O'Connell Kathleen, Landreville Jeffrey, Dudek Nancy, McDougall Allan, Reed Melissa, Cheung Warren J
is a Resident Physician, University of Ottawa, Ottawa, Ontario, Canada.
is an Assistant Professor, Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.
J Grad Med Educ. 2025 Apr;17(2):182-188. doi: 10.4300/JGME-D-24-00603.1. Epub 2025 Apr 15.
Despite calls for increased direct observation for workplace feedback and assessment, such forms of observation are not always feasible. A considerable amount of trainee observation occurs via indirect means. To explore attending and resident perspectives on direct and indirect observation to determine their impact on workplace feedback and assessment. Ten attending and 8 resident physicians were interviewed about their experiences and perspectives regarding direct and indirect observation. Data were collected from January to November 2021. Interview transcripts were analyzed using inductive thematic analysis. Major themes identified included: varying descriptions of direct and indirect observation, factors influencing the selection of observation type, the perceived utility of each observation type, and the perceived quality and credibility of feedback generated by each observation type. Direct observation was preferred for assessment of technical, communication, and leadership skills. Attending physicians felt they could provide an accurate assessment of the learner's clinical reasoning and management using indirect observation. However, residents did not consistently find the resultant feedback to be credible. This tension seemed to stem from residents not being aware of how indirect observation informed attending physicians' judgements and feedback. Residents with more insight on the use and methods for indirect observation perceived this feedback as credible. Participants identified that indirect methods can be useful and appropriate for the assessment of clinical reasoning and for fostering independence. Residents demonstrating an understanding of how indirect observation informed attending physicians' assessments appeared to find this feedback more credible.
尽管有人呼吁增加对工作场所反馈和评估的直接观察，但这种观察形式并不总是可行的。大量的实习生观察是通过间接方式进行的。为了探讨主治医生和住院医生对直接和间接观察的看法，以确定它们对工作场所反馈和评估的影响。对10名主治医生和8名住院医生就他们对直接和间接观察的经历和看法进行了访谈。数据收集于2021年1月至11月。使用归纳主题分析法对访谈记录进行了分析。确定的主要主题包括：对直接和间接观察的不同描述、影响观察类型选择的因素、每种观察类型的感知效用，以及每种观察类型产生的反馈的感知质量和可信度。直接观察更适合用于评估技术、沟通和领导技能。主治医生认为他们可以通过间接观察对学习者的临床推理和管理提供准确的评估。然而，住院医生并不总是认为由此产生的反馈是可信的。这种矛盾似乎源于住院医生不知道间接观察是如何为主治医生的判断和反馈提供依据的。对间接观察的使用和方法有更多见解的住院医生认为这种反馈是可信的。参与者认为间接方法对于评估临床推理和培养独立性可能是有用和合适的。表现出理解间接观察如何为主治医生的评估提供依据的住院医生似乎认为这种反馈更可信。
