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Active Observation

Advantages of active observation include: direct assessment of key skills, better impression of overall performance, insights to clinical reasoning and problem solving, direct application to clinical practice, and an enhanced learner-teacher partnership.

"Elementary my dear Watson"

You 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 the Sherlock Holmes character was modeled on Joseph Bell, a professor of surgery, and was written by a physician.

The principal advantages of observing students include:

  • Direct assessment of key skills
  • Better impression of overall performance
  • Insights to their clinical reasoning and problem solving
  • Direct application to clinical practice
  • Enhanced learner-teacher partnership

The principal disadvantages and/or limitations of observing students include:

  • Time
  • 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)

Steps to active observation:

  1. Prepare the situation. Make sure your learner, patients and office staff know what you are doing by observing your learner's patient visits and why it is important. This can feel awkward, but it pays huge benefits to avoid misunderstandings or dissatisfaction by all parties involved. This also helps you stay in role of an observer rather than stepping in to take over as the provider too early during the encounter. Patients and office staff can also act as observers and provide feedback to learners.
  2. Watch and listen for specific items or actions. As the teacher, decide the purpose of your observation and what you specifically want to learn about your student. Early in the rotation, you may be focused on general style, communication abilities, or skills in a physical examination in order to help you assess the learner and plan their experience in your practice. Toward the end of the rotation, you may need more specific information in order to complete evaluation documents that require 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 encounters under direct supervision. Make sure the purpose of the observation is clear to the student.
  3. Interpret, clarify and instruct based on the observation. You may choose to do this during the encounter or immediately afterward depending on your personal style and the situation with the patient and the student. (See "Feedback")
  4. Follow up to assess change in behavior (integration of the learning into future cases). Observations set up powerful teaching opportunities. The learner is ready for immediate feedback on performance or is ready to ask questions about a patient encounter they have just observed.

Key Point Observation need not take a lot of time and saves time overall by providing good first-hand information about learners.

"Merely looking is not observing."
KU School of Medicine

Office of Rural Medical Education
3901 Rainbow Blvd.
Mail Stop 1049
Kansas City, KS 66160 

Fax: 913-588-5259