Introduction of a Direct Observation Program Into a Pediatric Resident Continuity Clinic: Feasibility, Acceptability, and Effect on Resident Feedback

Abstract

Background: Direct observations of trainee performance are essential to the evaluation of clinical skills, and are now required by the Accreditation Council on Graduate Medical Education (ACGME). Purpose: We sought to describe the feasibility and acceptability of a direct observation program in a pediatric resident clinic, and evaluate its effect on feedback. Methods: We modified the Structured Clinical Observation (SCO) for use in a pediatric resident clinic. Preceptors and residents were asked about the frequency and content of feedback given before and after the introduction of the observations. Results: One-hundred-sixty-six structured clinical observations were performed. Their use increased the frequency of feedback provided, and resulted in more feedback on listening skills and less feedback on medical knowledge and decision making. Conclusions: Structured clinical observations can be successfully introduced into a pediatric resident continuity clinic. This is a valuable supplement to the traditional precepting, and fulfills the mandate to include direct observations in the assessment of residents’ clinical competence.

We thank Drs. Lane and Gottlieb from Jefferson Medical College, Philadelphia, Pennsylvania, for the idea of the SCO, and Drs. Cuzzi, Coddington, and Hamburger from Children’s National Medical Center, Washington, DC, who developed a SCO checklist for use with pediatric residents. We thank Dr. Jay Weedon for statistical assistance and Dr. Suzanne S. Mirra for her help with the manuscript.