The University of British ColumbiaThe University of British ColumbiaFaculty of MedicineFaculty of MedicineDepartment of Family PracticeDepartment of Family PracticePost Graduate ProgramPost Graduate Program

ObjectivesOutline the College of Family

Physician’s 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

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 MedicineMust document that the learner is learning

quantitative and qualitative information.Must record 32 direct observations, some of which

are video tapedMust involve a variety of patients and skills,

including history –taking, physical exam, procedural skills and the doctor patient relationship with difficult patients.

The Red BookHow many

observations?32 over 2 years4 direct observations

per month on block time.

1 observation per month on half days back

Our program requires 8 video taped sessions.

What is Direct Observation?ObservingBeing ObservedTaking notes and Recording

Making a judgement

Question/discussionWhen 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 resident’s interaction?

Trying to be invisible

Question:What are the Pros and Cons of video taped encounters?

Video taped encountersPros:

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

Video tips for the preceptor1/ You don’t 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 don’t have to review it all with your resident

A framework for observation and evaluationCuesHypotheses

generationTestingManagement

decisionsFollow-up .........

And back to Cues

Clinical Content Direct Observation Evaluation Encounter

CUES

HYPOTHESIS GENERATION

TESTING

MANAGEMENT

FOLLOW - UP

Eg. Non-verbal cues

Eg. Interviewing skills

Eg. Lab test assessment

Diagnosis

Stated Plan

Assesss

Assess

Assess

Assess

Assess

Evaluation

Feedback

Cues

Clinical Content Direct Observation Evaluation Encounter

CUES

HYPOTHESIS GENERATION

TESTING

MANAGEMENT

FOLLOW - UP

Eg. Non-verbal cues

Eg. Interviewing skills

Eg. Lab test assessment

Diagnosis

Stated Plan

Assesss

Assess

Assess

Assess

Assess

Evaluation

Feedback

Management

Hypothesis Generation

Clinical Content Direct Observation Evaluation Encounter

CUES

HYPOTHESIS GENERATION

TESTING

MANAGEMENT

FOLLOW - UP

Eg. Non-verbal cues

Eg. Interviewing skills

Eg. Lab test assessment

Diagnosis

Stated Plan

Assesss

Assess

Assess

Assess

Assess

Evaluation

Feedback

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?

Observations

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

To be effective we need to consider:The learning

objectives of the resident for the rotation based on the resident’s 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.

What to observe?When using your observation framework,

plan to observe areas of weakness you have previously identified or items identified in your resident’s 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 hadn’t previously considered.

RememberBeing observed during a clinical encounter creates anxiety for the resident.

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

Good luck with your observation.

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 modulePlease 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@shaw.ca