Direct Observations

Section 3: Assessment Activity

3 credits per hour

Rationale and Target Audience:

This tool is for you if you are seeking feedback on your practice through direct observation from peers, colleagues, or other health professionals. The feedback may help identify future learning and/or continuous improvement opportunities.

1Identify an area of your practice you would like to improveChoose an area of your practice to assess.

I would like to:

  • Improve my working knowledge and application of the Enhanced Recovery After Surgery (ERAS) guideline recommendations after colonic surgery.
2Identify performance question(s)Identify specific performance question(s) you have about this area of your practice (e.g. clear communication with patients, correct use of a circular stapler in the OR etc.).

My specific question(s) is/are:

  • What percentage of my patients develop surgical site incision infections?
  • How many of my patients are optimized preoperatively
  • How many of my patients are appropriately receiving deep vein thrombosis (DVT) prophylaxis after surgery
3Select one to three professional standards or criteriaSelect one to three criteria/standards to compare your performance against (e.g. hospital/university guidelines, teamwork expectations, patient metrics, provincial performance data, etc.)

I will compare how I currently perform against: 

  • ERAS guidelines for perioperative care in elective colonic surgery
  • National Surgical Quality Improvement Program (NSQUIP) data
  • General surgery program- specific and hospital- wide surgical site infection prevalence and DVT prophylaxis data-Hospital prehabilitation data (if available)
4Assess your performanceObservations of your performance can be conducted by trusted peer(s) (based specifically on the performance chosen to be observed).

The data sources that I will use to learn more about my current performance: 

  • Direct or video assisted O.R. observation from a colleague with regards to skin preparation, drain placement, closing technique, surgical site dressing choice etc.
  • Peer chart review regarding DVT prophylaxis ordering and timing of 1st administration, preoperative optimization, bowel preparation, etc.
5Compare your current performance with the standards include:Review and analyze the data you collected about your performance in step #4 and compare it to the guidelines selected in step #3. This will help you identify gaps and learning opportunities.

Gaps noted in current performance vs. existing standards 

  • In contrast to ERAS guidelines, my common practice is to place surgical site drains and nasogastric tubes in all patients. Many of my patients are receiving DVT prophylaxis >12 hrs. rather than 6-12 hrs. post-operatively.
  • In contrast to a colleague, and ERAS recommendations, my common practice is to administer intravenous antibiotics before an incision.
6Discuss your findings with trusted peer(s)Share and discuss your findings with trusted colleagues, peers, or mentors to get input and feedback on the gaps/opportunities you identified and plan for next steps.

I will collect input and review feedback from:

  • A general surgery colleague who observed my performance
  • A wound care/surgical ward nurse
7Identify the next steps for practice improvementUse the data and feedback you collected on your performance to identify the actions you will take to close the gap between your current performance (guideline #4) and your desired performance (guideline #5) (e.g. additional learning, modifications to a practice process etc.).

Self-assessment of my performance identified:

  • Need to write specific post-op orders related to removal timing, and type of DSD for the first dressing change
  • Need to write specific time for 1st dose DVT prophylaxis administration 6 hrs. post-op rather than simply state start P.O.D. #1
8Document this process and the outcomes in your MAINPORT ePortfolioTime spent on steps 1 through 7 can be claimed under Section 3: Direct Observation.I spent 2 hours reviewing the feedback received from my colleague, and I created a plan of action for improvement. I will claim this activity in my MAINPORT account under Section 3: Direct Observation.


  1. What aspect(s) did you perform well? What aspect(s) are recommended for improvement?
  2. What surprised you from the data and feedback you received?
  3. What pleased you from the data and feedback you received?
  4. What specific actions (including additional CPD) are you planning to complete to respond to the feedback you received?
  5. What challenges, if any, do you anticipate in implementing these plans for improvement?
  6. What measures would enable you to determine if the planned changes are successful?
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Use your reflections on these (or other similar questions) to record the outcomes on the feedback you received from a peer, colleague or health professional.

To claim MOC credit for this assessment activity, visit MAINPORT and complete the fields under Section 3: Direct Observation for 3 credits per hour.