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I’ve Got My Eye on You: Identifying Barriers to Direct Observation of Medical Students during their Ob/Gyn Clerkship

Objectives: Describe practices and barriers related to direct faculty observation of students during their obstetrics/gynecology clerkship.

Study Design: A survey was administered to faculty at 15 institutions and assessed practices and attitudes related to direct observation of students. The primary outcome was direct observation of history/exam in the last six weeks. Frequencies and proportions describe variables. Chi-square tests were used in bivariate analysis and logistic regression was used to compute adjusted odds ratios and 95% confidence intervals.

Results: Our response rate was 32% (178/559). 34% and 58% of faculty observed history and exam, respectively, in the last six weeks. Gender, practice duration, subspecialty status, and perceived compensation and after hours workload were not associated with direct observation. Comfort asking patients to allow students (OR 2.5, 95% CI 1.1-5.7) and a useful assessment tool (OR 2.5, 95% CI 1.2-5.2) increased observation of history. The belief that resident observation was sufficient decreased observation of history by 65% (OR 0.35, 95% CI 0.13-0.92). Observation of exam was more likely among faculty who believed efficiency was unaffected (OR3.5, 95% CI 1.03-11.6), felt comfortable asking patients to allow students (OR 5.1, 95% CI 1.8-14.6), were aware of LCME requirements (OR 3.6, 95% CI 1.5-8.6), held junior/mid-level rank (OR 4.2, 95% CI 1.3-13.9), and reported prior development (OR 2.7, 95% CI 1.0-6.9).

Conclusions: Fewer than 60% of faculty observed students perform history and exam. Barriers included comfort asking patients to allow students, maintenance of efficiency, not utilizing tools for assessment, and poor knowledge of LCME requirements.

Topics: 2014, Faculty, Clerkship Director, Osteopathic Faculty, Patient Care, Professionalism, UME, General Ob-Gyn,