Observing trainee encounters using a one-way mirror

Abstract

Summary Background Direct observation of patient encounters is a key component of evaluating residents during training, but there are scarce data on the various methods of observation. Aim To implement a novel method for direct observation of out‐patient encounters via a one‐way mirror in an internal medicine resident practice, and to assess the feasibility and acceptance of this method. Methods Each selected resident–patient encounter was directly observed by a preceptor through a one‐way mirror. The preceptor provided feedback to the resident at the conclusion of each encounter. A post‐visit survey assessed resident satisfaction and comfort with this method of observation. Results Using a one‐way mirror was a feasible method of observation. Fifty residents had a clinic visit that was directly observed, and 42 (84%) completed the post‐visit survey. Residents reported that they preferred direct observation through a one‐way mirror compared with other methods, including videotaped encounters or having a preceptor physically present in the room. They also felt that having a preceptor observing through the one‐way mirror had no negative effect on the clinic visit. Conclusions Direct observation through a one‐way mirror is a viable method in the out‐patient setting, and might be preferable for evaluating certain skills.

‘Sometimes the work just needs to be done’: socio-cultural influences on direct observation in medical training

“…McMaster University's approach to assessment in the emergency room setting is built on the principle that direct observation of learners must occur despite frequent interruptions, non‐standard patient presentations and competing interests such as the need to maintain efficient patient flow . Seghel's use of one‐way mirror observation of internal medicine residents in clinic settings is based, in part, on the principle that resident autonomy can be better maintained if the observer is not physically in the room during the encounter …”

“…Kennedy's work highlighted the value of independence within the medical culture and showed that residents’ desire to be (and to be seen to be) independent might dissuade them from asking for help . In two studies of direct observation in the out‐patient setting, residents expressed discomfort about being observed, related, in part, to a perceived loss of autonomy . If we are to successfully embed direct observation as a routine pedagogical practice, we require a better understanding of how these cultural factors, and others, might challenge our efforts.…”

Staging a performance: learners’ perceptions about direct observation during residency

“…Direct observation can serve either summative or formative purposes, and it may be used in a variety of settings, ranging from formalised assessment contexts like the objective structured clinical examination (OSCE) and the mini‐clinical examination (mini‐CEX), to informal coaching‐oriented contexts in which assessment is not the express goal . Observation‐based summative assessment tools have garnered the bulk of research attention, but direct observation can and should play a formative role in identifying learners’ strengths and weaknesses, to support continuous developmental feedback and to help learners create an action plan to address identified deficiencies. Observation, in short, forms the basis for coaching; however, the observational strategies that support effective coaching remain inadequately defined …”

A Decade of Teaching and Learning in Internal Medicine Ambulatory Education: A Scoping Review

“…However, 3 of the 41 studies (7%) describe the evaluation of resident practice through direct observation, demonstrating logistical feasibility and trainee acceptance. 50,63,64 Enhancing opportunities for direct observation may enable better assessment of competency and improved supervision.…”