Amy E. Fleming, MD, Joseph Gigante, MD, Vanderbilt University School of Medicine, Nashville, TN
Background: Direct expert observation with feedback is the gold standard for improving learner performance in clinical practice. However, this effective pattern of expert observation and feedback is often not occurring in medical training due to logistics and faculty time constraints. We implemented a program designed to facilitate individualized observation and feedback by a pediatric faculty member for each 3rd year medical student during their inpatient pediatric rotation. Methods: 27 teaching faculty from a variety of pediatric specialties were nominated and selected into a teaching society based on their history of excellence in teaching. Society faculty were asked to dedicate two hours on 4 afternoons per year for direct observation of students. Students were divided into groups of four and met as a group with the teaching faculty to perform a focused H&P on one of the student’s own patients. Faculty used a standardized Observation Encounter form. Free text comments were incorporated at the bottom of the form. Each student examined their patient while observed by the group. Immediate feedback was given to the student after the encounter. Results: The program has been operating for just over one year. 103 students have participated in this non-graded, but required, component of the rotation; 93 turned in their observation forms. Faculty spend on average 30 minutes per student (4 students in 2 hours). Comments from faculty in free text were predominantly encouraging (78%), with 22% constructive feedback. Comments were categorized by ACGME competency: Patient Care 32%, Medical Knowledge 8%, Practice Based Learning 1%, Systems Based Practice 0, Professionalism 4%, Communication 55%. Conclusion: Using a group of dedicated teaching faculty we were able to create a program where every 3rd year pediatric clerkship student received direct faculty observation and feedback about a clinical encounter. Faculty time requirement was approximately 30 min per student (8 total hours). Students received feedback particularly in the areas of patient care and communication. Faculty and students have described satisfaction with the program and feel that the time spent is worthwhile.