![]() Also at stake is the summative assessment of learners’ competence and ultimately the quality of care provided to patients. From a formative perspective, learners do not receive feedback to support the development of their clinical skills. Lack of high quality direct observation has significant implications for learning. However, despite its importance, direct observation of clinical skills is infrequent and the quality of observation may be poor. Direct observation is required by medical education accrediting bodies such as the Liaison Committee on Medical Education, the Accreditation Council of Graduate Medical Education and the UK Foundation Program. As a result, direct observation is an increasingly emphasized assessment method in which learners (medical students, graduate or postgraduate trainees) are observed by a supervisor while engaging in meaningful, authentic, realistic patient care and clinical activities. ’ Training programs and specialties have now defined required competencies, competency components, developmental milestones, performance levels and entrustable professional activities (EPAs) that can be observed and assessed. For the purposes of these guidelines, we use the following definition of competent: ‘Possessing the required abilities in all domains in a certain context at a defined stage of medical education or practice. While direct observation of clinical skills is a key assessment strategy in competency-based medical education, it has always been essential to health professions education to ensure that all graduates are competent in essential domains. Additional research to address the Don’t Knows can help educators realize the full potential of direct observation in competency-based education. Improving direct observation requires focus not just on individual supervisors and their learners, but also on the organizations and cultures in which they work and train. These guidelines offer important evidence-based Do’s and Don’ts that can help improve the frequency and quality of direct observation. High frequency, high quality direct observation of clinical skills can be challenging. Guidelines address recommendations for how to focus direct observation, select an assessment tool, promote high quality assessments, conduct rater training, and create a learning culture conducive to direct observation. Guidelines focus on two groups: individual supervisors and the educational leaders responsible for clinical training programs. ResultsĪ final set of 33 Do’s, Don’ts and Don’t Knows is presented along with a summary of evidence for each guideline. We then sought and compiled evidence to support each guideline and determine the strength of each guideline. Lists were compiled, discussed and revised. We built consensus through an iterative approach in which each author, based on their medical education and research knowledge and expertise, independently developed a list of Do’s, Don’ts, and Don’t Knows about direct observation of clinical skills. The goal is to provide a practical list of Do’s, Don’ts and Don’t Knows about direct observation for supervisors who teach learners in the clinical setting and for educational leaders who are responsible for clinical training programs. The guidelines presented in this paper synthesize the literature on direct observation of clinical skills. Direct observation of clinical skills is a key assessment strategy in competency-based medical education.
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