Medical educators have opined that the clinical, communication, and professionalism skills of medical students are best taught and assessed by faculty directly observing clinical encounters between students and patients. Nonetheless, the medical literature suggests that these direct observations of clinical encounters (DOCEs) occur during fewer than one quarter of internal medicine clerkships. Lack of faculty time is often cited as a barrier to completing DOCEs. Most previously reported DOCEs in internal medicine clerkships have involved interviewing, examining, and presenting new patients and have averaged 45 minutes to complete and provide feedback to the student.
To learn if DOCEs conducted during medical student prerounding on their hospital patients would be a useful learning exercise for medical students and to assess faculty time involved.
From April through October 2010, third‐year medical students were offered the opportunity of a DOCE during their internal medicine clerkship. This exercise was discussed with students during their clerkship orientation, and students were asked to directly contact the supervising faculty member to arrange a date and time. One of 2 academic hospitalists observed the student making prerounds on a patient that they had previously admitted and were following on‐service. Faculty used a checklist comprising 17 items in 3 categories: communication (8 items), physical examination (5 items), and professionalism (4 items). After the observation, faculty provided to the student a formative evaluation that did not contribute to the student's clerkship grade. Faculty made written comments on the checklist and gave a copy to the student. Thirty‐one of 34 students (91%) completed the DOCE, and records were available for 30 of these encounters. Time of observation averaged 15.3 minutes (range, 7–25 minutes), and feedback averaged 13.9 minutes (range, 8–22 minutes). Faculty provided feedback to students in the following areas (number and proportion of students): communication (30 of 30, 100%), physical examination (27 of 30, 90%), and professionalism (30 of 30, 100%). Twenty‐five of 31 students (81%) completed an anonymous satisfaction survey. Twenty‐three of these 25 students (92%) found the exercise to be useful or very useful (average 5‐point Likert score, 4.56) and 23 of 25 (92%) found it easy or very easy to schedule (average 5‐point Likert score, 4.48).
Academic hospitalists’ direct observation of clinical encounters of medical students prerounding on hospitalized internal medicine patients averaged 29 minutes, including feedback to the student. Students found this a useful exercise that was easy to schedule. In less than half an hour, hospitalists can observe medical students interacting with patients during hospital prerounds and consistently provide feedback in areas of communication, physical examination, and professionalism.
J. Pierce ‐ none; L. Noronha ‐ none