The Enablers and Barriers to the Use of Direct Observation of Trainee Clinical Skills by Supervising Faculty in a Psychiatry Residency Program
Madan, Robert, Conn, David, Dubo, Elyse, Voore, Peter, Wiesenfeld, Leslie, Canadian Journal of Psychiatry
Objective: Studies have reported that medical trainees do not get sufficient direct observation. Our study aimed to determine the frequency of direct observation and the enablers and barriers to direct observation in the department of psychiatry at a large Canadian university.
Method: Focus groups and interviews explored the role and use of direct observation, followed by a survey both of faculty and of residents.
Results: Direct observation was used in various contexts in the residents' last rotation. Missed opportunities are identified. Enablers include financial compensation, guidelines, and a discussion at the beginning of each clinical rotation. Barriers are identified at the resident, faculty, and administrative levels.
Conclusions: Direct observation is used in many contexts in psychiatric training. While there are barriers which limit its use, our data indicate numerous potential enablers and missed opportunities for more observation.
Objectif : Des études ont conclu que les stagiaires en médecine n'obtiennent pas suffisamment d'observation directe. Notre étude visait à déterminer la fréquence de l'observation directe ainsi que les outils et les obstacles de l'observation directe au département de psychiatrie d'une grande université canadienne.
Méthode : Des groupes de discussion et des entrevues ont exploré le rôle et l'usage de l'observation directe, suivis d'un sondage pour les professeurs et les résidents.
Résultats : L'observation directe a été utilisée dans divers contextes du dernier stage des résidents. Les occasions ratées ont été identifiées. Les outils sont notamment la rémunération, les lignes directrices, et une discussion au début de chaque stage clinique. Les obstacles sont identifiés au niveau des résidents, des professeurs, et de l'administration.
Conclusions : L'observation directe est utilisée dans de nombreux contextes de la formation psychiatrique. Bien que des obstacles en limitent l'usage, nos données indiquent de nombreux outils potentiels et des occasions ratées de plus d'observation.
Key Words: medical education, observation, evaluation
Received May 2011, revised, and accepted November 2011.
Residency is a time for faculty to ensure that residents develop clinical competence by directly observing trainees' work. The benefits to the evaluation of resident performance are well documented.1·2 Additionally, direct observation by faculty has been rated as a highly valuable experience by residents.3 Direct observation is a requirement in the evaluation of residents in the Royal College of Physicians and Surgeons of Canada Standards of Accreditation.4
There are few studies exploring direct observation in residency. Studies in emergency medicine have reported that residents receive infrequent observation by faculty.5·6 Evidence exploring the barriers to more frequent observation is lacking. Our study aimed to acquire information from residents and faculty in a department of psychiatry regarding the use of direct observation in psychiatric training. The goal was to explore the frequency of observation and the enablers and barriers to the use of direct observation in the program.
A mixed-methods case study approach was adopted7 to explore the experiences of residents and faculty with direct observation in a psychiatry residency training program in a large urban medical school in Canada (University of Toronto) and 3 affiliated teaching hospitals. Ethics approval was acquired from all institutions. Dillman's tailored design method,8 based on social exchange theory, was used for survey development and implementation.
A purposeful sampling technique7 was used to identify the 25 participants for the qualitative aspect of this study, the results of which informed survey development. With informed consent, five 60-minute focus groups were conducted by a research assistant in May and June 2008 with residents (1 from each of the 3 affiliated hospital sites), and 2 with faculty who supervise residents. …