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How to tackle your first DOPs

Dr Mei Ling Denney advises on how to avoid potential pitfalls when completing your direct observation of procedural skills (DOPs)

Dr Mei Ling Denney advises on how to avoid potential pitfalls when completing your direct observation of procedural skills (DOPs)

The Direct Observation of Procedural Skills (DOPS) is part of the new assessment package for nMRGCP workplace –based assessment, but its principles should be familiar to all those who have undergone foundation years training and assessment in the UK. But bear in mind that DOPs done during the GP speciality training years are not simply a repetition of DOPs performed in the foundation years.

For GP speciality training, the suggested DOPs have been divided into two parts: mandatory and optional. If it appears to your trainer or clinical supervisor, that a learning need exists in a DOPs area which has not been covered in either of these lists, you may be asked to repeat a DOPS assessment which would normally fall under the Foundation DOPs list. The mandatory DOPs procedures listed have been chosen because they were deemed sufficiently important or technically demanding to warrant specific assessment. This means that you will need to perform these procedures at the level of a GP fit for independent practice to be signed up as competent.

It is up to you to choose the timing, procedure and observer for each DOP. Each DOP should represent a different procedure, and there must be a different observer for each observed encounter during your three years of training (or equivalent, if part-time).

Steps to take

1. Decide which DOP you wish to be assessed – this may be pre-planned by asking a patient to attend on a specific date to see you for this, or opportunistic. The latter is more difficult as it is far less likely that you will find an assessor for your DOP with time on his/her hands to devote to this at very short notice, so enlist the help of your trainer/clinical supervisor in finding suitable cases for you.

2. Find an assessor who is willing to observe the procedure, assess you and give feedback. During your GP placement, this could be your trainer, another GP, or appropriate nursing staff. In a hospital setting, it may be a consultant, an experienced SpR, appropriate nursing staff etc. Remember that for accurate assessment and the ability to give useful feedback, your assessor must be familiar with DOPs and the procedure they are assessing - it would be preferable for your assessor to have received training in this. They will also need to have an assessor code in order to input the data into the e-portfolio.

3. Make sure you have allowed enough time for the DOP. This has been estimated as 5 - 15 min for the assessment, with five minutes for feedback. In practice, many doctors find they may need more time to perform intimate examinations on patients, in order to obtain informed consent for the procedure, and to preserve the patient's dignity. You will also need to allow a few minutes for the feedback to be typed into the ePortfolio.

4. Think about the criteria you will be judged on, concentrating on any areas of weakness identified during a previous DOP, or through some other method in your training. Remember it is not simply a technical skill that is being judged, but also your professional behaviour towards the patient, and your communication skills.

The ten criteria on which you could be judged are:

? Demonstrates understanding of indications, relevant anatomy, technique of procedure

? Obtains informed consent

? Demonstrates appropriate preparation pre-procedure

? Appropriate analgesia or safe sedation

? Technical ability

? Aseptic technique

? Seeks help where appropriate

? Post procedure management

? Communication skills

? Consideration of patient/professionalism

In addition to these, you will be given a grade on your overall ability to perform the procedure. Note that these grades are different from those awarded in the COT or CbD, and range from 'below expectation for completion' to 'above expectation'. A GP registrar will have to achieve a minimum grade of 'meets expectation' in the majority of the sections. U/C means 'unable to comment' because it has not been observed or not applicable for assessment of the procedures e.g. sterile technique or use of local anesthetic.

Note that not all the criteria will be appropriate for each DOP – if this is the case, the assessor will mark the form as 'U/C' denoting " unable to comment as the behaviour was not observed".

Your assessor will give you one of five possible grades:

? Insufficient evidence

? Below expectation for completion

? Borderline for completion

? Meets expectation

? Above expectation

As DOPS is designed to provide feedback on procedural skills essential to the provision of good clinical care, you can expect feedback on any area where your grade falls below 'meets expectation'. You may wish to schedule in another assessment of that particular procedure in the future, to see if you have improved, or you may wish to try some of the optional procedures as DOPs. Either way, it all adds to the evidence reviewed by your educational supervisor and final year trainer who will review your e-portfolio

The eight mandatory procedures to be covered are:

Breast examination Male genital examination

Female genital examination Rectal examination

Prostate examination Cervical cytology

Testing for blood glucose Application of simple dressings

Some of these procedures may be combined e.g. prostate and rectal examinations

There are 11 optional procedures which should be recorded, if undertaken:

Cryotherapy Curettage/shave excision

Cauterisation Incision and drainage of abscess

Aspiration of effusion Excision of skin lesions

Joint and peri-articular injections Hormone replacement implants

Proctoscopy Suturing of wound

Taking skin surface specimens for mycology

Dr Mei Ling Denney is a Course Organiser in Cambridgeshire, and an examiner for the RCGP

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