title: Interdisciplinary direct observation: impact on precepting, residents, and faculty.
abstract: BACKGROUND
  Direct observation of residents for training and assessment is a core recommendation in medical education policy initiatives. Limited research exists about the impact of direct observation on precepting, and we are unaware of any research examining the impact of interdisciplinary precepting on trainees or preceptors. Over the past 3 years we have implemented an Interdisciplinary Direct Observation Precepting Model (IDOPM). Residents are directly observed via closed-circuit television by a behavioral scientist and family physician team.
  
  
  METHODS
  Surveys and focus groups were used to examine the impact of the IDOPM. Authors analyzed survey responses and focus group transcripts using an immersion/crystallization approach to arrive at themes.
  
  
  RESULTS
  Between February and June 2009, 24 residents, 14 physician faculty, and eight behavioral science faculty members participated in 19 IDOPM clinics. Eighty-two percent of residents and 95% of faculty responded to surveys. Key findings were (1) Residents and faculty report addressing topics that are not usually discussed in traditional precepting, including communication skills, time management, electronic medical record use, responding to emotional complexity, and physical exam skills, (2) The model reinforced a biopsychosocial approach to care, (3) Residents report ambivalent feelings about being observed, and (4) Faculty value the team approach to strengthen training and promote faculty development.
  
  
  CONCLUSIONS
  The IDOPM addresses many core skills that are overlooked in traditional precepting encounters. Interdisciplinary direct observation may strengthen faculty ability to provide formative competency assessment in preparing residents to work in the complex world of primary care.
authors.affiliation: Family Medicine Residency, University of Washington, Seattle, WA 98125, USA. vross@fammed.washington.edu
authors.forename: Valerie
authors.initials: V
authors.lastname: Ross
authors.forename: Larry
authors.initials: L
authors.lastname: Mauksch
authors.forename: Jane
authors.initials: J
authors.lastname: Huntington
authors.forename: J Mark
authors.initials: JM
authors.lastname: Beard
mesh_terms: D001525:Behavioral Sciences / Q000193:education; D002983:Clinical Competence; D003625:Data Collection; D005180:Faculty, Medical; D017144:Focus Groups; D006801:Humans; D033183:Interdisciplinary Communication; D007396:Internship and Residency / Q000379:methods* / Q000592:standards; D017145:Models, Educational; D019370:Observation; D010821:Physicians, Family / Q000193:education*; D011231:Preceptorship / Q000379:methods*; D015397:Program Evaluation; D036301:Qualitative Research; D014481:United States