Good educators and orphans: the case of direct observation and feedback

Rietmeijer, Chris; Teunissen, Pim W.

doi:10.1111/medu.13835

Cited by 6 publications

(5 citation statements)

References 18 publications

(40 reference statements)

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“…While the resident-patient relationship was important, preceptors acknowledged limited opportunities for direct observation of resident-patient communication for a variety of reasons, including limited time. This challenge echoes prior literature on continuity clinic supervision and underscores the previously described need for preceptor models that decrease time constraints and facilitate direct observation [20,40]. Prior recommendations on supporting direct observation include discussing its utility with residents and implementing faculty development on observation and feedback [11,41,42].…”

Section: Discussionmentioning

confidence: 68%

How preceptors develop trust in continuity clinic residents and how trust influences supervision: A qualitative study

et al. 2021

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Introduction To advance in their clinical roles, residents must earn supervisors’ trust. Research on supervisor trust in the inpatient setting has identified learner, supervisor, relationship, context, and task factors that influence trust. However, trust in the continuity clinic setting, where resident roles, relationships, and context differ, is not well understood. We aimed to explore how preceptors in the continuity clinic setting develop trust in internal medicine residents and how trust influences supervision. Methods In this qualitative study, we conducted semi-structured interviews with faculty preceptors from two continuity clinic sites in an internal medicine residency program at an urban academic medical center in the United States from August 2018–June 2020. We analyzed transcripts using thematic analysis with sensitizing concepts related to the theoretical framework of the five factors of trust. Results Sixteen preceptors participated. We identified four key drivers of trust and supervision in the continuity clinic setting: 1) longitudinal resident-preceptor-patient relationships, 2) direct observations of continuity clinic skills, 3) resident attitude towards their primary care physician role, and 4) challenging context and task factors influencing supervision. Preceptors shared challenges to determining trust stemming from incomplete knowledge about patients and limited opportunities to directly observe and supervise between-visit care. Discussion The continuity clinic setting offers unique supports and challenges to trust development and trust-supervision alignment. Maximizing resident-preceptor-patient continuity, promoting direct observation, and improving preceptor supervision of residents’ provision of between-visit care may improve resident continuity clinic learning and patient care.

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Section: Discussionmentioning

confidence: 68%

How preceptors develop trust in continuity clinic residents and how trust influences supervision: A qualitative study

et al. 2021

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“…This, in turn, could perhaps help temper residents’ performance goal orientation for the benefit of their learning goal orientation (Teunissen et al, 2009 ). In addition to this, mutual expectations concerning the resident’s individual autonomy could perhaps sometimes make way for explicit mutual intentions to use DO situations for learning together (Rietmeijer & Teunissen, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

“…Informed by previous research, we expect that this use of DO will benefit from regularly planning DO sessions and making them bi-directional, meaning that the supervisor and the resident alternately take the role of the doctor and the observer (Young et al 2020 ; Voyer et al ( 2016 ) ; Rietmeijer et al, 2018 , Rietmeijer et al 2021 ). This approach is in line with principles of collaborative learning in which residents and supervisors are both on a learning continuum (Gibson et al, 2019 ; Rietmeijer & Teunissen, 2019 ).…”

Section: Implications For Practicementioning

confidence: 99%

A phenomenological investigation of patients’ experiences during direct observation in residency: busting the myth of the fly on the wall

Rietmeijer

Deves

Esch

et al. 2021

Adv in Health Sci Educ

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Direct observation (DO) of residents by supervisors is a highly recommended educational tool in postgraduate medical education, yet its uptake is poor. Residents and supervisors report various reasons for not engaging in DO. Some of these relate to their interaction with patients during DO. We do not know the patient perspectives on these interactions, nor, more broadly, what it is like to be a patient in a DO situation. Understanding the patient perspective may lead to a more complete understanding of the dynamics in DO situations, which may benefit patient wellbeing and improve the use of DO as an educational tool. We conducted a phenomenological interview study to investigate the experience of being a patient in a DO situation. Our analysis included multiple rounds of coding and identifying themes, and a final phase of phenomenological reduction to arrive at the essential elements of the experience. Constant reflexivity was at the heart of this process. Our results provide a new perspective on the role of the supervisor in DO situations. Patients were willing to address the resident, but sought moments of contact with, and some participation by, the supervisor. Consequently, conceptions of DO in which the supervisor thinks she is a fly on the wall rather than a part of the interaction, should be critically reviewed. To that end, we propose the concept of participative direct observation in workplace learning, which also acknowledges the observer’s role as participant. Embracing this concept may benefit both patients’ wellbeing and residents’ learning.

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“…Students commented that these underrepresented competency roles are often not explicitly addressed during clerkships and that they did not know what to include about these competencies in their portfolios. Rietmeijer and Teunissen [19] coined these underrepresented competencies as orphaned competencies. This underrepresentation of the non-medical expert roles is problematic, because both mentors and assessors need a complete and representative picture of the student's competence development.…”

Section: Discussionmentioning

confidence: 99%

Student perspectives on competency-based portfolios: Does a portfolio reflect their competence development?

Pool¹,

Jaarsma²,

Driessen³

et al. 2020

Perspect Med Educ

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Introduction Portfolio-based assessments require that learners' competence development is adequately reflected in portfolio documentation. This study explored how students select and document performance data in their portfolios and how they perceive these data to be representative for their competence development.Methods Students uploaded performance data in a competency-based portfolio. During one clerkship period, twelve students also recorded an audio diary in which they reflected on experiences and feedback that they perceived to be indicants of their competence development. Afterwards, these students were interviewed to explore the extent to which the performance documentation in the portfolio corresponded with what they considered illustrative evidence of their development. The interviews were analyzed using thematic analysis.Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40037-020-00571-7) contains supplementary material, which is available to authorized users. A. Oudkerk Pool ( ) School of Health Professions EducationResults Portfolios provide an accurate but fragmented picture of student development. Portfolio documentation was influenced by tensions between learning and assessment, student beliefs about the goal of portfolios, student performance evaluation strategies, the learning environment and portfolio structure. Discussion This study confirms the importance of taking student perceptions into account when implementing a competency-based portfolio. Students would benefit from coaching on how to select meaningful experiences and performance data for documentation in their portfolios. Flexibility in portfolio structure and requirements is essential to ensure optimal fit between students' experienced competence development and portfolio content.Keywords Portfolio · Assessment · Competencybased medical education · Medical students 166 Student perspectives on competency-based portfolios

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Good educators and orphans: the case of direct observation and feedback

Abstract: The authors propose the concept of orphaned competencies, those that are good for clinical education, but often are not taken up by good clinical educators. Prolonged direct observation is promoted as a way forward.

Cited by 6 publications

References 18 publications

How preceptors develop trust in continuity clinic residents and how trust influences supervision: A qualitative study

How preceptors develop trust in continuity clinic residents and how trust influences supervision: A qualitative study

A phenomenological investigation of patients’ experiences during direct observation in residency: busting the myth of the fly on the wall

Student perspectives on competency-based portfolios: Does a portfolio reflect their competence development?

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Good educators and orphans: the case of direct observation and feedback

Abstract: The authors propose the concept of orphaned competencies, those that are good for clinical education, but often are not taken up by good clinical educators. Prolonged direct observation is promoted as a way forward.

Cited by 6 publications

References 18 publications

How preceptors develop trust in continuity clinic residents and how trust influences supervision: A&nbsp;qualitative study

How preceptors develop trust in continuity clinic residents and how trust influences supervision: A&nbsp;qualitative study

A phenomenological investigation of patients’ experiences during direct observation in residency: busting the myth of the fly on the wall

Student perspectives on competency-based portfolios: Does a&nbsp;portfolio reflect their competence development?

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How preceptors develop trust in continuity clinic residents and how trust influences supervision: A qualitative study

How preceptors develop trust in continuity clinic residents and how trust influences supervision: A qualitative study

Student perspectives on competency-based portfolios: Does a portfolio reflect their competence development?