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Background: Medical educators have opined that clinical, communication, and professionalism skills of medical students are best taught and assessed by faculty directly observing clinical encounters between students and patients. Nonetheless, the medical literature suggests that these direct observations of clinical encounters (DOCE) occur during less than one-quarter of internal medicine clerkships. Lack of faculty time is often cited as a barrier to completing DOCE. Most previously reported DOCE in internal medicine clerkships have involved interviewing, examining and presenting new patients, and averaged 45 minutes to complete and provide feedback to the student. \xa0Purpose: To learn if DOCE conducted during medical student pre-rounding on their hospital patients would be a useful learning exercise for medical students and to assess faculty time involved. Description. From April through October, 2010, third-year medical students were offered the opportunity of a DOCE during their internal medicine clerkship. This exercise was discussed with students during their clerkship orientation, and students were asked to contact directly the supervising faculty member to arrange a date and time. One of two academic hospitalists observed the student making pre-rounds on a patient that they had previously admitted and were following on-service. Faculty used a checklist comprised of 17 different items in three categories: communication (8 items), physical examination (5 items), and professionalism (4 items). After the observation, faculty provided to the student a formative evaluation that did not contribute to the students clerkship grade. Faculty made written comments on the checklist and gave a copy to the student. 31/34 (91%) students completed the DOCE, and records were available for 30 of these encounters. Time of observation averaged 15.3 minutes (range 7 - 25 minutes) and feedback averaged 13.9 minutes (range 8 - 22 minutes). Faculty provided feedback to students in the following areas (proportion of students): communication (30/30, 100%); physical examination (27/30, 90%); professionalism (30/30, 100%). 25/31 (81%) of students completed an anonymous satisfaction survey. 23/25 (92%) of these students found the exercise to be useful or very useful (average 5 point Likert score = 4.56) and 23/25 (92%) found it easy or very easy to schedule (average 5 point Likert score = 4.48).'


Presented at Society of Hospital Medicine, 05/13/2011, Dallas, TX. J Hosp Med 2011;6(Suppl 2):S125.