Observation as a tool for effective evaluation

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Observation as a tool for effective evaluation

• The University of British ColumbiaFaculty of
  MedicineDepartment of Family PracticePost
  Graduate Program

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Objectives

• Outline the College of Family Physicians
  requirements for observation in the Evaluation
  Process
• Explore what Direct Observation is and how it
  aids evaluation
• Create a Framework to understand the process of
  evaluation through observation
• Understand how to make our observation and
  evaluation effective

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The Red Book (College Standards for
Accreditation)

• Defines a number of requirements that all
  teaching programs must incorporate in their
  evaluation process
• MUST focus on the 4 principles of Family Medicine
• Must document that the learner is learning
  quantitative and qualitative information.
• Must record 32 direct observations, some of which
  are video taped
• Must involve a variety of patients and skills,
  including history taking, physical exam,
  procedural skills and the doctor patient
  relationship with difficult patients.

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The Red Book

• How many observations?
• 32 over 2 years
• 4 direct observations per month on block time.
• 1 observation per month on half days back
• Our program requires 8 video taped sessions.

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What is Direct Observation?

• Observing
• Being Observed
• Taking notes and Recording
• Making a judgement

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Question/discussion

• When sitting in the room with a patient and the
  resident, how do you avoid or at least reduce
  interaction with the patient while you are trying
  to observe the residents interaction?

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Trying to be invisible
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Question

• What are the Pros and Cons of video taped
  encounters?

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Video taped encounters

• Pros
• Removes interference of the teacher
• Allows learner to see himself or herself as an
  observer
• Observation by the teacher can be done at his or
  her convenience

• Cons
• Requires written consent from the patient
• Makes patient or resident self -conscious/uneasy
• Requires planning and set-up

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Video tips for the preceptor

• 1/ You dont need a camera.
• The resident has a camera available to him or her
  through the Program. He or she can set it up
  before the office begins.
• 2/ The resident is responsible to explain the
  process of video taping to the patient and get
  informed consent.
• 3/ You can review the tape at your convenience.
• You can concentrate on one aspect of the video.
  You dont have to review it all with your
  resident

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A framework for observation and evaluation

• Cues
• Hypotheses generation
• Testing
• Management decisions
• Follow-up .........
• And back to Cues

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Question

• Your resident is about to see a new mom and her
  one week old daughter for a first routine check.
• Suggest what skills or functions you might
  decide to observe on this encounter?

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Observations
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Making your observations and evaluation effective

• Effective means Having the intended or
  expected effect producing a strong impression or
  response
• Your observation and evaluation is effective when
  it has a positive benefit for the resident and
  the Program

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To be effective we need to consider

• The learning objectives of the resident for the
  rotation based on the residents past experience
  and his or her perceived needs.

• The Educational objectives of the Program based
  on the Four Principles of Family Medicine of the
  College of Family Physicians.

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What to observe?

• When using your observation framework, plan to
  observe areas of weakness you have previously
  identified or items identified in your
  residents learning objectives.
• The advantage of observation over a post
  encounter discussion with your resident is that
  you will observe issues that should be addressed
  that you hadnt previously considered.

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Remember

• Being observed during a clinical encounter
  creates anxiety for the resident.

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Recording

• Forms to record observation sessions are
  available on our website at http//www.familymed.
  ubc.ca/residency/evaluation/evaluation.htm

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Good luck with your observation.
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Thank you

• This module was written as an aid to the
  Preceptors in the Postgraduate Family Practice
  Program at the University of BC.
• Study credit is available to groups of preceptors
  who complete the module
• Please give us your feedback on the module so
  that we may improve it for others.
• Email your comments to Dr. John Edworthy, Faculty
  Development, UBC Family Practice
• jedworthy_at_shaw.ca