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Effects of Training in Direct Observation of Medical Residents' Clinical Competence: A Randomized Trial

Eric S. Holmboe, MD; Richard E. Hawkins, MD; and Stephen J. Huot, PhD, MD
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From Yale University, New Haven, Connecticut, and the Uniformed Services University of the Health Sciences, Bethesda, Maryland.


Note: Dr. Hawkins was Associate Professor of Medicine at the Uniformed Services University of the Health Sciences during the duration of this study.

Acknowledgments: The authors thank Yun Wang, MS, for his statistical expertise, Leslie Galaty for her help in data entry and organization, Dr. Jeffrey Chung for his invaluable assistance in the research, Dr. Louis Pangaro for his assistance in reviewing videotapes, Dr. John Norcini and Rebecca Lipner for their statistical advice, and Drs. Patrick O'Connor and Daniel Duffy for their review of the research.

Grant Support: By the Robert Wood Johnson Foundation and the American Board of Internal Medicine Foundation.

Potential Financial Conflicts of Interest:Honoraria: E.S. Holmboe (American Board of Internal Medicine Foundation); Grants received: E.S. Holmboe (Robert Wood Johnson Foundation, American Board of Internal Medicine, Bureau of Primary Healthcare, Agency for Healthcare Research and Quality, Mitchell Center for Prisoner of War Studies, Reynolds Foundation, American College of Physicians Foundation).

Corresponding Author: Eric S. Holmboe, MD, Department of Medicine, Waterbury Hospital, Pomeroy 6, 64 Robbins Street, Waterbury, CT 06721.

Current Author Addresses: Dr. Holmboe: Department of Medicine, Waterbury Hospital, Pomeroy 6, 64 Robbins Street, Waterbury, CT 06721.

Dr. Hawkins: National Board of Medical Examiners, 3750 Market Street, Philadelphia, PA 19104-3102.

Dr. Huot: Yale University School of Medicine, 33 Cedar Street, 1074 LMP, New Haven, CT 06520.

Author Contributions: Conception and design: E.S. Holmboe, R.E. Hawkins, S.J. Huot.

Analysis and interpretation of the data: E.S. Holmboe, R.E. Hawkins.

Drafting of the article: E.S. Holmboe, S.J. Huot.

Critical revision of the article for important intellectual content: E.S. Holmboe, R.E. Hawkins.

Final approval of the article: E.S. Holmboe, R.E. Hawkins, S.J. Huot.

Provision of study materials or patients: E.S. Holmboe, R.E. Hawkins.

Obtaining of funding: E.S. Holmboe.

Administrative, technical, or logistic support: E.S. Holmboe, R.E. Hawkins.

Collection and assembly of data: E.S. Holmboe, R.E. Hawkins.


Ann Intern Med. 2004;140(11):874-881. doi:10.7326/0003-4819-140-11-200406010-00008
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Forty-three faculty members were originally randomly assigned. Forty were enrolled at baseline: 17 in the intervention group and 23 in the control group (Figure). Three faculty members were excluded because of unanticipated clinical responsibilities. Thirty-seven faculty members (93%) (16 in the intervention group and 21 in the control group) completed both the baseline and follow-up assessments. One participant in the intervention group missed the direct observation of competence training at baseline but completed all videotape reviews. One participant each from the intervention and control groups left their institutions during the academic year and were unavailable for follow-up. One participant from the control group declined to complete the follow-up assessment. The demographic characteristics of the 2 groups are shown in Table 2.

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Flow of participants through the study.
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Summary for Patients

Direct Observation of Medical Trainees' Clinical Skills

The summary below is from the full report titled “Effects of Training in Direct Observation of Medical Residents' Clinical Competence. A Randomized Trial.” It is in the 1 June 2004 issue of Annals of Internal Medicine (volume 140, pages 874-881). The authors are E.S. Holmboe, R.E. Hawkins, and S.J. Huot.

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