Integrating Direct Observation of Procedural Skills as a workplace‐based assessment tool for residents working in an intensive care unit

Main Article Content

N Nazir
B Bhandari
S Gupta
A Saxena
R Singh
G Sinha

Abstract





Background. Direct Observation of Procedural Skills (DOPS) is a workplace-based assessment tool where the student is directly observed by the assessor during the procedure in an actual clinical situation, followed by immediate feedback.


Objectives. To introduce DOPS as an assessment tool for ultrasound-guided central venous catheter insertion by residents (registrars) working in an intensive care unit.


Methods. A mixed-methods study design was used for assessment (two sessions) using a pre-validated DOPS checklist for scoring 25 residents. Feedback was obtained from faculty members and residents after the second session using an anonymous questionnaire, and the satisfaction index was calculated for each item.


Results. With the implementation of DOPS, a significant improvement in the second session score in comparison with the first session was observed (p<0.001). This improvement can be attributed to use of the DOPS checklist, deconstruction of steps and provision of immediate constructive feedback, which helped to cover all the aspects of the procedure in a systematic manner. The overall perception of the residents as assessed by the feedback questionnaire was satisfactory, with most of them feeling that the assessment by DOPS was unbiased and that constructive feedback positively impacted on their learning process, making it more engaging and interesting. The satisfaction index for all the items was ≥88%. Faculty members were also satisfied with DOPS as a formative assessment tool.


Conclusion. DOPS promotes active and deep learning with effective assessment methods. It can improve teaching and training if there is commitment from all stakeholders and a supportive organisation.





Downloads

Download data is not yet available.

Article Details

Section

Original Research: Articles

How to Cite

1.
Nazir N, Bhandari B, Gupta S, Saxena A, Singh R, Sinha G. Integrating Direct Observation of Procedural Skills as a workplace‐based assessment tool for residents working in an intensive care unit. Afr J Thoracic Crit Care Med [Internet]. 2025 Dec. 19 [cited 2026 Jan. 24];31(4):e3120. Available from: https://samajournals.co.za/index.php/ajtccm/article/view/3120

References

1. KornbauC,LeeKC,HughesGD,FirstenbergMS.Centrallinecomplications.IntJCrit Illn Inj Sci 2015;5(3):170-178. https://doi.org/10.4103/2229-5151.164940

2. 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(5):731-737.

3. Tetzlaff JE. Assessment of competency in anesthesiology. Anesthesiology 2007;106(4):812-825. https://doi.org/10.1097/01.anes.0000264778.02286.4d

4. Singh G, Kaur R, Mahajan A, Thomas AM, Singh T. Piloting direct observation of procedural skills in dental education in India. Int J Appl Basic Med Res 2017;7(4):239-242. https://doi.org/10.4103/ijabmr.IJABMR_54_17

5. Norcini JJ, Mackinley DW. Assessment methods in medical education. Teach Teacher Educ 2007;23(3):239-250. https://doi.org/10.1016/j.tate.2006.12.021

6. Pelgrim E, Kramer A, Mokkink H, van den Elsen L, Grol R, van der Vleuten C. In-training assessment using direct observation of single-patient encounters: A literature review. Adv Health Sci Educ Theory Pract 2011;16(1):131-142. https:// doi.org/10.1007/s10459-010-9235-6

7. Smee S. ABC of learning and teaching in medicine. Skill based assessment. BMJ 2003;326(7391):703-706. https://doi.org/10.1136/bmj.326.7391.703

8. Miller GE. The assessment of clinical skills/competence/performance. Acad Med 1990;65(9 Suppl):S63-S67. https://doi.org/10.1097/00001888-199009000-00045

9. Modi JN, Singh T. Direct observation-based assessment of clinical skills. In: Singh T, ed. Principles of Assessment in Medical Education. Jaypee, India: Anshu Publishers, 2022;114-137.

10. Bindal N, Goodyear H, Bindal T, Wall D. DOPS assessment: A study to evaluate the experience and opinions of trainees and assessors. Med Teach 2013;35(6):1230-1234. https://doi.org/10.3109/0142159X.2012.746447

11. Burgess A, van Diggele C, Roberts C, Mellis C. Feedback in the clinical setting. BMC Med Educ 2020;20(Suppl 2):460. https://doi.org/10.1186/s12909-020-02280-5

12. 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. https://doi.org/10.14196/mjiri.32.45

13. Somerville TM, Stout A, Humphrey V, Robinson K, Daly K, Moultrie S. Mastery skills pathway, Central venous catheter insertion, NHS Lothian, Medical Education Directorate 2020. https://www.med.scot.nhs.uk/simulation/the-mastery-programme/ central-venous-catheter-insertion/documents (accessed 14 November 2025).

14. Van de Ridder JMM. Pendleton’s Rules: A mini review of a feedback method. Am J Biomed Sci Res 2023;19(1):AJBSR.MS.ID.002542. https://doi.org/10.34297/ AJBSR.2023.19.002542

15. 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(3):202-209. https://doi. org/10.4103/ija.IJA_124_20

16. Mehta B, Bhandari B. Engaging medical undergraduates in question making: A novel way to reinforcing learning in physiology. Adv Physiol Educ 2016;40(3):398-401. https://doi.org/10.1152/advan.00068.2016

17. Hill K, Silcock D, Burns F, Jeffrey S, Chaudhri S. Abstract PR071: Use of a directly observed procedural skills assessment tool for candidate evaluation after an ultrasound guided central line insertion workshop. Anesth Analg 2016;123(3S):101-102. https:// doi.org/10.1213/01.ane.0000492479.07126.90

18. Kamat C, Todakar M, Patil M, Teli A. Changing trends in assessment: Effectiveness of Direct Observation of Procedural Skills (DOPS) as an assessment tool in anaesthesiology postgraduate students. J Anaesthesiol Clin Pharmacol 2022;38(2):275- 280. https://doi.org/10.4103/joacp.JOACP_329_20

19. McLeod RA, Mires GJ, Ker JS. The use of the Direct Observation of Procedural Skills (DOPS) assessment tool in the clinical setting – the perceptions of students. Int J Clin Skills 2011;5(2):77-82.

20. Sethi S, Badyal DK. Clinical procedural skills assessment during internship in ophthalmology. J Adv Med Educ Prof 2019;7(2):56-61. https://doi.org/10.30476/ jamp.2019.44709

21. Bindal N, Goodyear H, Bindal T, Wall D. DOPS assessment: A study to evaluate the experience and opinions of trainees and assessors. Med Teach 2013;35(6):1230-1234. https://doi.org/10.3109/0142159X.2012.746447

22. Bould MD, Crabtree NA, Naik VN. Assessment of procedural skills in anaesthesia. Br J Anaesth 2009;103(4):472-483. https://doi.org/10.1093/bja/aep241

23. 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(2):161-166. https://doi.org/10.1007/s12070-019-01624-y

24. AminiA,ShirzadF,MohseniM,SadeghpourA,ElmiA.DesigningDirectObservation of Procedural Skills (DOPS) test for selective skills of orthopedic residents and evaluating its effects from their points of view. Res Dev Med Educ 2015;4(2):147-152. https://doi.org/10.15171/rdme.2015.026

Similar Articles

You may also start an advanced similarity search for this article.