title: Direct observation of resident-patient encounters in continuity clinic: a controlled study of parent satisfaction and resident perceptions.
abstract: BACKGROUND
  Direct observation (DO) by teaching physicians of medical care provided by resident physicians offers a method to evaluate clinical skills beyond traditional measures that focus solely on medical knowledge assessment.
  
  
  OBJECTIVE
  We sought to determine if the presence of the teaching physician observer affects parental satisfaction with care and to assess resident perceptions of DO in a general pediatrics residency clinic.
  
  
  METHODS
  A cross-sectional parent survey compared visit satisfaction of parents who experienced a DO with controls in a traditional clinic visit. Additionally, a pre-post survey measured resident perceptions of direct observation before and after implementation of DO in the clinic.
  
  
  RESULTS
  Parents frequently described their overall satisfaction with care as "excellent" after DO and traditional visits (DO 70%, 95% CI, 50-86% and control 80%, CI 66-89%). However, parents in DO visits were less likely to rate their satisfaction with the amount of time spent in the room as excellent (DO 78%, CI 58-91%; Control 95%, CI 85-99%). Most resident physicians were in favor of the DO process (63%) and agreed that DO provides feedback about history-taking (94%), physical examination (94%) and interpersonal skills (91%).
  
  
  CONCLUSIONS
  Direct observation by attending physicians does not decrease overall parental satisfaction during clinical encounters. Additionally, residents have a generally favorable opinion of direct observation and believe that it can provide useful feedback.
authors.affiliation: Children's Hospital of Boston, USA. amy.jost@childrens.harvard.edu
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Starmer
authors.forename: Greg D
authors.initials: GD
authors.lastname: Randolph
authors.forename: Karen L
authors.initials: KL
authors.lastname: Wysocki
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Steiner
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D002983:Clinical Competence / Q000592:standards; D003430:Cross-Sectional Studies; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007396:Internship and Residency; D008297:Male; D009657:North Carolina; D019370:Observation; D010290:Parents / Q000523:psychology*; D010817:Physician-Patient Relations