faculty participants. Unscheduled observations were felt to be more authentic than scheduled observations since residents perceived their behavior to be unmodified. Unscheduled observations allowed for increased numbers of observations per resident, which permitted more frequent formative assessments. Residents and faculty preferred remote video observation compared to in-room observation. Participants found direct observation a useful learning tool for high-yield, specific feedback. CONCLUSIONS: Unscheduled remote direct observation captures authentic clinical encounters while minimizing learner behavior modification. An unscheduled observation approach results in more frequent formative assessment and therefore in more instances of valuable feedback compared to scheduled observations. These findings can help guide the best practice approaches to direct clinical observation in order to enhance residents learning and experience.
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spelling pubmed-70575132020-03-10 Perceptions of scheduled vs. unscheduled directly observed visits in an internal medicine residency outpatient clinic Rea, Joanna Stephenson, Christopher Leasure, Emily Vaa, Brianna Halvorsen, Andrew Huber, Jill Bonnes, Sara Hafdahl, Luke Post, Jason Wingo, Majken BMC Med Educ Research Article INTRODUCTION: Learners may subconsciously change their behavior once they know they are being observed, and this Hawthorne effect should be considered when designing assessments of learner behavior. While there is a growing body of literature to suggest direct observation is the ideal standard for formative assessment, the best method to directly observe learners is unknown. We explored scheduled and unscheduled methods of direct observation among internal medicine residents in the outpatient continuity clinic to advance the understanding of both observation methods. METHODS: We conducted a thematic analysis of faculty and internal medicine residents in an outpatient clinic setting. A semi-structured interview guide for focus group sessions was created. Focus groups were used to explore the internal medicine resident and core teaching faculty perceptions of the scheduled and unscheduled direct observation methods in the outpatient clinc. An experienced qualitative research interviewer external to the internal medicine residency was moderating the sessions. Eight peer focus groups were held. Abstraction of themes from focus group transcripts identified resident and faculty perceptions of the different observation methods. RESULTS: Focus groups had 14 resident participants and 14 faculty participants. Unscheduled observations were felt to be more authentic than scheduled observations since residents perceived their behavior to be unmodified. Unscheduled observations allowed for increased numbers of observations per resident, which permitted more frequent formative assessments. Residents and faculty preferred remote video observation compared to in-room observation. Participants found direct observation a useful learning tool for high-yield, specific feedback. CONCLUSIONS: Unscheduled remote direct observation captures authentic clinical encounters while minimizing learner behavior modification. An unscheduled observation approach results in more frequent formative assessment and therefore in more instances of valuable feedback compared to scheduled observations. These findings can help guide the best practice approaches to direct clinical observation in order to enhance residents learning and experience. BioMed Central 2020-03-04 /pmc/articles/PMC7057513/ /pubmed/32131806 http://dx.doi.org/10.1186/s12909-020-1968-1 Text en © The Author(s). 2020 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Rea, Joanna
Stephenson, Christopher
Leasure, Emily
Vaa, Brianna
Halvorsen, Andrew
Huber, Jill
Bonnes, Sara
Hafdahl, Luke
Post, Jason
Wingo, Majken
Perceptions of scheduled vs. unscheduled directly observed visits in an internal medicine residency outpatient clinic
title Perceptions of scheduled vs. unscheduled directly observed visits in an internal medicine residency outpatient clinic
title_full Perceptions of scheduled vs. unscheduled directly observed visits in an internal medicine residency outpatient clinic
title_fullStr Perceptions of scheduled vs. unscheduled directly observed visits in an internal medicine residency outpatient clinic
title_full_unstemmed Perceptions of scheduled vs. unscheduled directly observed visits in an internal medicine residency outpatient clinic
title_short Perceptions of scheduled vs. unscheduled directly observed visits in an internal medicine residency outpatient clinic
title_sort perceptions of scheduled vs. unscheduled directly observed visits in an internal medicine residency outpatient clinic
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7057513/
https://www.ncbi.nlm.nih.gov/pubmed/32131806
http://dx.doi.org/10.1186/s12909-020-1968-1
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