| Summary: | Abstract Direct observation of residents is a key assessment tool for competency in (1) patient care, (2) professionalism, and (3) communication. Although several observation tools exist, most do not have known validity and reliability. In addition, the feasibility of many of those tools is limited by time constraints and discomfort levels of both observers and those being observed. We developed a simplified observation tool, used within a pediatric resident continuity clinic, to evaluate the three specific competencies listed above and provide timely feedback. This brief tool, requiring 5–10 minutes, provides documentation not only of the three competencies for the individual resident but also of direct observation for the Residency Review Committee. In addition, it helps guide faculty feedback to residents, which should result in improvement and growth in resident performance that could be documented longitudinally. We conducted a pilot study to measure feasibility of the tool to evaluate the three competencies and provide timely feedback. The study was performed in the pediatric resident continuity clinic of a large children's hospital. A direct observation form with a 3-point scale for 14 items in the domains of patient care, professionalism, and communication skills was developed. The form was divided by portion of visit (i.e., history, exam, counseling); specific items also mapped to the appropriate competencies. The form was designed to be used in multiple, short observations of portions of a visit during the course of the year. At the end of the clinic session, the attending physician was asked to provide direct feedback on the observed encounter to the resident. After each observed encounter, faculty and residents completed surveys rating the process (ease of use, satisfaction, and self-assessed usefulness) on a 5-point Likert scale. Attending physicians completed 67 surveys during the pilot. The form was felt to be easy to use in 99% of the observations (66/67). Use of the form did not interfere with patient flow 99% of the time (66/67). In 93% (62/67) of the observations, attending physicians felt the form provided useful information for resident feedback. Residents completed 54 surveys. Most residents (72%; 39/54) felt comfortable being directly observed by an attending, and 89% (48/54) thought direct observation did not significantly affect efficiency. Nearly all of the time (96%; 52/54), residents felt they were provided useful feedback based on the observation.
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