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Does weekly direct observation and formal feedback improve intern patient care skills development? A randomized
Gretchen Shelesky1, Frank D'Amico, Ruta Marfatia
1Medical Student Education, UPMC St Margaret, New Kensington, PA 15068, USA. sheleskyg@upmc.edu
Family Medicine
|July 14, 2012
Summary
Weekly direct observation with feedback improved intern comfort with patient care skills early in residency. However, clinical skills assessed via video did not significantly improve, suggesting targeted feedback
Area of Science:
- Medical Education Research
- Clinical Skills Assessment
- Residency Training
Background:
- Direct observation (DO) is a key method for evaluating patient care.
- Assessing the impact of structured feedback on intern development is crucial.
Purpose of the Study:
- To evaluate if weekly direct observation with formal feedback (DO-FF) enhances clinical skills and comfort with patient care skills (CWPCS) in interns.
- To determine the feasibility of randomized controlled trials (RCTs) in medical education research.
Main Methods:
- A single-blinded, stratified RCT with 14 interns in a family medicine residency program.
- Intervention group received DO-FF four times/month; control group did not.
- Clinical skills assessed via videotaped history and physicals (H&Ps); comfort assessed via patient care comfort survey (PCCS).
Main Results:
- Interns receiving DO-FF showed significantly improved CWPCS on 32 of 35 survey questions at 6 weeks.
- Specific areas of improvement included end-of-life discussions and management of various conditions.
- Differences in CWPCS largely resolved by 12 weeks; no significant difference in video-assessed clinical skills between groups.
Conclusions:
- DO-FF can enhance intern comfort with specific patient care skills in the short term.
- No significant improvement in objectively assessed clinical skills was observed.
- RCTs are feasible for studying educational interventions in residency programs.
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