“You have to add your own character”: Medical Student Perspectives on Observing Clinical Encounters

Introduction The authors aimed to investigate how medical students interpret the observation of a more experienced clinician modeling both exemplary and flawed behaviors as well as how that interpretation influences their subsequent clinical performance. Methods We presented a recorded patient sexual history to 11 medical students. The recording displayed both exemplary and flawed behaviors. Students then obtained a sexual history from a standardized patient themselves. Using an interview methodology and constructivist analytic approach, we explored the process of learning from clinical observations. Results Students attended to flawed modeled behaviors, challenges specific to the task, and how areas of their own personal development were accomplished. They took a piecemeal approach to classifying modeled behaviors as done well or poorly based on previous instruction, experience, or perceived downstream effects. When applying their observations, students choose to copy, adapt, or avoid modeled behaviors based on their classification of the behavior. Discussion To optimize learning from observation, faculty can identify task-specific challenges and a student’s personal goals, which naturally draw the student’s attention, before observation in order to develop a shared mental model. When debriefing observed encounters, faculty may consider natural targets of learner attention, challenges specific to learning from observation, and factors likely to influence a learner’s judgement of modeled behaviors.