Oh, What You Can See: The Role of Observation in Medical Student Education

Abstract

This article is the third in a series by the Council on Medical Student Education in Pediatrics (COMSEP) that focuses on skills and strategies that can help good clinical teachers become great. The purpose of this article is to outline the critical role of observation in medical student education settings. Observation of students can take many forms, including direct observation during a clinical encounter (eg, taking a history, performing a physical examination, or talking with patients and families), with a standardized patient, or indirectly while watching a videotaped encounter. In this article, we focus on direct observation of medical students in clinical settings for the purpose of gathering information for feedback and student assessment. In the past 2 decades, medical education has shifted toward competency-based curricula in which students must demonstrate specific skills and behaviors.1 Some student attributes, such as medical knowledge, are readily and effectively assessed by using multiple-choice examinations. Other attributes such as professionalism and clinical and communication skills are best taught and assessed by observing students with patients. Think of a group of young adults who have never played tennis but who want to learn to play well enough to compete in a local tournament. How would you teach them and assess their progress? A lecture followed by a multiple-choice examination seems unlikely to be effective, but instruction while watching them hitting a tennis ball is much more likely to improve their skills. Recognizing the importance of direct observation, both the Liaison Committee on Medical Education (the body responsible for accrediting medical schools) … Address correspondence to Janice L. Hanson, PhD, EdS, Departments of Medicine and Pediatrics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814. E-mail: jhanson{at}usuhs.edu