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Year : 2009  |  Volume : 22  |  Issue : 3  |  Page : 325

Direct Observation of Resident-Patient Encounters in Continuity Clinic: A Controlled Study of Parent Satisfaction and Resident Perceptions

1 Children's Hospital of Boston, Boston, USA
2 The University of North Carolina, North Carolina, USA

Correspondence Address:
A J Starmer
300 Longwood Avenue, Boston, MA 02115
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Source of Support: None, Conflict of Interest: None

PMID: 20029767

Context: 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. Objectives: 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. Findings: 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.

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