> For the complete documentation index, see [llms.txt](https://ismms-md-program.gitbook.io/medinfoapp/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://ismms-md-program.gitbook.io/medinfoapp/legacy-clerkships/psychiatry/introduction-to-the-clerkship-direct-observations.md).

# Introduction to the 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>

<p align="center"><strong>Academic Year 2025-2026</strong>
<br><em>Revised June 11, 2025</em></p>

### Introduction

Direct Observations (DOs) in the clerkships are designed to provide you with opportunities to
\
demonstrate your history taking and physical examination skills in an observed setting. You are also
\
expected to demonstrate important interpersonal skills related to history taking and physical examination
&#x20;in any patient encounter.

\
The ultimate goal of these exercises is to provide you with formative and summative feedback on these
\
skills identified by the clerkship director as critical to their particular field/discipline. Feedback is critical in
&#x20;every stage of development for a physician and we encourage you to use this chance to hone your
\
clinical skills and your ability to receive feedback thoughtfully.

***

### General Information&#xD;

* All encounters will occur at the Morchand Center on the 13th floor of Annenberg.
* All encounters are in-person with standardized patients (SPs).
  * 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.
* Email notifications of the time and date of your DOs will come from the Clerkship Coordinator.

  * Time slot assignments may change; please monitor your email prior to arrival.
  * You must **arrive** at your designated arrival time.
  * There will be NO RESCHEDULING of late arrivals.
* Masking guidelines are aligned with [Mount Sinai Health System Guidelines](https://www.mountsinai.org/about/covid19/staff-resources/policies?accordionAction=accordion-jump_link-64348856) for the hospital/clinical setting.

***

### What to Expect at the Morchand Center

*Prior to Arrival at the Morchand*

* 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.
  * At the end of the video, linked for review is the ISMMS Academic Integrity Policy.
  * This policy governs all assessments.

*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.
* Wear your white coat, and make sure your letter badge is clearly visible on it.
* All 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 Snellen card and access to a clock with seconds hand) will also be provided.

*Arrival and 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 note taking during feedback.

*Format and Timing of Encounters*

**Neurology – 1 Direct Observation, with 1 SP**

* One 15-minute encounter with an SP (physical examination only).
  * 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.

**Psychiatry – 2 Direct Observations, with 2 different SPs**

* Two 10-minute encounters with an SP (history taking and mental status examination).
  * You will receive a 5-minute warning prior to the end of each encounter.
* 15-minute waiting period while SP completes video review and checklist after each encounter.
* 10-minute in-person feedback with SP after each encounter.

  * You will receive a 2-minute warning prior to the end of each 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 concrete skills that were expected of you as well as their experience of empathy, concern, and respect from the perspective of a patient.
* 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%2FlMNnO8oDICD98C3MI3F6%2FDO-Student-Self-Assessment-Form%20\(2025-26\).pdf?alt=media\&token=e8343ce8-9fd8-4f05-8998-d1c5fc5702c0).

  * 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%2FlMNnO8oDICD98C3MI3F6%2FDO-Student-Self-Assessment-Form%20\(2025-26\).pdf?alt=media\&token=e8343ce8-9fd8-4f05-8998-d1c5fc5702c0) 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.**