title: Twelve tips for implementing tools for direct observation of medical trainees' clinical skills during patient encounters.
abstract: BACKGROUND
  Direct observation of medical trainees by their supervisors with actual patients is essential for trainees to develop clinical skills competence. Despite the many available tools for direct observation of trainees by supervisors, it is unclear how educators should identify an appropriate tool for a particular clinical setting and implement the tool to maximize educational benefits for trainees in a manner that is feasible for faculty.
  
  
  OBJECTIVE
  Based on our previous systematic review of the literature, we provide 12 tips for selecting and incorporating a tool for direct observation into a medical training program. We focus specifically on direct observation that occurs in clinical settings with actual patients.
  
  
  RESULTS
  Educators should focus on the existing tools for direct observation that have evidence of validity. Tool implementation must be a component of an educational program that includes faculty development about rating performance, providing meaningful feedback, and developing action plans collaboratively with learners.
  
  
  CONCLUSIONS
  Educators can enhance clinical skills education with strategic incorporation of tools for direct observation into medical training programs. Identification of a psychometrically sound instrument and attention to faculty development and the feedback process are critical to the success of a program of direct observation.
authors.affiliation: Department of Medicine, University of California, San Francisco, CA 94143-0120, USA. karen.hauer@ucsf.edu
authors.forename: Karen E
authors.initials: KE
authors.lastname: Hauer
authors.forename: Eric S
authors.initials: ES
authors.lastname: Holmboe
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Kogan
mesh_terms: D002983:Clinical Competence; D004501:Education, Medical / Q000379:methods; D017408:Guidelines as Topic; D006801:Humans; D019370:Observation; D010817:Physician-Patient Relations; D013337:Students, Medical