Direct Observation: Assessing Orthopaedic Trainee Competence in the Ambulatory Setting

Area of Science:

• Medical Education
• Surgical Training
• Competency-Based Assessment

Background:

• Accreditation Council of Graduate Medical Education mandates six core competencies for residency programs.
• Effective assessment is crucial for trainee competence and patient care quality.
• Direct observation offers a feasible method for assessing nontechnical skills and providing feedback.

Purpose of the Study:

• To evaluate a structured, direct observation program for assessing core competencies in residents.
• To determine the feasibility of using direct observation in outpatient settings for competency assessment.
• To identify methods for tracking and addressing faculty concerns regarding resident performance.

Main Methods:

• Trained faculty conducted direct observations of residents in outpatient settings.
• Checklists were utilized to document communication skills, clinical reasoning, physical examination, and medical record keeping.
• Faculty concerns regarding professionalism, medical knowledge, fatigue, and self-assessment were systematically tracked.
• Serial observations were employed to monitor and reinforce skills and identify areas for improvement.

Main Results:

• The direct observation program facilitated assessment of all core competencies.
• Checklists provided structured documentation of resident performance in key areas.
• Faculty concerns were tracked, allowing for early identification of residents needing additional coaching.
• Serial observations enabled monitoring of progress and reinforcement of skills.

Conclusions:

• Structured direct observation is a feasible and effective method for assessing core competencies in residency programs.
• This approach allows for individualized educational programs and ensures trainees excel across all domains of competence.
• Early identification and intervention for residents needing support are facilitated by serial observations.