Peer Observations to Enhancing Bedside Clinical Teaching

In academic medical centers, residents and studies get bedside teaching and direct patients care experience by teaching clinical attendings. To improve their teaching skills, these teaching attendings need feedback on their teaching. Teaching attendings receive feedback through learner evaluations, which has been shown to improve teaching effectiveness, but to provide anonymity to the learner, these evaluations are usually aggregated and given to the attending months later, limiting timely improvements. In addition, learners may lack the framework to give effective feedback on teaching and may base evaluations on a variety of factors, such as a desire to achieve a good grade. It is not uncommon that a learner who received poor feedback during a clinical rotation gives poor evaluations to a teaching attending.

Peer observation with feedback is a solution to the drawbacks of learner evaluation of teaching attendings. Peer observation of teaching behaviors encourages reflection by both the observer and the teaching attending being observed, leading to increased confidence and performance. Peer observation of teaching skills in lecture or small group settings has been evaluated but there is a paucity of studies examining the effect of feedback provided by peers observing the teacher during bedside rounds.

One framework often used is the Stanford Faculty Development Program (SFDP). The SFDP describes seven domains of effective clinical teaching: learning climate, control of teaching session, communication of goals, promotion of understanding and retention, evaluation, feedback, and promotion of self-directed learning. Investigators for this study designed a survey tool using SFDP and used it for peer-observation of teaching skills. Such a study is tedious, time consuming, difficult to do, and requires very engaged faculty who is ready to volunteer significant amount of their personal time for observation.

The survey tool focused on five teaching domains (learning climate, control of session, promotion of understanding and retention, evaluation, and feedback) relevant to the inpatient teaching environment excluding the other two. Teaching attendings were observed at the beginning of a two-week teaching rotation, given feedback, and then observed at the end of the rotation. Overall, they completed 70 observations over 27 teaching attendings. Mean survey tool scores in teaching behavior domains ranged from 2.1 to 2.7. In unadjusted and adjusted analysis, each teaching observation was followed by higher scores in learning climate (adjusted improvement = 0.09; 95% CI = 0.02-0.15; p = 0.007) and promotion of understanding and retention (adjusted improvement = 0.09; 95% CI = 0.02-0.17; p = 0.01). The standardized observation tool had Cronbach’s alpha of 0.81 showing high internal validity.

The study shows that the peer observation of bedside teaching followed by feedback using a standardized tool is feasible and results in measured improvements in desirable teaching behaviors.