KUSM-W Volunteer Faculty/Preceptor
The site dedicated to assisting the nearly 1,000 KUSM-W community teachers
The University of Kansas School of Medicine - Wichita

Using Active Observation of Students

elementary my dear watsonYou 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:

The principal disadvantages of observing students include:

Using your observational skills in teaching has many similarities to patient care.

As a teacher you...

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...

  1. 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.

  2. 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.

  3. The follow-up

    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.

Key Point

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.



Site development made possible in part by an HRSA grant.

Introduction | Getting ready to teach | Orienting students
Strategies for teaching in a busy practice | The one-minute preceptor | Using active observation
Teaching Clinical Skills | Feedback | Giving Short Talks on the Run
Teaching at the bedside | Evidence-based medicine | Evaluating learners
The unwritten curriculum | When things go wrong | Giving talks and lectures
PDA Resources for Teaching | FAQs about community based teaching

Introduction
Getting ready to teach
Orienting students
 starting well

Strategies for teaching in
 a busy practice

The one-minute preceptor
 tools for effective teaching
 in limited time

Using active observation
 not just show and tell

Teaching Clinical Skills
 beyond "see one, do one"

Feedback
 the under used "power tool"

Giving Short Talks on the Run
 short focused didactics that are
 more powerful than lectures

Teaching at the bedside
 and on hospital rounds

Evidence-based medicine
Evaluating learners
The unwritten curriculum
When things go wrong
Giving talks and lectures
PDA Resources for Teaching
FAQs about community
 based teaching