Original Publication
Open Access

Tool for Documenting Clinical Point-of-Care Direct Observation and Formative Feedback

Published: July 21, 2015 | 10.15766/mep_2374-8265.10093

Included in this publication:

  • Instructor's Guide.docx
  • Point-of-Care Tool.docx
  • Preceptor's Guide.docx
  • Sample Clinical Encounter.docx
  • Learner and Preceptor Survey.doc

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file.


Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.

Abstract

Introduction: Formative feedback during patient encounters (point-of-care) is valuable for the development of learner clinical skills since students can address gaps identified in history taking or physical exam skills, and faculty are more likely to recollect and address the identified strengths and deficiencies. Medical student ratings of direct observation and formative feedback are usually lowest in end-of-clerkship evaluations. Most clerkships use direct observation cards/checklists that do not allow for preceptors to provide the students with a global assessment of their developmental progress (i.e., what level are the students performing at and where they should be). We piloted a point-of-care tool that addresses this gap by documenting direct observation, developmental progress feedback, self-reflection and life-long learning, and student level of responsibility (direct patient contact). Methods: This point-of-care tool was designed using the reporter-interpreter-manager-educator (RIME) framework to both document direct observation and provide formative feedback on a student’s developmental progress. Additionally, this tool provides a uniform vocabulary to calibrate the progress of trainees. Setting level-appropriate expectations therefore guides the feedback. The tool requires medical students to self-reflect on this feedback and formulate a plan for future growth through the use of handouts such as the Point-of-Care Tool, in addition to facilitator lectures. Results: We have had significant improvements in scores for end-of-clerkship statements that asked if students were directly observed obtaining history and physical examinations (moderate to high degree). The scores for resident direct observation increased more than those for attending physicians. This may be due to the fact that the tool is mainly completed by residents. On the post-clerkship survey, a majority (80%) of students in the first year of implementation were satisfied with the feedback received. The students also stated that completion of the tool for each encounter took less than a 2-3 minutes (91%). Discussion: The tool is useful for a clerkship that is seeking a way to provide and document real-time feedback to learners at the bedside. The individual point-of-care entries also help learners self-reflect and create a plan of action to address their weaknesses for mid-clerkship feedback.


Educational Objectives

After using this resource, learners will be able to:

  1. Identify their own strengths and deficiencies related to their knowledge and skills in: (a) obtaining a history, (b) conducting a physical examination, and (c) formulating/presenting a plan of care for individual clinical encounters.
  2. Demonstrate the ability to self-reflect on feedback received from others (both positive and negative) towards the goal of personal and professional growth.
  3. Utilize feedback to formulate a plan of action to correct knowledge and clinical skill gaps.
  4. Recognize the reporter-interpreter-manager-educator (RIME)-based developmental stages.

After using this resource, clinical preceptors will be able to:

  1. Recognize the developmental stages of the RIME framework in the point-of-care tool.
  2. Develop familiarity with best practice guidelines for providing formative feedback.
  3. Demonstrate the ability to use the point-of-care tool.

Author Information

  • Sangeeta Lamba, MD, MBBS: Rutgers New Jersey Medical School
  • Roxanne Nagurka: Rutgers New Jersey Medical School

Disclosures
None to report.

Funding/Support
None to report.



Citation

Lamba S, Nagurka R. Tool for documenting clinical point-of-care direct observation and formative feedback. MedEdPORTAL. 2015;11:10093. https://doi.org/10.15766/mep_2374-8265.10093