TY - JOUR
T1 - Coaching Residents in the Ambulatory Setting
T2 - Faculty Direct Observation and Resident Reflection
AU - Graddy, Ryan
AU - Reynolds, Stasia S.
AU - Wright, Scott M.
PY - 2018/8/1
Y1 - 2018/8/1
N2 - Background : Direct observation can be valuable for learners' skill development in graduate medical education, but it is done infrequently. Information on how to optimize trainee learning from, and best practices of, direct observation interventions in the ambulatory setting is limited. Objective : We explored the impact of a focused outpatient direct observation and coaching intervention on internal medicine residents. Methods : Using a behavior checklist based on tenets of clinical excellence, 2 faculty preceptors observed outpatient primary care visits with 96% (46 of 48) of the internal medicine residents in 2017. Residents self-assessed their performance after the visit using the same checklist. Next, a focused coaching feedback session, emphasizing reflection, was structured to highlight areas of discrepancy between resident self-assessment and coach observation (blind spots), and residents were asked to identify goals for practice improvement. Results : Common blind spots in resident self-assessment related to collaborating with patients while using the electronic health record (48%, 21 of 44), hand washing (43%, 20 of 46), and asking thoughtful questions (40%, 18 of 45). At 1-month follow-up, 93% (43 of 46) of responding residents reported change in practice toward goals often or sometimes. All residents reported that the intervention felt comfortable, and 98% (45 of 46) noted that it helped them identify new behaviors to incorporate into clinical practice. Conclusions : Structured episodes of direct observation and coaching in the outpatient setting, with a behavior checklist, appear acceptable and useful for internal medicine residents' learning and development.
AB - Background : Direct observation can be valuable for learners' skill development in graduate medical education, but it is done infrequently. Information on how to optimize trainee learning from, and best practices of, direct observation interventions in the ambulatory setting is limited. Objective : We explored the impact of a focused outpatient direct observation and coaching intervention on internal medicine residents. Methods : Using a behavior checklist based on tenets of clinical excellence, 2 faculty preceptors observed outpatient primary care visits with 96% (46 of 48) of the internal medicine residents in 2017. Residents self-assessed their performance after the visit using the same checklist. Next, a focused coaching feedback session, emphasizing reflection, was structured to highlight areas of discrepancy between resident self-assessment and coach observation (blind spots), and residents were asked to identify goals for practice improvement. Results : Common blind spots in resident self-assessment related to collaborating with patients while using the electronic health record (48%, 21 of 44), hand washing (43%, 20 of 46), and asking thoughtful questions (40%, 18 of 45). At 1-month follow-up, 93% (43 of 46) of responding residents reported change in practice toward goals often or sometimes. All residents reported that the intervention felt comfortable, and 98% (45 of 46) noted that it helped them identify new behaviors to incorporate into clinical practice. Conclusions : Structured episodes of direct observation and coaching in the outpatient setting, with a behavior checklist, appear acceptable and useful for internal medicine residents' learning and development.
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U2 - 10.4300/JGME-17-00788.1
DO - 10.4300/JGME-17-00788.1
M3 - Article
C2 - 30154978
AN - SCOPUS:85064857779
SN - 1949-8349
VL - 10
SP - 449
EP - 454
JO - Journal of graduate medical education
JF - Journal of graduate medical education
IS - 4
ER -