title: Direct Versus Remote Clinical Observation: Assessing Learners' Milestones While Addressing Adolescent Patients' Needs.
abstract: BACKGROUND
  Direct clinical observation is an essential component of medical trainee assessment, particularly in the era of milestone-based competencies. However, the adolescent patient's perspective on this practice is missing from the literature. Quality health care is patient centered, yet we did not know if our educational practices align with this clinical goal.
  
  
  OBJECTIVE
  We sought to better understand our adolescent/young adult patients' perspectives of the direct observation of our medical trainees in the outpatient clinical setting.
  
  
  METHODS
  As a quality improvement initiative, we surveyed adolescent/young adult patients, medical trainees, and physician observers in our outpatient clinical practice regarding their experience following a direct observation encounter. We performed descriptive analyses of the data.
  
  
  RESULTS
  During a 1-year period, responses were received from 23 adolescent/young adult patients, 8 family members, 14 trainees, and 6 faculty observers. Nearly all adolescent/young adult patients (n=22) and all surveyed family members (n=8) expressed comfort with direct observation, and all respondents felt the care they received was the same or better. All patient/family respondents preferred direct observation to the idea of remote observation, and most, but not all, trainees and faculty observers expressed similar opinions.
  
  
  CONCLUSIONS
  Adolescent/young adult patients and their family members found direct observation of their trainee providers to be comfortable and beneficial. Despite adolescent and young adults' facility and comfort with modern technologies, there was an expressed preference for direct versus remote observation.
authors.forename: Sarah
authors.initials: S
authors.lastname: Pitts
authors.forename: Joshua
authors.initials: J
authors.lastname: Borus
authors.forename: Adrianne
authors.initials: A
authors.lastname: Goncalves
authors.forename: Holly
authors.initials: H
authors.lastname: Gooding
mesh_terms: D000293:Adolescent; D002983:Clinical Competence; D004521:Educational Measurement / Q000379:methods*; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D019370:Observation / Q000379:methods*; D011787:Quality of Health Care