DOCENT: A Direct Observation Clinical Experience with feedback iN real-Time (DOCENT)

Abstract

Background Observation of student skills is essential for accurate assessment of entrustment and competence. Time spent directly observing students in patient care must balance with the need to serve adequate numbers of patients and, in some instances, revenue generation. Clinical education may also be hampered by a negative learning climate. The authors created a Direct Observation Clinical Experience with feedback iN real Time (DOCENT) clinic with patients from the Emergency Department (ED) to provide care for low-acuity patients while observing student care to determine the best location for the clinic and interprofessional education opportunities. Methods Patient number, chief complaints, estimated severity of illness (ESI), and use of radiology resources were logged. ESI, length of stay (LOS), and satisfaction were monitored for non-inferiority to ED patients. Student evaluations collected information on amount of direct observation, quality of feedback, learning climate and both peer-to-peer and interprofessional teaching. Results Musculoskeletal (MSK) complaints were the most common category of complaints. Patient LOS in DOCENT was shorter than for ED patients (mean 4.5 vs. 6.4 hours, p < 0.0001). DOCENT patient satisfaction was higher than ED patient satisfaction. Patients with higher ESI could be seen when the clinic was located closer to the ED. Over 90% of students reported receiving constructive and reinforcing feedback and 100% reported a positive learning climate. Conclusions Creation of a DOCENT clinic in the ED provided an enriched student experience without compromising patient care. The high rates of MSK complaints provided great opportunity for interprofessional collaboration with physical therapy.