Clinical procedural skills assessment during internship in ophthalmology

Directly observed procedural skills (DOPS) is a unique method for assessment since it tests the trainee's ability to apply his knowledge and skills in performing a particular procedure and provides an assessment of the practical work performed by the trainee on a 'real' patient under supervision of an experienced faculty. The study aims to make use of DOPS rating for assessment and further improvement in procedural skills in interns in Ophthalmology rotational posting.

A prospective study was planned and 15 interns on 2 weeks' rotational posting in the department of Ophthalmology were included by purposive sampling over a duration of 2 months. Four clinical procedural skills were identified and in the second week of posting, the interns were assessed by three DOPS encounters at an interval of 2 days for each clinical skill. The DOPS ratings were analyzed quantitatively using R-statistical software by repeated measure ANOVA and Banfuroni test.

A total of 180 DOPS were undertaken for 15 interns in 4 core areas of ophthalmic examination. The mean overall DOPS rating for DOPS-1 was 3.70±0.82, DOPS-2, 3.83±1.82 and DOPS-3, 4.93±1.65; the difference in DOPS rating between the first and second encounter was not statistically significant (p=0.497), between the second and the third and between the first and the third were statistically significant (p=0.000 in both cases) using Banfuroni test. The overall difference was also statistically significant (p=0.000) using repeated measure ANOVA. Both the assessor and intern satisfaction increased significantly from the first to the third DOPS, but not statistically significant between the first and the second and between the second and the third DOPS.

We found significant improvement in interns' clinical skills through repeated DOPS and the method was well accepted by both the students and the faculty. Internship period can be well utilized for improving clinical skills and novel performance assessment methods like DOPS might prove to be highly beneficial in ensuring adequacy of learning during internship and also to assess their readiness for accepting professional responsibilities in future.