“See One, Coach One”: Demystifying Direct Observatio­­n in Competence by Design

June 25, 2019 | Author: Royal College Staff

 “ Documenting CBD Observations should take no longer than ordering a cup of coffee. You’re providing actionable feedback and recording your “progress note” on your resident’s ability that day. ” – Jason R. Frank

Imagine: You just received an inbox request to observe a resident’s Entrustable Professional Activity (EPA). Now what?

If you have questions about what it means to document a direct observation, here’s what you need to know:

  1. CBD is designed to increase coaching and learning opportunities for residents. Frequent and timely coaching conversations between a learner and observer are a critical element of workplace-based assessment (WBA). Frontline clinical teachers are expected to observe residents in practice and then provide verbal and written feedback designed to promote learner growth. Frontline clinical teachers do not make summative judgements about learners.
    • There is no pass-fail pressure on you or the resident during an observation. Use the opportunity to understand the learner’s goals and then give them verbal and written feedback or pointers, like a coach to a player. Part of your job is to help them learn and improve.
  2. Document the observation as soon as possible. Soon after observing an EPA, take a moment to document the observation in your electronic portfolio app or on your desktop. It should take about two minutes to answer the questions and briefly record advice for the resident to enhance their abilities.
    • Remember: A documented observation is not a final decision that the resident has/has not achieved an EPA. It is both coaching for the resident and a “progress note” that documents the development of the learner for the Competence Committee.
  3. The Competence Committee makes the progression recommendation. Throughout each stage of training, Competence Committee members review all documented observations in the electronic portfolio, plus any other assessment information available to them. Committee members make the final recommendation as to whether all EPAs were sufficiently completed, and ultimately, if the resident can progress to the next stage of training.
      • Depending on individual program needs, programs have the flexibility to decide who should sit on the Competence Committee and whether they will review each resident’s progress more than twice per year.

     Did you know? During each stage of training, residents should request to be observed multiple times by multiple observers while working on EPAs. Learners are encouraged to document early stage observations, so they can show progress over time. A low score early in the stage should be expected, but later in the stage it might be a flag for added support. This is how CBD is designed to support learning with a developmental view.

  4. Training: Entrustability O-score Rating. Under CBD, it is mandatory that at least some of the observations are recorded using an entrustability scale and narrative feedback. Entrustability scales are proven to be more reliable than previous WBA tools, but clinical teachers often have many questions about how to use them when they first start using the scale. Training on how to use entrustability scales is a critical step in the transition to CBD. It’s important that all observers have a common understanding of entrustment so that residents are given similar, standardized, predictable ratings. Note: Many programs are choosing to incorporate other assessment tools to supplement the 0-score ratings.

Resources related to Direct Observation

For a complete listing of Royal College Competence by Design Faculty Development resources, please visit the CBD Resource Directory, searchable by topic.


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