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What happens under the flag of direct observation, and how that matters: A qualitative study in general practice residency.

Research output: Contribution to journalArticlepeer-review

Chris B T Rietmeijer, Annette H Blankenstein, Danielle Huisman, Henriette E van der Horst, Anneke W M Kramer, Henk de Vries, Fedde Scheele, Pim W Teunissen

Original languageEnglish
Pages (from-to)937-944
Number of pages8
JournalMedical Teacher
Issue number8
Published25 Mar 2021

Bibliographical note

Funding Information: The authors wish to thank the residents who participated in this study. Anne de Wit, psychologist at the department of General Practice and Elderly Care Medicine at Amsterdam University Medical Center, location VUmc, Amsterdam, facilitated two of the focus groups. Marilyn Hedges provided feedback on English grammar and style. Publisher Copyright: © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors


Introduction: In competency-based medical education, direct observation (DO) of residents’ skills
is scarce, notwithstanding its undisputed importance for credible feedback and assessment. A
growing body of research is investigating this discrepancy. Strikingly, in this research, DO as a concrete educational activity tends to remain vague. In this study, we concretised DO of technical
skills in postgraduate longitudinal training relationships.
Methods: Informed by constructivist grounded theory, we performed a focus group study among
general practice residents. We asked residents about their experiences with different manifestations of DO of technical skills. A framework describing different DO patterns with their varied
impact on learning and the training relationship was constructed and refined until theoretical sufficiency was reached.
Results: The dominant DO pattern was ad hoc, one-way DO. Importantly, in this pattern, various
unpredictable, and sometimes unwanted, scenarios could occur. Residents hesitated to discuss
unwanted scenarios with their supervisors, sometimes instead refraining from future requests for
DO or even for help. Planned bi-directional DO sessions, though seldom practiced, contributed
much to collaborative learning in a psychologically safe training relationship.
Discussion and conclusion: Patterns matter in DO. Residents and supervisors should be made
aware of this and educated in maintaining an open dialogue on how to use DO for the benefit of
learning and the training relationship.

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