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Table 2 Preference regarding observation modality (remote camera versus in-room)

From: Perceptions of scheduled vs. unscheduled directly observed visits in an internal medicine residency outpatient clinic

Scheduled Observation-ResidentsUnscheduled Observation-Residents
• “Mostly [remote camera] just because it ensures a one-on-one encounter with the patient so that the two of you are working together and not in between some intermediate source.”
• “It’s [remote camera] more of the natural environment”
• “So remote, to me, feels more like a real patient encounter and is a more natural kind of environment. Someone sitting in the room with you is kind of babysitting.”
• “It [in-room] makes you feel like your autonomy has been taken away”
• “I think it [remote camera] also enhances your clinical decision making. You know you’re the only one in the room and you know you have to make some sort of medical decision while you’re there instead of kind of leaning or using a crutch of someone being in the room with you.”
• “It changes the entire encounter when the faculty’s with you and you lose all credibility.”
• “Remote video is better, because if you have someone there, it just impacts your patient interaction. The patient will keep looking at whoever is, like, older, seems more prestigious in the room. They won’t think that I’m their doctor.”
• “Plus, they’d [faculty] have to just totally keep their mouth shut … which wouldn’t happen.”
• “I mean, if we’re trying to become physicians and our place of work, and art and everything that we do and love and put everything into this vocation of ours is supposed to be in that room with us and the patient, this is a time that we learn how to do that and navigate that without somebody else sitting in the room. And I think that’s a super special and sacred place, and to learn how to navigate that now is primarily why we’re here training, so I think it really undermines that.”
Scheduled Observation-FacultyUnscheduled Observation-Faculty
• “If the goal is to teach them to think on their own and decide on their own, then they need to be in the room alone with the patient.”
• “If I am in the room, the patient looks to me then as the physician, because I’m the highest-ranking physician. You don’t get that at all with the remote, right, so there’s no looking past the resident to the attending, “Oh, what do you think?” kind of thing.”
• “We want our residents to establish rapport with their patients, develop longitudinal relationships. They can’t do that with someone staring over their shoulder”
• “Video observation allows you as the faculty to have more flexibility as a preceptor. If you’re observing something but then there is a bolus of residents who need staffing, you can temporarily step away. So, it gives you a little bit more of finger on the pulse of how things are going otherwise. If you’re pulled into the room, you’re out of commission for that complete duration of time.”