A phenomenological investigation of patients’ experiences during direct observation in residency: busting the myth of the fly on the wall

Chris B.T. Rietmeijer*, Mark Deves, Suzanne C.M. van Esch, Henriëtte E. van der Horst, Annette H. Blankenstein, Mario Veen, Fedde Scheele, Pim W. Teunissen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

7 Citations (Scopus)
23 Downloads (Pure)


Direct observation (DO) of residents by supervisors is a highly recommended educational tool in postgraduate medical education, yet its uptake is poor. Residents and supervisors report various reasons for not engaging in DO. Some of these relate to their interaction with patients during DO. We do not know the patient perspectives on these interactions, nor, more broadly, what it is like to be a patient in a DO situation. Understanding the patient perspective may lead to a more complete understanding of the dynamics in DO situations, which may benefit patient wellbeing and improve the use of DO as an educational tool. We conducted a phenomenological interview study to investigate the experience of being a patient in a DO situation. Our analysis included multiple rounds of coding and identifying themes, and a final phase of phenomenological reduction to arrive at the essential elements of the experience. Constant reflexivity was at the heart of this process. Our results provide a new perspective on the role of the supervisor in DO situations. Patients were willing to address the resident, but sought moments of contact with, and some participation by, the supervisor. Consequently, conceptions of DO in which the supervisor thinks she is a fly on the wall rather than a part of the interaction, should be critically reviewed. To that end, we propose the concept of participative direct observation in workplace learning, which also acknowledges the observer’s role as participant. Embracing this concept may benefit both patients’ wellbeing and residents’ learning.

Original languageEnglish
Pages (from-to)1191-1206
Number of pages16
JournalAdvances in Health Sciences Education
Issue number4
Early online date25 Mar 2021
Publication statusPublished - Oct 2021

Bibliographical note

Funding Information:
The authors wish to thank the patients who participated in this study and the residents and supervisors who cooperated. Martina Ann Kelly and Sven Schaepkens helped us find our way in the world of phenomenology. Marilyn Hedges provided feedback on English grammar and style.

Publisher Copyright:
© 2021, The Author(s).


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