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Factors and Interactions Influencing Direct Observation: A Literature Review Guided by Activity Theory
Margaret Swanberg1, Sarah Woodson-Smith2, Louis Pangaro3
1Department of Neurology, Uniformed Services University, Bethesda, Maryland, USA.
Teaching and Learning in Medicine
|July 9, 2021
Summary
Direct observation in medical education is crucial for patient safety. This study found that social factors, not just tools or raters, significantly impact workplace-based assessments, highlighting an underexplored area for improvement.
Area of Science:
- Medical Education
- Healthcare Quality and Safety
Background:
- Competency-based medical education emphasizes workplace-based assessments for physician competence.
- Direct observation in authentic patient care contexts is key but faces objectivity challenges.
Purpose of the Study:
- To systematically review factors influencing direct observation of medical trainees in authentic patient care settings.
- To identify underexplored factors, particularly social elements, affecting assessment objectivity.
Main Methods:
- Conducted a systematic literature review of studies on direct observation of undergraduate (UME) and graduate (GME) medical trainees.
- Searched PubMed, Embase, Web of Science, and ERIC databases.
- Applied Activity Theory to analyze factors and interactions affecting direct observation in patient care contexts.
Main Results:
- Nineteen articles were included, with most focusing on GME learners and settings like the operating room and Emergency Department.
- While rater and tool influences are studied, the impact of social elements (rules, environment, community) on direct observation is largely underexplored.
- Activity Theory revealed significant interactions and tensions between various factors affecting these assessments.
Conclusions:
- Activity Theory provides a valuable framework for understanding and improving direct observation in medical education.
- Future research should focus on the identified underexplored social and contextual factors to enhance assessment objectivity and effectiveness.
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