# Introduction to the Inpatient Medicine Clerkship Direct Observations

<h2 align="center"><mark style="color:purple;">Introduction to the Clerkship Direct Observations of History Taking and Physical Examination Skills</mark></h2>

### <mark style="color:$primary;">Introduction</mark>

Direct Observations (DOs) are designed to provide you with opportunities to demonstrate your history-taking, physical examination, medical decision-making, and communication and interpersonal skills in an observed setting. You are expected to demonstrate important interpersonal skills related to history taking and physical examination in any patient encounter.

The ultimate goal of these exercises is to provide you with formative and summative feedback on skills identified by the clerkship directors as critical to their particular field/discipline. Feedback is critical in every stage of development for a physician, and we encourage you to use this chance to hone your clinical skills and also your ability to receive feedback thoughtfully.

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### <mark style="color:$primary;">General Information</mark>&#xD;

* The [ISMMS Academic Integrity Policy](https://ismms-md-program.gitbook.io/medical-student-handbook/policies-and-procedures/md-program-specific-policies-and-procedures/student-and-faculty-conduct#academic-integrity-policy) governs this assessment.
* All encounters will occur at the Morchand Center on the 13th floor of Annenberg.
* All encounters are in-person with standardized patients (SPs) and/or part-task simulators.
  * You should treat all SP encounters with the same respect, empathy, and concern that you would have with actual patients.
* We expect professional behavior with the staff in the Morchand Center.
* Consumption of any candy, food, or gum in the Morchand Center is strictly prohibited.
* You will receive email notifications of the time and date of your DOs from the Clinical Curriculum Team.

  * Time slot assignments are firm.&#x20;
  * However, please monitor your email for unexpected delays or adjustments prior to arrival.
  * There will be NO RESCHEDULING of late arrivals.
  * You must arrive at your designated arrival time.
* Masking guidelines are aligned with [Mount Sinai Health System Guidelines](https://www.mountsinai.org/about/covid19) for the hospital/clinical setting.

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### <mark style="color:$primary;">What to Expect at the Morchand Center</mark>

*Prior to Arrival*

* You will receive access to an ORIENTATION VIDEO shortly before the program.
  * Please watch the orientation video, in full, prior to your assigned arrival time.

*Orientation*

* The Proctor will meet you for your ON-SITE orientation at the location designated in the email.
* Please give the Proctor your full attention during orientation (no cell phone usage, etc.).
* The Proctor will also provide you with a letter badge to be worn outside of your coat.
* Make sure your letter badge is always visible.
* Wear your white coat and bring a pen.
* Please bring your stethoscope.
* Any other diagnostic tools needed will be provided by the Morchand Center.
* Clipboards, paper, and pens will be available if you wish to take notes.
* Any other necessary equipment to complete any of the physical examination tasks (including access to a clock with seconds hand) will also be provided.

*Exam Room Set-Up*

* Inside the Morchand Center, all personal items, textbooks, study materials, cell phones, smartwatches, and devices with audio or video recording capabilities will be safely stored.
  * When encounters have ended, you may retrieve and take your belongings with you.

* Each DO encounter will be captured by audio/visual equipment in the exam room.

* DO NOT CLICK anything on the computers outside of your assigned exam room.
  * Doing otherwise will cause technical difficulties and significant delays.

* For camera angles, sit on the chair/stool provided while taking a history and DO NOT MOVE it.

* During a physical examination, you can move freely; the cameras will follow you.

* There is no write-up, so you do not have to take notes.

  * If you do take notes, they will be collected at the end of each encounter.

* There is no notetaking during feedback.

*Format and Timing of Encounters*

* One 20-minute encounter with an SP (targeted physical examination and discharge).
  * You will receive a 5-minute warning prior to the end of the encounter.
* 15-minute waiting period while SP completes video review and checklist.
* 10-minute in-person feedback with SP.
  * You will receive a 2-minute warning prior to the end of the feedback session.

*Feedback Format*

* Prior to delivering feedback, the SP will review your video and complete a paper checklist.
* During feedback, the SP will discuss their experience of empathy, concern, and respect from the perspective of a patient; SPs will not provide feedback on history or physical exam items and they cannot provide you with a score.
* For any discrepancy between SP feedback and personal recollection of your own performance, please let the SP know and it will be noted for secondary review.
* All encounters are recorded on video and available for the faculty to review.

*Required Video Review*

* The Clerkship Director (CD) alerts Aaron Yellin and Meghan Green (<aaron.yellin@mssm.edu>, <meghan.green@mssm.edu>) to the need for remediation and confirms you have been notified.
  * If you require remediation, you must review your encounter video(s).
* Aaron schedules video review and remediation encounter(s) directly with you.
* Video review is scheduled for the soonest possible date.
* During video review, you complete the [DO Self-Assessment Form](https://files.gitbook.com/v0/b/gitbook-x-prod.appspot.com/o/spaces%2FOo7oNvix0SS7VR7eryOZ%2Fuploads%2Fz0tHCFmN5qksrKGvGTy7%2FDO%20Student%20Self-Assessment%20Form.pdf?alt=media\&token=acb51e7c-0dbc-4c3c-bac6-82ef7cbf7d73).

  * If video review is required, you must share your form with your CD.

*Elective Video Review*

* You should send an email to <themorchandcenter@mssm.edu>, addressed to Aaron Yellin.
* The [DO Self-Assessment Form](https://files.gitbook.com/v0/b/gitbook-x-prod.appspot.com/o/spaces%2FOo7oNvix0SS7VR7eryOZ%2Fuploads%2Fz0tHCFmN5qksrKGvGTy7%2FDO%20Student%20Self-Assessment%20Form.pdf?alt=media\&token=acb51e7c-0dbc-4c3c-bac6-82ef7cbf7d73) will be provided, but completing is optional.

**NOTE: Video review is not to be used for score adjustments as these requests must be made immediately after the exam when you receive verbal feedback from your SP.**
