288 - Implementation of a Direct Observation Program for Pediatric Trainees using a QR Code Linked Evaluation Tool

Poster Number: 288
Publication Number: 288.421

Menaka Reddy, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston-Salem, NC, United States; janel D. Hunter, Wake Forest School of Medicine, Winston-Salem, NC, United States; Elizabeth E. Halvorson, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston-Salem, NC, United States; Jeanna Auriemma, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston-Salem, NC, United States; Julie K. Wood, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston Salem, NC, United States; Laurie W. Albertini, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston Salem, NC, United States; Thomas B. Russell, Wake Forest Baptist Health - Brenner Children's Hospital, Winston Salem, NC, United States; Shannon G. Hanson, Wake Forest Baptist Health - Brenner Children's Hospital, Winston Salem, NC, United States; John Darby, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, WINSTON SALEM, NC, United States; Andrea D. Triplett, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston-Salem, NC, United States

Background: Direct observation (DO), defined as “The active process of watching learners perform in order to develop an understanding of how they apply their knowledge and skills to clinical practice” is an integral part of medical training. Despite its many advantages, residency programs struggle to incorporate DO into clinical rotations, and little guidance is available on technology’s role in facilitating DO and feedback between faculty and resident physicians.

Objective: To understand qualitative and quantitative outcomes of a DO program using a quick response (QR) code-linked evaluation tool implemented in a medium-sized pediatric residency during the 2020-2021 academic year

Design/Methods: We used qualitative and quantitative analysis to evaluate the program. We performed semi-structured, key informant interviews with interns and faculty members, which were recorded, transcribed verbatim and coded using an inductive approach by at least two research team members. Themes were abstracted with content analysis and grounded theory methodology. Additionally, we collected data from evaluations regarding clinical setting, faculty specialty and skill observed; results were analyzed with descriptive statistics.

Results: In interviews with 9 faculty and 7 interns, key themes included commentary on (1) the quality of feedback; (2) the role of mentorships in the program; (3) the ability to individualize or tailor education; (4) the integration of the program into clinical workflow; (5) QR-code related technology; (6) the impact of DO and feedback on the learning environment; and (7) the logistics of program promotion and implementation. Participants also reflected on which clinical skills were useful to have observed, as well as if they had a positive, negative, or neutral experience with the program. In total, faculty members from 10 subspecialties performed 113 observations. The most common settings included inpatient wards (34%) and general pediatrics clinic (25%). Skills observed include patient communication (47%), plan development/execution (18%), history gathering (15%) and physical exam (13%).Conclusion(s): Faculty members performed the majority of observations in the inpatient wards setting and observed patient communication skills most frequently. Participants in this DO program noted effects on faculty feedback and intern learning environment. QR technology enabled documentation of feedback for the residency program. Future work may include expansion of this program to other pediatric residents and analysis of the quality of feedback.