1. The University of British Columbia Faculty of Medicine Department of Family Practice Post Graduate Program

2. Objectives Outline the College of Family Physician’s requirements for observation in the Evaluation Process Explore what Direct Observation is and how it aids evaluation Create a Framework to understand the process of evaluation through observation Understand how to make our observation and evaluation effective

3. The Red Book (College Standards for Accreditation) Defines a number of requirements that all teaching programs must incorporate in their evaluation process: MUST focus on the 4 principles of Family Medicine Must document that the learner is learning quantitative and qualitative information. Must record 32 direct observations, some of which are video taped Must involve a variety of patients and skills, including history –taking, physical exam, procedural skills and the doctor patient relationship with difficult patients.

4. The Red Book How many observations? 32 over 2 years 4 direct observations per month on block time. 1 observation per month on half days back Our program requires 8 video taped sessions.

5. What is Direct Observation? Observing Being Observed Taking notes and Recording Making a judgement

6. Question/discussion When sitting in the room with a patient and the resident, how do you avoid or at least reduce interaction with the patient while you are trying to observe the resident’s interaction?

7. Trying to be invisible

8. Question : What are the Pros and Cons of video taped encounters?

9. Video taped encounters Pros: Removes interference of the teacher Allows learner to see himself or herself as an observer Observation by the teacher can be done at his or her convenience Cons: Requires written consent from the patient Makes patient or resident self - conscious/uneasy Requires planning and set-up

10. Video tips for the preceptor 1/ You don’t need a camera. The resident has a camera available to him or her through the Program. He or she can set it up before the office begins. 2/ The resident is responsible to explain the process of video taping to the patient and get informed consent. 3/ You can review the tape at your convenience. You can concentrate on one aspect of the video. You don’t have to review it all with your resident

11. A framework for observation and evaluation Cues Hypotheses generation Testing Management decisions Follow-up......... And back to Cues

15. Question: Your resident is about to see a new mom and her one week old daughter for a first routine check. Suggest what skills or functions you might decide to observe on this encounter?

16. Observations

17. Making your observations and evaluation effective “Effective” means “Having the intended or expected effect; producing a strong impression or response” Your observation and evaluation is effective when it has a positive benefit for the resident and the Program

18. To be effective we need to consider: The learning objectives of the resident for the rotation based on the resident’s past experience and his or her perceived needs. The Educational objectives of the Program based on the Four Principles of Family Medicine of the College of Family Physicians.

19. What to observe? When using your observation framework, plan to observe areas of weakness you have previously identified or items identified in your resident’s learning objectives. The advantage of observation over a post encounter discussion with your resident is that you will observe issues that should be addressed that you hadn’t previously considered.

20. Remember Being observed during a clinical encounter creates anxiety for the resident.

21. Recording Forms to record observation sessions are available on our website at :http://www.familymed.ubc.ca/resi dency/evaluation/evaluation.htm

22. Good luck with your observation.

23. Thank you This module was written as an aid to the Preceptors in the Postgraduate Family Practice Program at the University of BC. Study credit is available to groups of preceptors who complete the module Please give us your feedback on the module so that we may improve it for others. Email your comments to Dr. John Edworthy, Faculty Development, UBC Family Practice jedworthy@shaw.ca