Direct Observation of Procedural Skills: A Formative Assessment Tool for Postgraduate Training in Obstetrics and Gynecology

Abstract

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.