Published: 2019-09-25

Workplace based clinical procedural skills assessment using directly observed procedural skills in interns in Otorhinolaryngology rotation

Sanjeev Puri, Rohit Verma


Background: In view of changing requirements in healthcare systems and planned reforms of medical education curricula, effective teaching and assessment of clinical skills in the undergraduate setting has become more and more important. There is a need for implementation of newer methods of evaluation keeping in mind the principles of adult learning and self-directed learning. DOPS (directly observed procedural skills) is a highly structured assessment tool for assessment of the practical work performed by a trainee on a real patient under supervision of experienced faculty. This study aimed to make use of DOPS as a method of workplace based assessment for interns in otorhinolaryngology posting.

Methods: 15 interns posted in department of otorhinolaryngology participated in the study. Three clinical procedural skills included were anterior rhinoscopy, otoscopy and indirect laryngoscopy. Three DOPS were undertaken for each skill. The performance was noted as DOPS ratings. The results were tabulated and statistically analysed.

Results: A total of 135 DOPS were undertaken for 15 interns. Mean overall DOPS rating improved from DOPS 1 to DOPS 3. The difference in value between DOPS 1 and 3 for anterior rhinoscopy was statistically significant. For otoscopy and indirect laryngology, the difference between DOPS 1 and 2, DOPS 1 and 3 was statistically significant. Both faculty and interns found DOPS to be an efficient tool for assessment.

Conclusions: DOPS  is a cost effective assessment tool. It has an effective role in facilitating students’ learning and skill development as it is based on the direct observation of trainees’ procedural skills in real clinical environment.



Assessment, Directly observed procedural skills, Internship, Medical education, Otorhinolaryngology, Workplace-based assessment

Full Text:



Delamothe T. Modernising medical careers: final report. BMJ. 2008;336(7635):54-5.

Day SC, Grosso LJ, Norcini JJ Jr, Blank LL, Swanson DB, Horne MH. Residents' perception of evaluation procedures used by their training program. J Gen Intern Med. 1990;5(5):421-6.

Beard J, Strachan A, Davies H, Patterson F, Stark P, Ball S, et al. Developing an education and assessment framework for the Foundation Programme. Med Educ. 2005 Aug;39(8):841-51.

Naeem N. Validity, reliability, feasibility, acceptability and educational impact of direct observation of procedural skills (DOPS). J Coll Physicians Surg Pak. 2013 Jan;23(1):77-82.

Association of American Medical Colleges. Medical school graduation questionnaire: All schools report, 2004. Available at: Accessed 19 May 2005.

Bagher M, Sadeghnezhad M, Sayyadee T, Hajiabadi F. The Effect of direct observation of procedural skills (DOPS) evaluation method on learning clinical skills among emergency medicine students. Iranian J Med Educ. 2014;13(12):1073-81.

Farajpour A, Amini M, Pishbin E, Mostafavian Z, Akbari Farmad S. Using Modified Direct Observation of Procedural Skills (DOPS) to assess undergraduate medical students. JAMP. 2018;6(3):130-6.

Shumway JM, Harden RM. Association for Medical Education in Europe. AMEE Guide No. 25: The assessment of learning outcomes for the competent and reflective physician. Med Teach 2003;25(6):569-84.

Kundra S, Singh T. Feasibility and acceptability of direct observation of procedural skills to improve procedural skills. Indian Pediatr. 2014 Jan;51(1):59-60.

Kumar N, Singh NK, Rudra S, Pathak S. Effect of formative evaluation using direct observation of procedural skills in assessment of postgraduate students of obstetrics and gynecology: Prospective study. JAMP. 2017;5(1):1-5.

Profanter C, Perathoner A. DOPS (Direct Observation of Procedural Skills) in undergraduate skills-lab: Does it work? Analysis of skills-performance and curricular side effects. GMS Z Med Ausbild. 2015 Oct 15;32(4):Doc45.

McLeod R, Mires G, Ker J. Direct observed procedural skills assessment in the undergraduate setting. Clin Teach. 2012 Aug;9(4):228-32.

Amini A, Shirzad F, Mohseni M, Sadeghpour A, Elmi A. Designing Direct Observation of Procedural Skills (DOPS) Test for Selective Skills of Orthopedic Residents and Evaluating Its Effects from Their Points of View. Res Dev Med Edu. 2015;4(2):147-52.

Bazrafkan L, Shokrpour N, Torabi K. Comparison of the Assessment of Dental Students. J Medical Education. 2009;13(1-2):16-23.

Akbari M, Mahavelati Shamsabadi R. Direct Observation of Procedural Skills (DOPS) in Restorative Dentistry: Advantages and Disadvantages in Student’s Point of View. Iranian J Med Educ. 2013;13(3):212-20.

Khoshrang H. Assistants specialized perspectives on evaluation method of practical skills observations (DOPS) in Guilan University of Medical Sciences. J Research in Medical Educ. 2011;2(2):40-4.