Continuity-structured clinical observations: Assessing the multiple-observer evaluation in a pediatric resident continuity clinic

Karen P. Zimmer, Barry Solomon, George K. Siberry, Janet Rose Serwint

Research output: Contribution to journalArticle


OBJECTIVES. The continuity-structured clinical observation tool was developed and used to conduct a multiple-observer evaluation to assess residents in the core competency areas of patient care, interpersonal and communication skills, and professionalism. The objectives were to assess pediatric resident performance in a continuity clinic by using direct observation and to compare evaluations among preceptors, residents, and parents. METHODS. Pediatric residents in a large continuity clinic participated between August and December 2005. The continuity-structured clinical tool included items in the following domains: opening the interview, history taking, relationship skills, personal manner, negotiation or management, and physical examination. Each resident was directly observed during 1 entire patient encounter. Parents, preceptors, and residents completed evaluations by selecting 1 of 4 possible responses for performance of each item. We dichotomized responses as "yes" versus "no/partial" and analyzed aggregate scores for individual items and domains among the 3 evaluators by McNemar test, percentage agreement, and interoberserver agreement (κ). RESULTS. Fifty-four of 57 eligible residents had all 3 evaluations completed. Parents rated residents the highest and showed least variability (only 2 items for which parents indicated the task was completed in

Original languageEnglish (US)
Issue number6
StatePublished - Jun 2008



  • Continuity-clinic experience
  • Continuity-structured clinical observations
  • CSCO
  • Multiple-observer assessments
  • Resident education

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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