THE PRACTICALITIES OF COMPETENCY BASED MEDICINE AND DOPS.

Direct observation of procedural skills or DOPS has become a standard tool in surgical education, but direct observation by qualified assessors is inherently restrictive, necessitating a more robust means of objective skill assessment. POV video could be the answer.

Direct Observation of Procedural Skills in Surgery (DOPS) is one of a number of assessments used in the clinical setting to help the teaching and assessment of a clinical skill. In common with the other workplace-based assessments, its primary purpose is to provide structured teaching and feedback in particular areas of clinical practice.


The assessment involves an assessor directly observing the trainees performance of a practical part of surgical procedure, normally broken down into components, the summation of which comprise the full procedure.

However, it is not always possible, nor practical to have a registered trainer on hand for direct observation and observation is restricted to trainers in the trainees own faculty. The breakdown of DOPS into individual procedural components also means many trainees can reach consultant level without having conducted some procedure types from start to finish. Whilst DOPS may have been done and their competency in individual procedural elements directly assessed, the whole is not always the sum of it's parts.

Objective evaluation demonstrates that high quality, POV video recording can compliment direct observations as a useful tool for teaching high level concepts, such as decision making, and for individualising instruction and feedback to individual trainees. The Japanese Society for Endoscopic Surgery implemented a skill certification systems based on review of unedited video footage of laparoscopic urological procedures in 2006. In a 2010 review, they showed that surgeons assessed by this system as qualified, experienced less frequent complications when compared to those who failed. Video assessment now forms part of their surgical training and certification process. Many other surgical bodies have followed suit and there are many more to come.

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