Direct Observation
What is direct observation and why use it?
Direct observation of trainees interacting with patients is vital to assess the learner "in action". Direct observation is just as it sounds, watching learners perform clinical skills such as history taking, physical examination and communication. Direct observation is important to actually witness the process of the learner collecting data from patients.
When and how do I use direct observation?
Direct observation can be used in various areas of patient care. Below are three main areas that direct observation assesses:
• History taking
• Physical exam
• Communication skills
You can use direct observation by simply watching the learner perform a specific skill and recording the interaction. Allow the learner to perform the entire skill before making comments or becoming involved in the patient learner interaction. Try to spread out your observations and use different patients to assess different skills. Don't use one patient encounter to evaluate all of the learner's skills. It can be very useful to use your affiliated university's observation recording form to allow you to record the event and make an assessment.
Early in the rotation use frequent direct observation to assess the degree of independence appropriate for the learner. Ensure that you record a direct observation at least once a week throughout the clinical attachment using the Field Notes
Wakefield- preceptor manual needs complete ref.
Westberg & Jason. Collaborative Clinical Education : The Foundation of Effective Health Care. 1994. Springer publishing company USA
Quick Tips:
- Focus on one component of the patient-learner interaction
- Be a "fly on the wall" when observing a learner
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Possible Pitfalls:
- Interrupting and making comments throughout the patient-learner encounter
- Assessing all of the learner's skills with only one patient
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How can I prevent observing the learner from slowing down my practice?
If you book patients for yourself while the learner sees his/her own patients you can observe certain aspects of the patient-learner interaction. For example, if you wish to observe the learner taking a history, schedule your own patient 10 minutes after the learner sees his/her patient. This will allow you time to observe the skill while still keeping a regular flow of patients through your office. 1
1 Wakefield- preceptor manual needs complete ref.
2
Westberg & Jason. Collaborative Clinical Education : The Foundation of Effective Health Care. 1994. Springer publishing company USA
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