Advancing Our Understanding of Narrative Comments Generated by Direct Observation Tools: Lessons From the Psychopharmacotherapy-Structured Clinical Observation

J Grad Med Educ. 2019 Oct;11(5):570-579. doi: 10.4300/JGME-D-19-00207.1.


Background: While prior research has focused on the validity of quantitative ratings generated by direct observation tools, much less is known about the written comments.

Objective: This study examines the quality of written comments and their relationship with checklist scores generated by a direct observation tool, the Psychopharmacotherapy-Structured Clinical Observation (P-SCO).

Methods: From 2008 to 2012, faculty in a postgraduate year 3 psychiatry outpatient clinic completed 601 P-SCOs. Twenty-five percent were randomly selected from each year; the sample included 8 faculty and 57 residents. To assess quality, comments were coded for valence (reinforcing or corrective), behavioral specificity, and content. To assess the relationship between comments and scores, the authors calculated the correlation between comment and checklist score valence and examined the degree to which comments and checklist scores addressed the same content.

Results: Ninety-one percent of the comments were behaviorally specific. Sixty percent were reinforcing, and 40% were corrective. Eight themes were identified, including 2 constructs not adequately represented by the checklist. Comment and checklist score valence was moderately correlated (Spearman's rho = 0.57, P < .001). Sixty-seven percent of high and low checklist scores were associated with a comment of the same valence and content. Only 50% of overall comments were associated with a checklist score of the same valence and content.

Conclusions: A direct observation tool such as the P-SCO can generate high-quality written comments. Narrative comments both explain checklist scores and convey unique content. Thematic coding of comments can improve the content validity of a checklist.

MeSH terms

  • Checklist
  • Clinical Competence*
  • Educational Measurement / methods
  • Faculty, Medical*
  • Humans
  • Internship and Residency / statistics & numerical data*
  • Psychiatry / education*
  • Psychopharmacology / education
  • Writing