Table 4 Representative responses to open ended survey question soliciting general comments
From: Milestones-based direct observation tools in internal medicine resident continuity clinic
Category | Na | Comment |
|---|---|---|
Sample resident quotations before introduction of new tools | ||
Observation | 13 | Rarely do my preceptors directly observe me, and if observed it is only in the final discussion in clinic after I have done the initial evaluation. I often don’t know in advance if a patient will have questions or an emotional response I need to respond to, so I can’t tell my preceptor when to observe me |
Value | 5 | Although we are all short on time and therefore having a more involved evaluation system would probably be a burden for all, I believe that the current feedback system is moderately insufficient. Typically, a preceptor will agree to fill out a mini-cex, observe 1–2 min of a patient interaction and either hand the form back to you or to the program office without reviewing it with you. Most of the time, these forms are just check boxes or 1-5 scales and have little substantive feedback. It would be nice to have a more involved feedback system as I feel that feedback is a significant part of the training process. |
Preceptor availability | 9 | Can be very difficult to work the mini-CEX into a busy clinic because it takes away one of the preceptors from the rest of the group. It ends up causing other people to wait and backing up the clinic. |
Artificial | 8 | I think the mini-cex is too limited an evaluation to properly assess how we interact with patients. There is so much to the interaction that is not observed. Additionally, when someone is observing, it interferes with rapport and trust, as the patient is not really sure why we’re being supervised and may doubt our abilities. |
Sample resident quotations after introduction of new tools | ||
Value | 10 | The DOTs provide useful feedback. However, clinic is often very busy and I feel that the expectation to get 1 DOT done per clinic week is too high and adds additional stress to the already busy clinic day when we’re running behind. I think that encouraging direct observation and feedback is important. I do not think that different forms or tools really make much of a difference. The time and attention of the preceptor is really what is important. Overall helpful in making observation take place. Having four different forms is almost irrelevant, but pulling the preceptor in before lengthy discussions with the patient does provide a valuable opportunity for feedback that occurs quite rarely in clinic |
Scope | 5 | it is difficult to get these completed as it is hard to predict prior to the visit when the patients will have the appropriate issue for discussion, and it often feels awkward/is difficult to not have the discussion during the initial part of the visit (prior to precepting). While I appreciate the idea of being observed by preceptors and getting feedback on patient interactions, the DOTs are far too structured and have very limited applicability. |
Sample faculty quotations before introduction of new tools | ||
Value | 7 | In doing this survey I am reminded of the saying ‘tis a poor carpenter that blames his tools.....our observations are guided by the form but are not limited to what is on the form. I think the evaluation form could do better in listing more specific behaviors we should be looking for. We can always free text our observations, but nice to have specific things that all the attendings look for. I find the mini-CEX is just a tool that promotes discussion rather than the tool itself giving feedback. I think this is fine as it creates a situation that promotes feedback |
Artificial | 4 | I understand a measurement tool has to be used however I still think the interactions/observations are artificial; even residents who I know struggle are able to put on a reasonable performance while I am observing them. I think a combination of sitting in the room and letting the residents know I am there to enhance their experience with the patient and not to score … 5 mini cex [tools] would seem more valuable. |
Sample faculty quotations after introduction of new tools | ||
Narrow scope | 8 | due to the specific nature of the tools it has been consistently difficult for my residents to get me in the room for the conversation without stopping their visit and coming to get me which can be awkward |
Value | 6 | I do feel that the new … forms are easier to use than the old ones - and I very much like the way they target specific high-yield communications topics that frequently arise in primary care clinic. Finding time to do the direct-observations continues to be an issue. |