Does direct observation happen early in a new competency-based residency program?

To the best of our knowledge, this study is the first to report patterns of observation in a competency-based residency program. The results suggest that direct observation can be quickly adopted as the primary means of workplace-based assessment. Indirect observation comprised a sizeable minority of observations and may be an underrecognized contributor to workplace-based assessment. The preference toward either direct or indirect observation for certain EPA assessments suggests that the entrustable professional activity itself may influence the type of observation.