• graduate medical education;
  • clinical skills;
  • teaching;
  • skills;
  • resident;
  • emergency medicine


Objective: To describe the experience of a residency program in emergency medicine with an intensive observational evaluation of resident performance in the ED.

Methods: Each resident was directly observed and evaluated during a clinical shift four times each academic year: once by each residency codirector and twice by the resident's faculty advisor. The faculty members performed this evaluation outside of “clinical staffing time,” shadowing the resident for several hours in the ED during the resident's assigned shift. The resident and assigned faculty member discussed the patients' histories and physical examination findings and developed treatment plans together. Prior to initiation of the observation, the faculty were provided with guidelines for the evaluation of specific skills. Immediate feedback of strengths and deficiencies was provided to the resident.

Results: Subjective evaluations by faculty suggest that new insights into resident clinical strengths and weaknesses were determined using this approach. Objective scoring of resident performance demonstrated heterogeneity of skills between residents as well as inconsistency of skills for specific residents.

Conclusions: The program provided the faculty with protected teaching time, an opportunity to share clinical pearls, and unique insights into resident performance that are not obvious during standard clinical interactions.