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| ORIGINAL ARTICLE |
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| Year : 2023 | Volume
: 18
| Issue : 3 | Page : 353-356 |
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Direct observation of procedural skills: A formative assessment tool for postgraduate training in obstetrics and gynecology
Nikita Vijay1, Alka Tulshiramji Rawekar2, Anuja Vivek Bhalerao1, Savita Ashutosh Somalwar1, Amrita Singh1
1 Department of Obstetrics and Gynecology, NKP Salve Institute of Medical Sciences and Research Centre, Nagpur, Maharashtra, India
2 Department of Physiology, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India
| Date of Submission | 14-Aug-2022 |
| Date of Decision | 05-Jan-2023 |
| Date of Acceptance | 23-Jan-2023 |
| Date of Web Publication | 29-Aug-2023 |
Correspondence Address:
Prof. Nikita Vijay
Department of Obstetrics and Gynecology, NKP Salve Institute of Medical Sciences and Research Centre, Nagpur, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jdmimsu.jdmimsu_363_22
Background: Direct observation of procedural skills (DOPS), a method of workplace-based assessment helps the students to shape their learning. DOPS requires direct observation and assessment of students while performing in a real-life setting using a structured checklist with constructive feedback for improvement. Most of the medical institutes in India still assess the students on the basis of traditional methods, where theoretical knowledge is mainly assessed as a summative assessment. This study was conducted to bridge this gap by introducing DOPS as a formative assessment tool for PG students in obstetrics and gynecology and to explore the perspectives of faculty and students for DOPS as a formative assessment tool. Materials and Methods: In the department of obstetrics and gynecology at a tertiary care teaching institute in Central India, this prospective interventional research was conducted for a period of 1 year. Eighteen 2nd year and final year postgraduate students and nine faculty from the obstetrics and gynecology specialty were identified for inclusion in this study using convenient sampling. IEC approval (NKPSIMS and RC and LMH/IEC/09/2021) and informed consent were taken. Postgraduate students were assessed for 5 procedures using a validated structured checklist: (1) per speculum and per vaginal examination, (2) Pap's smear collection, (3) conduction of artificial rupture of membrane, (4) introduction of intrauterine contraceptive device, and (5) episiotomy repair. Feedback after assessment was given by the faculty. There were 3 DOPS assessment sessions for each procedure. Perception of students and faculty was collected using a prevalidated questionnaire using 3-point Linkert's scale. Descriptive statistics of response was considered to calculate percentages. Using thematic analysis, the responses of open-ended questions were analyzed based on the quantitative data form. Results: Perception of students were positive as effective teaching learning tool (94%), skill improvement (100%), constructive feedback (100%), time provided for feedback (100%), confidence gain (100%), assessment in nonthreatening environment (100%), motivation (94%), Faculty responded positively regarding improved attitude toward teaching (100%), in depth assessment of skill (78%), useful teaching learning tool (100%), improves student–teacher relationship (78%), identifies developmental needs of student (100%). Themes identified were DOPS provide more systematic learning, personal attention to each student, better understanding, learn proper steps of procedure, one on one interactive method of learning, improvement of clinical skills, and more confident. Challenges perceived by students were time constraint and person who grades is not the same teacher and by faculty were more time and dedication needed and more paper work is required. Conclusion: DOPS was considered as an effective teaching learning and assessment tool and can be incorporated as a formative assessment tool during residency in Obstetrics and Gynecology (OBGY) by both faculty and students. Time for assessment is a challenge considered by Faculty as well as by students.
Keywords: Direct observation of procedural skills, formative assessment, postgraduate training in OBGY, workplace-based assessment
How to cite this article:
Vijay N, Rawekar AT, Bhalerao AV, Somalwar SA, Singh A. Direct observation of procedural skills: A formative assessment tool for postgraduate training in obstetrics and gynecology. J Datta Meghe Inst Med Sci Univ 2023;18:353-6 |
| Introduction | |  |
Formative assessment with constructive feedback is the hallmark of competency-based medical education. Assessment of medical students for procedural skill during their training period for safe clinical practice is a need of hour. Direct observation of procedural skills (DOPS), a method of workplace-based assessment (WPBA), helps the students to shape their learning and requires direct observation and assessment of students while performing in a real life setting using a structured checklist with constructive feedback for improvement. DOPS assesses a highest level of competence of Miller's pyramid.[1] DOPS provides the better way of structured assessment and feedback.[2]
Most of the medical institutes in India still assess the students on the basis of traditional methods, where theoretical knowledge is mainly assessed as a summative assessment. DOPS is already a part of formal assessment in royal college of obstetrics and gynecology, London. Lack of systemic assessment of psychomotor skills and no scope for individual feedback were addressed by DOPS as teaching learning tool at workplace.[3] This study was conducted to bridge this gap by introducing DOPS, for PG student in obstetrics and gynecology as a formative assessment tool and to explore the perspectives of faculty and students.
| Materials and Methods | | |
In the obstetrics and gynecology department of at a tertiary care teaching institute in Central India, this prospective interventional research was conducted for a period of 1 year. Eighteen 2nd year and final year postgraduate students and nine faculty from the obstetrics and gynecology specialty were identified for inclusion in this study using convenient sampling. IEC approval (NKPSIMS and RC and LMH/IEC/09/2021) and informed consent was taken. Postgraduate students were assessed for 5 procedures using a validated structured checklist: (1) per speculum and per vaginal examination, (2) Pap's smear collection, (3) conduction of artificial rupture of membrane, (4) introduction of Intrauterine contraceptive device, and (5) episiotomy repair. Feedback after assessment was given by the faculty. There were 3 DOPS assessment sessions for each procedure. Perception of students and faculty was collected using a prevalidated questionnaire using 3-point Likert scale based on open-ended questions. Faculty and students were sensitized first by a power point lecture. Structured procedure checklist for assessment were discussed and designed in the department for all the skills. Each student was assessed for 5 skills for 3 assessment session at 1 month interval. Students and faculty were informed in prior for assessment session. Each assessment session was conducted for 10–15 min followed by constructive feedback session for 5 min. Prevalidated feedback questionnaire was collected from faculty and students after all 3 assessments. Descriptive statistics of response was considered to calculate percentages. Using thematic analysis, the responses of open-ended questions were analyzed from the quantitative data.
Ethical clearance
Approval was obtained from Institutional Ethics Committee for the conduct of the study. Institutional Ethics Committee Approval Number: NKPSIMS & RC and LMH / IEC/09/2021.
| Results | | |
Perception of faculty and students regarding DOPS was assessed. Most of the responses were found to be positive. Responses of PG were positive about skill improvement (100%), constructive feedback (100%), time provided for feedback (80%), confidence gain (90%), effective teaching learning tool (100%), assessment in nonthreatening environment (99%), motivation (100%), opportunity creation (99%), and better option than conventional teaching (100%) [Table 1]. Faculty responded positively regarding improved attitude toward teaching (100%), in depth assessment of skill (78%), useful teaching learning tool (78%), improves student–teacher relationship (95%), identifies developmental needs of student (100%) [Table 2]. | Table 1: Postgraduate student's response to closed-ended questions on Likert scale
Click here to view |
DOPS provide more systematic learning, personal attention to each student, better understanding, learn proper steps of procedure, one to one interactive method of learning, improvement of clinical skills and more confidence in performing skills [Box 1] and [Box 2]. Challenges perceived by students were time constraint and person who grades is not the same teacher and by faculty were more time and dedication needed and more paper work is required.
| Discussion | | |
Concern regarding patient safety brought the paradigm shift from conventional knowledge-based training to competency-based training during postgraduate medical education.[4] For safe clinical practice, postgraduates need to achieve competency and proficiency in clinical skills during postgraduate training.
Assessment system in our country mainly focuses on cognitive domain, where assessment of acquisition of knowledge is seen and limited significance is given to assessment of procedural skills. For procedural competence, log book with list of procedures performed is used for assessment. Assessment of procedural skills is done by various procedures including DOPS, stations with mannequins, and objective-structured clinical examination.
DOPS marks the uppermost level of Miller's triangular pyramid for clinical assessment. DOPS has high reliability, good feasibility, and validity, but needs training for optimal reliability.[5] DOPS involves a criterion attributed assessment includes clinical knowledge, preparation, consent, infection control and technical ability and assess cognitive, psychomotor and affective domain [Figure 1] and [Table 3]. | Table 3: Direct observation of procedural skills criterion referenced checklist (skill-episiotomy suturing)
Click here to view |
In this study, DOPS was considered an effective teaching and learning assessment tool. Faculty thought that DOPS helps in refining procedural skills of PGs, helps in more systematic learning, improves clinical skills and confidence in skills, and provides personal attention to each student. Students also thought that DOPS helps in better understanding, creates opportunities for learning, one to one interactive method of learning, and improves student–teacher relationship. These findings are similar to other studies.[6],[7],[8] Prior sensitization and training of faculty plays an important role to make assessment in nonthreatening environment and provide prior intimation for assessment of skills. All faculty were sensitized prior to assessment which helped high satisfaction outcome in our study.
Some limitations were observed as assessor bias as different faculty give importance to different point, time constraints as emergency or multiple work at a time, small sample size as postgraduates are less in a stipulated time. These limitations are there in similar to other studies.[9],[10],[11]
| Conclusion | | |
DOPS during OBGY training is considered as an effective tool for teaching-learning as it creates an opportunity for learning and motivates students to learn better. Adequate time for assessment is a challenge during busy days for both faculty and students.
Impact of the study
DOPS as a formative assessment tool during residency in OBGY will help improve on clinical and surgical skills and boost confidence among students. This will be helpful in near future for safe clinical practice.
Acknowledgments
- Head of department, whose permission allowed to start DOPS in the department
- Faculties from the obstetrics and gynecology department
- Postgraduate students for their active participation.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Miller GE. The assessment of clinical skills/competence/performance. Acad Med 1990;65:S63-7.  |
| 2. | Wanjari S, Rawekar A. Effectiveness of DOPS direct observation of procedural skills as a method of formative assessment for improving the clinical skills of postgraduate students in the department of obstetrics and gynecology. J Educ Technol Health Sci 2019;6:29-34. |
| 3. | Dabhadkar S, Panchanadikar T, Nimbargi V, Taralekar V. Workplace based assessment by direct observation of procedural skills for postgraduate students in obstetrics and gynecology. South-East Asian J Med Educ 2019;13:46-52. |
| 4. | Lagoo JY, Joshi SB. Introduction of direct observation of procedural skills (DOPS) as a formative assessment tool during postgraduate training in anaesthesiology: Exploration of perceptions. Indian J Anaesth 2021;65:202-9. [Full text] |
| 5. | Erfani Khanghahi M, Ebadi Fard Azar F. Direct observation of procedural skills (DOPS) evaluation method: Systematic review of evidence. Med J Islam Repub Iran 2018;32:45. |
| 6. | Bansal M. Introduction of Directly Observed Procedural Skills (DOPS) as a part of competency-based medical education in otorhinolaryngology. Indian J Otolaryngol Head Neck Surg 2019;71:161-6. |
| 7. | Tenzin K, Gyamtsho S, Wangdon T, Buttia PC, Chandans L, Rege N. Effect of use of direct observation of procedural skills for assessment for learning in Obstetrics and gynaecology postgraduate students at medical University, Bhutan: A prospective study. Bhutan Health J 2019;5:9-13. |
| 8. | Sande S. Direct observation of procedural skills as an assessment tool for postgraduate in medical microbiology. IJHSR 2017;7:56-62. |
| 9. | Dabhadkar DS, Wagh DG, Panchanadikar DT, Mehendale DS, Saoji DV. To evaluate direct observation of procedural skills in OBGY. Natl J Integr Res Med 2014;5:92-7. |
| 10. | Sethi S, Badyal DK. Clinical procedural skills assessment during internship in ophthalmology. J Adv Med Educ Prof 2019;7:56-61. |
| 11. | Waqar SH. Student's perception of direct observation of procedural skills as workplace based assessment tool in general surgery. Pak Armed Forces Med J 2016;66:731-7. |
[Figure 1]
[Table 1], [Table 2], [Table 3]
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