Experience-based guidance for implementing a direct observation checklist in a pediatric emergency department setting

Area of Science:

• Medical Education
• Pediatric Emergency Medicine
• Clinical Skills Assessment

Background:

• Direct observation is crucial for residency training but faces implementation challenges.
• Physician time constraints and limited resources hinder effective direct observation.
• Sustainable methods for direct observation in medical education are needed.

Purpose of the Study:

• To develop and pilot a direct observation tool for assessing intern history and physical examination skills.
• To evaluate the feasibility and benefits of this tool in a pediatric emergency department rotation.

Main Methods:

• Developed specific history and physical examination checklists for common pediatric conditions.
• 10 faculty attendings observed 34 interns over one academic year.
• Assessed feasibility and benefits through interviews with faculty and interns.

Main Results:

• 33 of 34 interns were observed, with observations averaging 20 minutes.
• Observations facilitated clear, useful feedback and identified learning gaps.
• Interns and faculty reported significant learning benefits and improved teaching focus.

Conclusions:

• Direct observation checklists are feasible and beneficial for assessing intern clinical skills.
• Implementation details and challenges provide insights for others adopting direct observation.
• This method supports effective feedback and targeted teaching in residency programs.