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Oversight, ownership, and the development of expertise

Part 6: Direct observation


If you're looking for ways to increase the quality of feedback you're able to provide, consider more direct observation on your next shift. This allows you to assess multiple competency areas and give behavior-specific feedback to inform deliberate practice.

1. Tell the learner that you'd like to do some direct observation during their shift. Some learners may perceive this as a lack of trust; reassure them that your goal is to be able to provide them with better feedback.

2. Choosing specific items to observe and give feedback on prior to direct observation helps you know what to look for. These may include:

  • Goals set by the resident at the beginning of shift

  • A set of milestones, such as those included on myTIPreport

  • Some or all of a standardized direct observation tool  (SDOTS are anchored checklists designed to improve the reliability and validity of direct observation. Click here for the CORD SDOT.)

3. Observe. Taking notes is often helpful.  

4. Discuss your observations with the learner in an appropriate setting. Avoid providing feedback on personality or stylistic factors. As we've discussed before, it's important to evaluate performance using criterion-based metrics.

It can be tempting to interject questions and comments into the encounter you're observing. Try to sit back and listen as much as possible and ask your questions when the learner is finished. If necessary, use a pen and paper to help you remember important details, questions, and feedback. 

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Biondi EA, Varade WS, Garfunkel LC, et al. Discordance Between Resident and Faculty Perceptions of Resident Autonomy. Academic Medicine 2015;90(4):462–71.

Ericsson KA. (2016). Peak: Secrets from the New Science of Expertise. Boston : Houghton Mifflin Harcourt.

Ericsson KA. (2004). Deliberate Practice and the Acquisition and Maintenance of Expert Performance in Medicine and Related Domains. Academic Medicine, 79(10), S70–S81.

Ericsson KA, Krampe RT,  Tesch-Römer, C. (1993). The role of deliberate practice in the acquisition of expert performance. Psychological Review, 100(3), 363–406.

Ericsson, KA. (2009). Development of professional expertise: toward measurement of expert performance and design of optimal learning environments. New York, Cambridge University Press. 

Gladwell, M. (2008). Outliers: The story of success.

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