"You have to add your own character": Medical Student Perspectives on Observing Clinical Encounters

Abstract

Introduction: The authors aimed to investigate how medical students interpret the observation of a more experienced clinician modeling both exemplary and flawed behaviors as well as how that interpretation influences their subsequent clinical performance. Methods: We presented a recorded patient sexual history to 11 medical students. The recording displayed both exemplary and flawed behaviors. Students then obtained a sexual history from a standardized patient themselves. Using an interview methodology and constructivist analytic approach, we explored the process of learning from clinical observations. Results: Students attended to flawed modeled behaviors, challenges specific to the task, and how areas of their own personal development were accomplished. They took a piecemeal approach to classifying modeled behaviors as done well or poorly based on previous instruction, experience, or perceived downstream effects. When applying their observations, students choose to copy, adapt, or avoid modeled behaviors based on their classification of the behavior. Discussion: To optimize learning from observation, faculty can identify task-specific challenges and a student's personal goals, which naturally draw the student's attention, before observation in order to develop a shared mental model. When debriefing observed encounters, faculty may consider natural targets of learner attention, challenges specific to learning from observation, and factors likely to influence a learner's judgement of modeled behaviors.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

Funding for participant incentives, standardized patients and transcription services was provided by a pilot grant from the Bucksbaum Foundation for Clinical Excellence at University of Chicago.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Approved by the IRB at University of Chicago and University of Illinois at Chicago

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.

Yes

Data Availability

All data produced in the present study are available upon reasonable request to the authors

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