The Enablers and Barriers to the Use of Direct Observation of Trainee Clinical Skills by Supervising Faculty in a Psychiatry Residency Program

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Abstract
Objective: Studies have reported that medical trainees do not get sufficient direct observation. Our study aimed to determine the frequency of direct observation and the enablers and barriers to direct observation in the department of psychiatry at a large Canadian university. Method: Focus groups and interviews explored the role and use of direct observation, followed by a survey both of faculty and of residents. Results: Direct observation was used in various contexts in the residents' last rotation. Missed opportunities are identified. Enablers include financial compensation, guidelines, and a discussion at the beginning of each clinical rotation. Barriers are identified at the resident, faculty, and administrative levels. Conclusions: Direct observation is used in many contexts in psychiatric training. While there are barriers which limit its use, our data indicate numerous potential enablers and missed opportunities for more observation.

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