Structured Clinical Observations (SCO)

1. Structured Clinical Observations(SCO) USUHS Pediatric Education Section September 2003

2. Miller’s Triangle Miller’s triangle of clinical competence (Miller GE. The assessment of clinical skills/ Competence/performance. Acad Med 1990; 65: 563-7)

3. Drs. K. Pituch, S. Bogdewic, M. Harris Indiana University • Developed BSOs (brief structured observations) in early 1990s. • Includes a debrief of the learner “What were you trying to accomplish during the segment of the encounter.” “What did you find out or communicate” “What else is important to find out or communicate?” • Academic Medicine May 1999

4. Drs. L. Lane and R. Gottlieb Jefferson • Responding to 1995 literature review and GEA of AAMC noting shortcomings in teaching and evaluation of clinical skills. • Developed SCO as a clinical skills teaching model that is economical of time and low cost. • Provide observation to ensure clinical competence. • Short, limited feedback points. • Teaching experience, not evaluation.

5. Evaluation of SCO (Lane and Gottlieb) • 60 students, 6-10 faculty, 368 observations, mean observations per student of 6 • Rated as highly educational by both faculty and students. • For 50% of students, it was only experience of direct observation of a clinical encounter. • Redirects energies of faculty to formative rather than summative assessment. • Pediatrics April 2000

6. How are SCO’s done? • Students learn what the SCO is during the clerkship orientation. • During each clinic session students review the 3 different checklist forms (Data Gathering, Physical Exam, and Information Giving). • http://www.pedsedu.com/forms.htm • Preceptors advise students that the focus of the observation will be on the process of the interview, physical exam, or information giving session.

7. How are SCO’s done? • Time permitting, the faculty preceptor unobtrusively enters the room and observes part of the student/patient encounter • Observations are focused by using the objective skills guidelines listed on the individual SCO checklists.

8. SCO Checklist Data Gathering • Opening/Closing the interview • Data collection ( open-ended questions, logical sequencing of questions) • Relationship skills (listens carefully, legitimizes patients feelings or concerns) • Personal Manner (good eye contact, appropriate body language)

9. How are SCO’s done? • After 3 feedback points (positive or negative) are observed, the preceptor exits the exam room and allows the student to complete the encounter. • Feedback should be given to the student, either immediately after the encounter, or before the end of the clinic day.