Saleem Farook

Acceptability and feasibility of the standardized direct observation assessment tool in the emergency department in Qatar

Workplace-based Assessments (WBAs) are important tools designed to assess the performance of residents in a clinical setting. The Standardized Direct Observation Tool (SDOT) is a WBA tool used by emergency medicine (EM) residency programs to assess the performance of residents. The SDOT, originally designed for use in the United States (US) residency programs, was implemented in other international programs as a part of their accreditation by the Accreditation Council for Graduate Medical Education-International (ACGME-I).1 Along with the many foundational requirements, the ACGME-I sets out the six core competencies of medical knowledge, patient care, professionalism, interpersonal communication skills, practice-based learning, and system-based practice. The SDOT is designed to assess these competencies. Studies on the SDOT have focused on its reliability, but have not assessed its feasibility and acceptability to practitioner and institutions.2,3 The busy clinical practice environment of an emergency department (ED) presents numerous challenges which could adversely impact the implementation of the SDOT. The resource implications of time spent in conducting and documenting, the potential cost of the physicians’ time and other administrative variables need consideration. The EM residency program (EMRP) in Qatar is based at one of the busiest EDs in the world, with an annual attendance of over four hundred thousand patients. The SDOT was introduced to the EMRP in 2013 as a part of ACGME-I accreditation. The EMRP had a rich mix of approximately 40 residents and 100 faculty physicians drawn from international training and cultural backgrounds for those who the concept of WBA was unfamiliar. In its early phase, the implementation of the SDOT was mitigated by several feasibility and acceptability issues. Therefore, we embarked on an evaluation of SDOT use in the ED with an intention to make subsequent improvements to its implementation within the program. The aim of the paper is to explain our experiences and the lessons learned of the acceptability and feasibility of the SDOT in Qatar.