Structured Clinical Observations (SCO)

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Structured Clinical Observations(SCO)

• USUHS Pediatric Education Section
• September 2003

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Millers Triangle
Millers triangle of clinical competence (Miller
GE. The assessment of clinical skills/ Competence/
performance. Acad Med 1990 65 563-7)
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Drs. K. Pituch, S. Bogdewic, M. Harris Indiana
University

• Developed BSOs (brief structured observations) in
  early 1990s.
• Includes a debrief of the learner What were you
  trying to accomplish during the segment of the
  encounter. What did you find out or
  communicate What else is important to find out
  or communicate?
• Academic Medicine May 1999

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Drs. L. Lane and R. Gottlieb Jefferson

• Responding to 1995 literature review and GEA of
  AAMC noting shortcomings in teaching and
  evaluation of clinical skills.
• Developed SCO as a clinical skills teaching model
  that is economical of time and low cost.
• Provide observation to ensure clinical
  competence.
• Short, limited feedback points.
• Teaching experience, not evaluation.

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Evaluation of SCO (Lane and Gottlieb)

• 60 students, 6-10 faculty, 368 observations, mean
  observations per student of 6
• Rated as highly educational by both faculty and
  students.
• For 50 of students, it was only experience of
  direct observation of a clinical encounter.
• Redirects energies of faculty to formative rather
  than summative assessment.
• Pediatrics April 2000

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How are SCOs done?

• Students learn what the SCO is during the
  clerkship orientation.
• During each clinic session students review the 3
  different checklist forms (Data Gathering,
  Physical Exam, and Information Giving).
• http//www.pedsedu.com/forms.htm
• Preceptors advise students that the focus of the
  observation will be on the process of the
  interview, physical exam, or information giving
  session.

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How are SCOs done?

• Time permitting, the faculty preceptor
  unobtrusively enters the room and observes part
  of the student/patient encounter
• Observations are focused by using the objective
  skills guidelines listed on the individual SCO
  checklists.

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SCO Checklist Data Gathering

• Opening/Closing the interview
• Data collection ( open-ended questions, logical
  sequencing of questions)
• Relationship skills (listens carefully,
  legitimizes patients feelings or concerns)
• Personal Manner (good eye contact, appropriate
  body language)

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How are SCOs done?

• After 3 feedback points (positive or negative)
  are observed, the preceptor exits the exam room
  and allows the student to complete the encounter.
• Feedback should be given to the student, either
  immediately after the encounter, or before the
  end of the clinic day.