PPM

We have set up physician superusers at each location that do the direct observation. 

Utilize something like the photomicrographs the Proficiency Providers use for testing in lieu of "live" specimens. Perhaps you could present the images via a Zoom, Teams, etc. meeting platform to circumvent the need for a viable specimen and directly observe the provider make the identification. I would argue that no one is doing a true direct observation for PPM unless you are using a dual head scope. 

I follow a process similar to the one stated above by Andries. I use the MTS educational modules that are assigned to the providers on a biannual basis. These MTS modules have 5 images that they have to identify on their own. The passing score is 100%. 
For the annual direct observations, I use photomicrographs from Proficiency testing in lieu of "live" specimens. Last year, due to the pandemic, I actually requested the clinic's  manager to invite me to one of their monthly faculty meetings, where I was able to do the "direct observations" via the Zoom meeting platform. For this purpose, prior to the meeting I emailed each physician an observation checklist with the necessary elements of compliance and relevant questions to be answered by the physicians on their own. An important component of the quiz was to identify 5 cellular elements presented during the meeting. 
I agree the PPM direct observation could be challenging for many reasons (e.g. sample viability, physicians busy schedule, availability of a dual head microscope) however, it can be accomplished on different ways. Let's keep sharing more ideas,

We use the MTS as well for part of the competency. The physicians are responsible for the other direct observations. They perform on eachother, annually. The samples are couriered over from our micro department. The elements are usually good, refrigerated, for a few days....enough for identification purposes.  I have a schedule and work with the Practice managers to follow up with the samples, documentation and retention.

We were told that we should not do the direct observations as we are not even qualified to perform testing under a PPM nor is there a technical consultant for a PPM.  Only providers and midlevel practitioners.  For fern testing, we gave them fixed slides.  For urine sediments, they hold comps when they have everyone together at a weekly meeting or two and I provide a sample for them to use.  We also have Medtraining which we manage for them but they have to sign off on the competencies  

We also use the MTS online competency for PPMP.  I also do a direct observation on the sample preparation, microscope usage (they have to find and focus on something on the slide, I usually do a cheek swab so they are looking for squamous cells) and maintenance (cleaning).  In some departments, I directly observe all the providers and some departments I have a MD or NP serve as my superuser after I have directly observed their techniques.