Abstract
BackgroundWith milestones-based assessment, there is an increased need for tools to facilitate direct observation of clinical trainees. This study was designed to compare a Mini-CEX tool to new direct observation tools (DOTs) linked to internal medicine milestones.MethodsA web based survey was used to examine satisfaction and usefulness of DOTs compared to the Mini-CEX. Residents and preceptors were surveyed three times over 6 months with half serving as control (using mini-CEX) compared to those using the DOTs. Likert scale quantitative answers and qualitative comments were analyzed using generalized estimating equations.ResultsOut of 94 residents and 32 faculty 81 and 90% completed the survey for at least one time point. In adjusted models, there was no significant change in resident evaluation comparing the tools on a number of questions including overall satisfaction and resident perception of receiving high quality feedback. By contrast, faculty preceptors reported increased ratings on many of the questions evaluating their use of the new tools including ability to provide higher quality feedback and overall satisfaction.A number of challenges and benefits of the new tools were identified in qualitative feedback by both residents and preceptors.ConclusionsAll parties recognized the value and limitations of direct observation. Overall these new office based DOTs were perceived similarly to the mini-CEX by residents while faculty reported higher satisfaction. The DOTs are a useful addition to the tool box available for the assessment of clinical skills of medical trainees, especially from the viewpoint of faculty preceptors.
Highlights
With milestones-based assessment, there is an increased need for tools to facilitate direct observation of clinical trainees
We aimed to evaluate faculty preceptors’ and internal medicine residents’ perceptions of satisfaction and usefulness of a pre-existing set of general Mini-CEX tools compared to four newly created milestone-based direct observation tools (DOTs) in a primary care continuity clinic setting
The number of residents who completed a survey at each time point by floor is as follows: 5th floor (Time point A, B, C: n = 23, n = 29, n = 19); 6th floor (Time point A, B, C: n = 31, n = 33, n = 33). (Figure 1 & Table 1) During the 4-month study time period a total 78 of the new DOTs were used- 36 of these were for lifestyle counseling, 18 for explaining a test result, 17 for discussing a screening test and 7 for having a discussion related to a controlled substance contract
Summary
With milestones-based assessment, there is an increased need for tools to facilitate direct observation of clinical trainees. This study was designed to compare a Mini-CEX tool to new direct observation tools (DOTs) linked to internal medicine milestones. Getting into the exam room to directly observe resident clinical performance has long been recognized as an important method of assessing internal medicine resident competence. With the introduction of milestones-based evaluation, internal medicine residency programs have an even greater need for direct observation of resident clinical care to inform the evaluation process [1]. Because MiniCEX tools can be general in nature and may measure clinical competence overall rather than any areas of competency programs are working to create tools that are more closely linked to the internal medicine reporting milestones [3].
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