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

Abstract

An 'observer effect' may partly explain learners' ambivalence about direct observation; being observed seemed to magnify learners' role ambiguity, intensify their tensions around professional development and raise questions about the credibility of feedback. In turn, an observer effect may impact learners' receptivity to feedback and may explain, in part, learners' perceptions that useful feedback is scant. For direct observation to be valuable, educators must be explicit about expectations, and they must be aware that how learners perform in the presence of an observer may not reflect what they do as independent practitioners. To nurture learners' professional development, educators must create a culture of observation-based coaching that is divorced from assessment and is tailored to developing learners' identities as practitioners of both the art and the science of medicine.

Assessment, feedback and the alchemy of learning

“…Learners, however, maintain some ambivalence about direct observation during their clinical education: they recognise that it has value, but also identify a certain discomfort with being observed that shapes how they respond . For learners, being observed typically feels like being assessed . Because they feel as if they are being assessed, they may alter their routines by, for example, interacting differently with their patient or adopting a checklist‐style approach to their history taking and physical examination as if they were performing in an examination setting rather than just doing their clinical work.…”

“…These alterations to the routine may create a performance that feels inauthentic to the learner: a performance geared toward doing well on an assessment rather than serving as the basis for feedback or coaching. When the performance on which feedback is crafted feels inauthentic, the feedback may ring hollow …”

Where philosophy meets culture: exploring how coaches conceptualise their roles

“…Direct observation is embraced as valuable by learners, but its use challenges two core cultural values in medicine: efficiency and autonomy . As a result, teachers and learners alike may harbour ambivalence about direct observation that compromises efforts to bolster the frequency of its use . Research on feedback has demonstrated that although feedback needs to be credible and constructive to be viewed as useful by learners, the very definitions of credible and constructive are culturally influenced; credible feedback in music and credible feedback in medicine may not be the same …”

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

“…Engaging in direct observation and feedback, according to a growing body of research, is challenging for residents and supervisors. Residents struggle with unclear stakes, fears of assessment, credibility judgements regarding the observer, and issues around authenticity, autonomy and efficiency . In this literature, longitudinal training relationships are mentioned as providing a way forward .…”