The relationship between direct observation, knowledge, and feedback: results of a national survey

UMMS Affiliation

Meyers Primary Care Institute

Publication Date


Document Type



Data Collection; Educational Measurement; *Feedback; Internship and Residency; Students, Medical; United States


Health Services Research | Medical Education | Primary Care


BACKGROUND: Multisource feedback can provide a comprehensive picture of a medical trainee's performance. The utility of a multisource feedback system could be undermined by lack of direct observation and accurate knowledge.

METHOD: The National Board of Medical Examiners conducted a national survey of medical students, interns, residents, chief residents, and fellows to learn the extent to which certain behaviors were observed, to examine beliefs about knowledge of each other's performance, and to assess feedback.

RESULTS: Increased direct observation is associated with the perception of more accurate knowledge, which is associated with increased feedback. Some evaluators provide feedback in the absence of accurate knowledge of a trainee's performance, and others who have accurate knowledge miss opportunities for feedback.

CONCLUSIONS: Direct observation is a key component of an effective multisource feedback system. Medical educators and residency directors may be well advised to establish explicit criteria specifying a minimum number of observations for evaluations.

DOI of Published Version



Acad Med. 2011 Oct;86(10 Suppl):S63-7; quiz S68. Link to article on publisher's site

Journal/Book/Conference Title

Academic medicine : journal of the Association of American Medical Colleges

Related Resources

Link to Article in PubMed

PubMed ID