TY - JOUR
T1 - What happens under the flag of direct observation, and how that matters
T2 - A qualitative study in general practice residency
AU - Rietmeijer, Chris B.T.
AU - Blankenstein, Annette H.
AU - Huisman, Daniëlle
AU - van der Horst, Henriëtte E.
AU - Kramer, Anneke W.M.
AU - de Vries, Henk
AU - Scheele, Fedde
AU - Teunissen, Pim W.
N1 - Publisher Copyright: © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021
Y1 - 2021
N2 - Introduction: In competency-based medical education, direct observation (DO) of residents’ skills is scarce, notwithstanding its undisputed importance for credible feedback and assessment. A growing body of research is investigating this discrepancy. Strikingly, in this research, DO as a concrete educational activity tends to remain vague. In this study, we concretised DO of technical skills in postgraduate longitudinal training relationships. Methods: Informed by constructivist grounded theory, we performed a focus group study among general practice residents. We asked residents about their experiences with different manifestations of DO of technical skills. A framework describing different DO patterns with their varied impact on learning and the training relationship was constructed and refined until theoretical sufficiency was reached. Results: The dominant DO pattern was ad hoc, one-way DO. Importantly, in this pattern, various unpredictable, and sometimes unwanted, scenarios could occur. Residents hesitated to discuss unwanted scenarios with their supervisors, sometimes instead refraining from future requests for DO or even for help. Planned bi-directional DO sessions, though seldom practiced, contributed much to collaborative learning in a psychologically safe training relationship. Discussion and conclusion: Patterns matter in DO. Residents and supervisors should be made aware of this and educated in maintaining an open dialogue on how to use DO for the benefit of learning and the training relationship.
AB - Introduction: In competency-based medical education, direct observation (DO) of residents’ skills is scarce, notwithstanding its undisputed importance for credible feedback and assessment. A growing body of research is investigating this discrepancy. Strikingly, in this research, DO as a concrete educational activity tends to remain vague. In this study, we concretised DO of technical skills in postgraduate longitudinal training relationships. Methods: Informed by constructivist grounded theory, we performed a focus group study among general practice residents. We asked residents about their experiences with different manifestations of DO of technical skills. A framework describing different DO patterns with their varied impact on learning and the training relationship was constructed and refined until theoretical sufficiency was reached. Results: The dominant DO pattern was ad hoc, one-way DO. Importantly, in this pattern, various unpredictable, and sometimes unwanted, scenarios could occur. Residents hesitated to discuss unwanted scenarios with their supervisors, sometimes instead refraining from future requests for DO or even for help. Planned bi-directional DO sessions, though seldom practiced, contributed much to collaborative learning in a psychologically safe training relationship. Discussion and conclusion: Patterns matter in DO. Residents and supervisors should be made aware of this and educated in maintaining an open dialogue on how to use DO for the benefit of learning and the training relationship.
KW - Assessment
KW - collaborative learning
KW - dialogue
KW - direct observation
KW - educational alliance
KW - feedback
KW - pattern theory
KW - residency
KW - residents’ agency
KW - technical skills
KW - training relationship
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U2 - https://doi.org/10.1080/0142159X.2021.1898572
DO - https://doi.org/10.1080/0142159X.2021.1898572
M3 - Article
C2 - 33765396
SN - 0142-159X
VL - 43
SP - 937
EP - 944
JO - Medical teacher
JF - Medical teacher
IS - 8
ER -