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Indian Pediatr 2014;51:
59-60 |
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Feasibility and Acceptability of Direct
Observation of Procedural Skills to Improve Procedural Skills
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Shaveta Kundra and Tejinder Singh
Department of Pediatrics, Christian Medical College
and Hospital, Ludhiana, Punjab, India.
Email:
[email protected]
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Procedural skill learning is usually
unobserved during post graduate training. This study is an attempt to
evaluate feasibility and acceptability of direct observation of
procedural skills in a medical school in Northern India for
postgraduates in Pediatrics. Eighty procedures performed by 15 trainees
were observed by 9 faculty members. Seven of nine assessors considered
direct observation to be feasible and non-intrusive in their routine
clinical and teaching schedule while 5 out of 9 felt that it was time
consuming. All fifteen trainees felt that direct observation enhanced
their procedural skills and wished it to be extended to all procedures.
Keywords: Postgraduate, Training, Evaluation.
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Acquiring clinical and procedural skills is an
essential part of the training of doctors for safe patient care. Skill
training and assessment during postgraduate training is often negligible
and opportunistic. Much of the trainee’s skill learning is unobserved,
occurring as a result of job requirements or peer instruction. Assessing
trainees through direct observation of procedural skills (DOPS) has been
shown to significantly improve skill learning [1,2] and is used in a
number of countries [3-5]. We assessed feasibility and acceptability of
DOPS for pediatric trainees in an Indian medical school.
Fifteen, second and final year MD and DCH residents
were assessed. Assessors (teachers of the rank of senior resident
upwards) and trainees were sensitized regarding DOPS by a short
presentation, including a video clip and live demonstration in separate
sessions. A session on techniques of feedback was taken for assessors
not versed with providing feedback. The generic DOPS form was used for
observation and recording [6]. The focus of DOPS was on core procedures
like intravenous cannulation, lumbar puncture, endotracheal intubation;
other procedures were observed as and when performed. The procedures
were observed in different clinical settings (OPD, inpatients, Emergency
room and PICU) depending on availability of patients, and faculty time.
An assessor observed a trainee while doing procedure on the patient,
asked about indications, potential complications and post procedure
care, and then provided immediate feedback to the trainee on observed
encounter and suggestions for further improvement. At the end of study,
feedback about DOPS was collected from the assessors and trainees
regarding the feasibility and acceptability of DOPS using a 5- point
scale and an open-ended question.
Eighty procedures performed by 15 trainees were
assessed by 9 assessors. Each trainee had five to six DOPS encounters.
About 80% of DOPS cases were done on inpatients and 85% encounters
focused on core clinical skills. Time taken for observation and
providing feedback ranged 7-10 min and 4-7 min, respectively. Seven of
nine assessors considered DOPS to be feasible while 5 out of 9 felt that
it was time consuming. Assessors were comfortable in providing the
feedback to the trainees and almost all the assessors felt that faculty
training and practice will improve the quality of their feedback. Seven
of nine assessors observed an improvement in trainee’s skills over
repeated observations. All is trainees felt that immediate feedback by
senior faculty improved their skills. Thirteen trainees felt that direct
observation by senior faculty improved their skills. Eleven of 15
trainees felt DOPS facilitated the learning of skills, and feedback by
faculty on observed procedures improved their confidence levels. Twelve
of fifteen trainees reported being nervous when observed by assessors
while performing the procedures.
We conclude that DOPS is a feasible and acceptable
tool under Indian settings. Direct observation followed by contextual
feedback helps postgraduates to learn and improve practical skills. It
requires initial faculty training, some extra time and faculty and
trainee sensitization.
Contributors: SK: designed and executed the
intervention, drafted the manuscript; TS: conceptualized and planned the
intervention and critically reviewed the manuscript.
Funding: None; Competing interests: None
stated.
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