Centre for Education Research & Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Med Educ. 2017 May;51(5):498-510. doi: 10.1111/medu.13232. Epub 2017 Feb 28.
Evidence strongly supports that direct observation is a valid and reliable assessment tool; support for its impact on learning is less compelling, and we know that some learners are ambivalent about being observed. However, learners' perceptions about the impact of direct observation on their learning and professional development remain underexplored. To promote learning, we need to understand what makes direct observation valuable for learners.
Informed by constructivist grounded theory, we interviewed 22 learners about their observation experiences. Data collection and analysis occurred iteratively; themes were identified using constant comparative analysis.
Direct observation was widely endorsed as an important educational strategy, albeit one that created significant anxiety. Opaque expectations exacerbated participants' discomfort, and participants described that being observed felt like being assessed. Consequently, participants exchanged their 'usual' practice for a 'textbook' approach; alterations to performance generated uncertainty about their role, and raised questions about whether observers saw an authentic portrayal of their knowledge and skill.
An 'observer effect' may partly explain learners' ambivalence about direct observation; being observed seemed to magnify learners' role ambiguity, intensify their tensions around professional development and raise questions about the credibility of feedback. In turn, an observer effect may impact learners' receptivity to feedback and may explain, in part, learners' perceptions that useful feedback is scant. For direct observation to be valuable, educators must be explicit about expectations, and they must be aware that how learners perform in the presence of an observer may not reflect what they do as independent practitioners. To nurture learners' professional development, educators must create a culture of observation-based coaching that is divorced from assessment and is tailored to developing learners' identities as practitioners of both the art and the science of medicine.
有强有力的证据表明直接观察是一种有效且可靠的评估工具；但它对学习的影响的证据则不那么有说服力，而且我们知道有些学习者对被观察持矛盾态度。然而，学习者对直接观察对他们的学习和专业发展的影响的看法仍然没有得到充分的探究。为了促进学习，我们需要了解是什么让直接观察对学习者有价值。
受建构主义扎根理论的启发，我们采访了 22 名学习者，了解他们的观察经验。数据收集和分析是迭代进行的；使用恒定性比较分析确定了主题。
直接观察被广泛认为是一种重要的教育策略，尽管它会引起很大的焦虑。不透明的期望加剧了参与者的不适，参与者描述说被观察就像是在被评估。因此，参与者将他们的“常规”做法换成了“教科书”式的做法；对表现的改变导致他们对自己的角色产生了不确定性，并质疑观察者是否看到了他们知识和技能的真实写照。
“观察者效应”可能部分解释了学习者对直接观察的矛盾态度；被观察似乎放大了学习者的角色模糊性，加剧了他们在专业发展方面的紧张情绪，并对反馈的可信度提出了质疑。反过来，观察者效应可能会影响学习者对反馈的接受程度，并在一定程度上解释了学习者认为有用的反馈很少的看法。为了使直接观察有价值，教育者必须明确期望，并且必须意识到学习者在观察者面前的表现可能并不反映他们作为独立从业者的实际表现。为了促进学习者的专业发展，教育者必须创造一种基于观察的辅导文化，这种文化与评估脱钩，并针对培养学习者作为医学艺术和科学的实践者的身份进行调整。
