Observation of Emergency Medicine Residents at the Bedside: How Often Does It Happen?

OBJECTIVE: To determine how often trainees in emergency medicine (EM) are observed while performing a history, a physical examination, or specific procedures. METHODS: The 26 members of the National Consensus Group on Clinical Skills in Emergency Medicine affiliated with an EM residency program were asked to circulate a survey to their residents during February and March 1994. Twenty-one programs participated, surveying a total of 514 residents. The residents were asked how many times they had been observed by an attending physician while they performed a history, a physical examination, endotracheal intubation, or central vein catheterization during training. The residents also were asked about observation of specific components of the physical examination, such as the heart, lung, and genitourinary systems. RESULTS: Three hundred nineteen residents (62%) responded to the survey. Thirteen percent of the residents reported that they had never been observed taking a history during training. During their PGY1 training, 19% of the residents reported that they had never been observed taking a history, 42% had been observed one to three times, 25% had been observed four to 12 times, and 13% had been observed > 12 times. Six percent of the residents reported that they had never been observed doing a physical examination during training. During their PGY1 training, 10% of the residents had never been observed performing a physical examination, 38% had been observed one to three times, 34% had been observed four to 12 times, and 18% had been observed > 12 times. CONCLUSIONS: Many residents report that they are infrequently observed performing histories and physical examinations during their EM training, with a significant number of residents reporting that they were never observed performing basic bedside clinical skills. More direct observation with trained faculty observers may provide an opportunity for better evaluation and remediation of bedside clinical skills.