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"All the ward's a stage": a qualitative study of the experience of direct observation of handoffs
Journal article   Peer reviewed

"All the ward's a stage": a qualitative study of the experience of direct observation of handoffs

Kathleen Huth, Sarah Schwartz, Shelly-Anne Li, Natalie Weiser, Sanjay Mahant, Christopher P Landrigan, Nancy D Spector, Amy J Starmer, Daniel C West, Maitreya Coffey, …
Advances in health sciences education : theory and practice, v 24(2), pp 301-315
May 2019
DOI: https://doi.org/10.1007/s10459-018-9867-5
PMID: 30539343
Featured in Collection :   UN Sustainable Development Goals @ Drexel

Abstract

Clinical Competence - standards Competency-Based Education Documentation Environment Faculty, Medical - standards Hospitals, Pediatric - standards Humans Internship and Residency - standards Interviews as Topic North America Observation Patient Handoff - standards Qualitative Research Stress, Psychological - epidemiology Time Factors
Direct observation of clinical skills is central to assessment in a competency-based medical education model, yet little is known about how direct observation is experienced by trainees and observers. The objective of the study is to explore how direct observation was experienced by residents and faculty in the context of the I-PASS Handoff Study. In this multi-center qualitative study, we conducted focus groups and semi-structured interviews of residents and faculty members at eight tertiary pediatric centers in North America that implemented the I-PASS Handoff Bundle. We employed qualitative thematic analysis to interpret the data. Barriers to and strategies for direct observation were described relating to the observer, trainee, and clinical environment. Residents and faculty described a mutual awareness that residents change their performance of handoffs when observed, in contrast to their usual behavior in a clinical setting. Changes in handoff performance may depend on the nature of the observer or 'audience'. Direct observation also highlighted the importance of handoffs to participants, recognized as a clinical activity that warrants feedback and assessment. Dramaturgical theory can be used to understand our finding of 'front-stage' (observed) versus 'backstage' (unobserved) handoffs as distinct performances, tailored to an "audience". Educators must be cognizant of changes in performance of routine clinical activities when using direct observation to assess clinical competence.

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3 citations in Scopus

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Collaboration types
Domestic collaboration
International collaboration
Web of Science research areas
Education & Educational Research
Education, Scientific Disciplines
Health Care Sciences & Services
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