title: Experience-based guidance for implementing a direct observation checklist in a pediatric emergency department setting.
abstract: BACKGROUND
  The importance and benefits of direct observation in residency training have been underscored by a number of studies. Yet, implementing direct observation in an effective and sustainable way is hampered by demands on physicians' time and shrinking resources for educational innovation.
  
  
  OBJECTIVE
  To describe the development and pilot implementation of a direct observation tool to assess the history and physical examination skills of interns in a pediatric emergency department rotation.
  
  
  METHODS
  A task force developed specific history and physical examination checklists for a range of common conditions. For the pilot implementation, 10 pediatric emergency medicine faculty attendings conducted the initial observations of 34 interns during the course of 1 academic year. At the conclusion of the pilot, the faculty observers and interns were interviewed to assess the feasibility and benefits of the process.
  
  
  RESULTS
  A total of 33 of the 34 interns were observed during their rotation, with 26 of the observations conducted when the faculty observer was off shift, and it took approximately 20 minutes to complete each observation. In terms of learning benefits, interns and faculty observers reported that it facilitated clear and useful feedback and revealed gaps that would not have otherwise been identified. Faculty observers also mentioned that it helped them focus their teaching effort, built empathy with learners, and gave them a way to demonstrate a true concern for their learning.
  
  
  CONCLUSIONS
  Our results offer evidence for the feasibility and benefits of the direct observation checklists. The description of the implementation, challenges, and response to those challenges may help others avoid some of the common problems faced when implementing direct observation methods.
authors.forename: Michael
authors.initials: M
authors.lastname: Fitzgerald
authors.forename: Mia
authors.initials: M
authors.lastname: Mallory
authors.forename: Matthew
authors.initials: M
authors.lastname: Mittiga
authors.forename: Charles
authors.initials: C
authors.lastname: Schubert
authors.forename: Hamilton
authors.initials: H
authors.lastname: Schwartz
authors.forename: Javier
authors.initials: J
authors.lastname: Gonzalez
authors.forename: Elena
authors.initials: E
authors.lastname: Duma
authors.forename: Constance
authors.initials: C
authors.lastname: McAneney