Evaluation of a Direct Observation, Coaching and Assessment Model for the Internal Medicine Clerkship

• DOI: 10.1111/tct.70091
• Publication Date: 2025-04-08T03:45:06Z
• Authors: Katherine C. Wrenn; Cancan Zhang; Amy R. Weinstein

ABSTRACTBackgroundWith a trend towards competency‐based assessment in medical education, there is a need for increased direct observation, feedback and coaching of medical students during clinical rotations.ApproachTo increase observation and provide more coaching and feedback, we designed a model in which a faculty coach met with students longitudinally during the internal medicine clerkship. The first session included an observed history and physical (H&P), and the coach and student identified skill areas to focus on in remaining sessions. All sessions included a debrief with feedback.EvaluationStudents received a survey to rate the amount and quality of observation and feedback received, and we used ordinal logistic regression models to assess the intervention. We conducted thematic analysis to assess what students found most useful. Students in the intervention group reported more direct observation performing the H&P (OR = 9.17, 95% CI [1.86, 70.05], p = 0.01) and found the personalized feedback and increased opportunities to discuss clinical reasoning valuable.ImplicationsWith a growing need for longitudinal observation of clinical skills to allow for competency‐based assessments, at a time in which there is often insufficient continuity between students and supervising physicians, this model helps address needs for increased direct observation, coaching and feedback on skill development over time.