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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