Using Active Observation of Students
are already a skilled observer. Working with patients requires that you are an expert at gathering, processing, and prioritizing large volumes of verbal, tactile, and non-verbal information. On every patient encounter you are Sherlock Holmes making complex but reliable judgments—remember Sherlock Holmes was written by a physician and the character was modeled on Joseph Bell, a professor of surgery!
The principal advantages of observing students include:
- direct assessment of key skills
- impression of overall performance
- insights to use of clinical reasoning and problem solving
- directly pertinent to clinical practice
- enhances learner-teacher partnership
The principal disadvantages of observing students include:
- insecurity about "how to do it”
- unpredictability - teacher is not completely in control
- limited in assessing knowledge: focuses on the actions rather than the rationales
- tends to be subjective
- the “Hawthorne” effect (the presence of the observer changes the usual behavior)
Using your observational skills in teaching has many similarities to patient care.
As a teacher you...
- Prepare the situation
- Watch and listen for specific items or actions
- Interpret, clarify and instruct based on the observation
- Follow up to assess change in behavior (integration of the learning into future cases)
Initially, preparing the situation can feel awkward, but it pays huge dividends in successful teaching and patient satisfaction when done well. The learner, patients, teacher, and office staff need to know what is going on and appreciate its importance. Unless someone explains the arrangement, the patient is likely to be uncertain as to why the learner is present, or why their usual physician is apparently being passive. A brief explanation of what is expected is also essential for the learner to benefit from the encounter, be ready for constructive feedback, and may assist the teacher stay in role. (A major problem with observation is that physicians find staying silent or still very difficult!).
As a teacher you decide...
The purpose of the observation
What do you need to know about the learner?
Early in the rotation, you may be focused on general style, communication abilities, or skills in physical examination in order to help you assess the learner and plan his/her experience in your practice. Towards the end of the rotation, you may need more specific information in order to complete evaluation documents that require a detailed knowledge of learner performance. Throughout the rotation, observation helps the teacher monitor progress or address specific needs. Some teachers select one patient per session where the learner conducts most of the patient encounter under direct supervision. Make sure the purpose of the observation is clear to the student.
The format of the encounter
The most common styles are:
- Active watching: Teacher making no intervention during the patient encounter, but discussion and teaching take place immediately afterwards.
- Participatory observation: Teacher gets involved if requested by learner or at a predetermined stage of the process. Examples include when a learner performs a part of the physical examination, then the teacher advises on technique and/or demonstrates the examination to confirm the findings; or the teacher intervenes when the learner requires additional information, clarification or redirection.
Observations set up powerful teaching situations. The learner is ready for immediate feedback on performance or is ready to ask questions about a patient encounter they have last observed.
Observation need not take a lot of time and saves time overall by providing good first hand information about learners.
The purpose and format of the observation should be clear to all.
Patients and office staff can also act as observers and provide feedback to learners.