Direct observation of resident-patient encounters in continuity clinic: a controlled study of parent satisfaction and resident perceptions.

CONTEXT: Direct observation (DO) by teaching physicians of medical care provided by resident physicians offers a method to evaluate clinical skills beyond traditional measures that focus solely on medical knowledge assessment. OBJECTIVES: We sought to determine if the presence of the teaching physician observer affects parental satisfaction with care and to assess resident perceptions of DO in a general pediatrics residency clinic. METHODS: A cross-sectional parent survey compared visit satisfaction of parents who experienced a DO with controls in a traditional clinic visit. Additionally, a pre-post survey measured resident perceptions of direct observation before and after implementation of DO in the clinic. FINDINGS: Parents frequently described their overall satisfaction with care as "excellent" after DO and traditional visits (DO 70%, 95% CI, 50-86% and control 80%, CI 66-89%). However, parents in DO visits were less likely to rate their satisfaction with the amount of time spent in the room as excellent (DO 78%, CI 58-91%; Control 95%, CI 85-99%). Most resident physicians were in favor of the DO process (63%) and agreed that DO provides feedback about history-taking (94%), physical examination (94%) and interpersonal skills (91%). CONCLUSIONS: Direct observation by attending physicians does not decrease overall parental satisfaction during clinical encounters. Additionally, residents have a generally favorable opinion of direct observation and believe that it can provide useful feedback.

Performance of the Modified Checklist for Autism in Toddlers in Spanish-speaking patients.

OBJECTIVE: To compare abnormal screening rates of 2 different Spanish versions of the Modified Checklist for Autism in Toddlers (M-CHAT) in US Spanish-speaking patients. METHOD: Quasi-experimental design was used with historical and English language controls. Abnormal screening rates were compared between Spain and Western-hemisphere Spanish versions, as well as to English controls during the same time periods using chi square analysis. RESULTS: M-CHAT questionnaires were scored from 589 subjects (English n = 415, Spanish n = 174). There was little difference between Spanish versions. Overall, the Spanish abnormal screening rate was double that of English (23.6% vs 11.3%, P < .001). CONCLUSIONS: Spanish M-CHAT questionnaires are abnormal more often than those in English even after changing to appropriate translation, despite lower prevalence of autism in Latinos. Issues with translation, interpretation, or cultural understanding of behaviors may contribute. Given abnormal screening rates for Latinos, the use of the M-CHAT follow-up interview in Spanish-speaking patients is beneficial but may be more time-consuming.

A modified healthy steps model to improve resident training in behavioral and developmental care.

OBJECTIVE: To assess whether implementing a modified Healthy Steps (HS) for young children program in residency clinics could improve resident education and their perception of the quality of care provided for common behavioral and developmental (B/D) issues. METHODS: Residents and faculty blinded to study intent were surveyed to assess perceptions of resident preparedness and the quality of behavioral and developmental (B/D) care at 4 pediatric residency training sites in North Carolina. Initially, Program 1 (with an established HS program) was compared with 3 sites without established programs at baseline (Programs 2, 3, and 4), and then the results before and after implementation at Programs 2 to 4 were compared. RESULTS: Initially, subjects at Program 1 were more likely than those at Programs 2 to 4 to rate residents as "well" or "very well" prepared to provide B/D care (63% vs 20% respectively, 95% confidence interval of the difference, 25-61%) and more likely to rate the overall quality of B/D care at their clinic as "high" or "extremely high" (94% and 47% respectively, 95% confidence interval for the difference, 34-59%). After implementation of HS at Programs 2 to 4, the mean percentage of subjects rating residents as "well" or "very well" prepared and the ratings of the care provided increased dramatically. CONCLUSION: A modified HS model focusing on resident B/D education substantially increased attending and resident ratings of residents' preparedness to deliver B/D care and increased the ratings of the quality of B/D care provided.