Direct observation as a focused teaching tool for doctors newly posted to the emergency department

Abstract

Introduction: The emergency department (ED) is a high risk working environment with clinical and operational protocols in place to attenuate the risks for doctors new to the ED. We implemented a structured direct observation program for new ED doctors who were not Emergency Medicine trainees. Method: An ED consultant observed each new ED doctor directly over two weeks without intervention in the clinical encounters. A structured form documented the doctor's performance in pre-defined areas relevant to patient care as well as mastery of operational procedures. Individual strengths and weaknesses were noted. Feedback was provided at the end of each session. After two weeks, the doctors completed a survey form with questions pertaining to their perceived level of competence in areas related to patient care and their experience with the direct observation program. Results: There was an overall improvement in their perceived levels of competence in most areas pertaining to patient care. Most felt that this program was useful. Only a minority found it stressful. None felt that it was a waste of time. Conclusion: Implementation of direct observation as a focused teaching tool is well received by both junior doctors and Emergency physicians. It provides early insight and feedback into the strengths and weaknesses of the junior doctors and helps new ED doctors to adapt quickly to the work process of the ED.