A recent twitter exchange has stimulated me to revisit the topic of ‘observation’ as a purposeful activity supporting clinical teaching, learning and assessment. I first wrote about observation in 2003, when contributing to some early web-based resources for clinical teachers for the London Deanery (now a well established suite of free on-line resources). I argued that observation, at it's best, was
‘an active, purposeful task that stimulates deep learning and the development of professional ‘know-how’. At worst it is a passive process that leads to either heightened anxiety or total ‘shut down’ in the learner’.
At the time, I was referring to a classic approach to clinical teaching, where students are invited to observe the practice of qualified professionals and engage in a dialogue about what was observed, afterwards. I argued that it was important to maximize such learning opportunities, by making the learning opportunities explicit, including the use of ‘advance- organisers’ to help structure student’s observations by signaling the types of theoretical knowledge they might draw upon to make sense of the observed practice i.e. providing a framework to guide their observations. Drawing on the work of Karl Popper, I challenged the idea that observation is somehow an objective or ‘neutral’ process, illustrating the ways in which experienced clinicians draw upon experience and theoretical frameworks to analyse and interpret the behaviours they witness.
“Clearly the instruction “observe!” is absurd. Observation is always selective. It needs a chosen object, a definite task, an interest, a point of view, a problem.” (Popper, 1972, page 46)
In the twitter exchange, I was vicariously part of a conference session, and the observation referred to was not that of student observing teacher, rather that of teacher observing a learner, in a simulated scenario. The idea that captured my imagination was around the importance of the teacher drawing upon ‘objective’ observations as the basis of a debrief conversation designed to support further learning. I questioned the position that teacher observation was objective, suggesting that all observation is subjective, in that it is selective; the choice of what to observe is, I believe, influenced by what the observer feels to be most important or pertinent at that particular time, or in that particular situation. So, whilst it may be possible, as the teacher, to provide a ‘factual’ account of what was observed (or indeed not observed) at a behavioural level, there are limits to the usefulness of such observations. We cannot see the situation with the same eyes as the person in the middle of the action; what they notice and how they respond is something we can only infer. ( I am reminded here of a wonderful digital story called ‘Another person’s eyes’ on the Patient Voices website which beautifully captures what I am trying to express here’.)
The complexity of professional activity lies in what is not readily observable - the internal dialogue, the affective response, the reflection-in-action arising when things do not go in the way we might anticipate. The learning arising from engagement in observed work activity (whether in vivo or in simulation) is often hidden from observers view. I have blogged before about the origins of debrief being from the battlefield – where the lived experience of one participant is used as a shared resource for others around them. Asking the learner to talk you through the situation you have observed (either from memory or shared viewing of a recording) will afford insights into the ways in which they observe, read and respond to situations encountered. Inviting them to provide you with an advanced-organiser, directing you to the aspects of their performance they would most value your help with, is a powerful learner-centred strategy. Together, these approaches can form the basis of the rich, developmental conversations that support further development. By all means share your observations, drawing out similarities and differences in perspective as a way to develop insights, but be cautious about claiming objectivity!
As a footnote to this blog, I am left reflecting upon the exponential growth in the use of workplace based observations as the basis for decisions about competence. We observe a selected set of behaviours, at a given time, in a given place, for a given purpose, interpret these behaviours and make and record a judgment. This judgment is taken as an objective, portable measure of competence, i.e. a judgment that tells us about not only what was done in the observed moment, but what might be done in future comparable moments. In recording these judgments on a form, or in a portfolio, we objectify the subjective.
Popper, K. (1972) Conjectures and refutations: the growth of scientific knowledge’