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💉 Directly Observed Procedural Skills (DOPS)
Directly Observed Procedural Skills (DOPS), also known as Clinical Examination and Procedural Skills (CEPS) or sometimes Procedure Based Assessments (PBAs), are a generic feedback tool that can be used to evaluate ability in a number of procedural skills. They are useful across all specialties and can be used to assess a wide variety of abilities. In this section, we will discuss when, why, and how to do a DOPS, and how to include one as evidence in an appraisal.
What is a DOPS?
The Directly Observed Procedural Skills (DOPS) assessment is a tool used for assessing practical skills. There are a huge number of DOPS skills that can be assessed, and vary widely by specialty and clinical environment.
Foundation doctors will be familiar with the DOPS as it is used to assess your core foundation skills such as venepuncture, catheterisation, and setting up an IV infusion. However, the list of possible procedures that can be assessed is actually immense and can include very niche procedures such as conducting sweat tests, supervising dynamic function tests, or giving laser treatment for raised intraocular pressure.
When should I do a DOPS?
A DOPS is used to evaluate technical skills, practical skills, and procedural skills (arguably all the same thing). In order do to a DOPS, you will need a qualified person to observe your pre-, intra-, and post-procedure techniques before they can sign you off for a DOPS.
What are some common DOPS skills?
- Physical observations
- Peak flow
- Direct ophthalmoscopy
- Blood cultures
- Arterial blood gas from radial artery
- Capillary blood glucose
- Urine dipstick
- 3 and 12 lead ECG
- Set up an infusion
- Moving and handling techniques
- Inhaler technique
- Prescribe and administer oxygen
- Prepare and administer IM, subcutaneous, or IV medication
- Blood transfusion
- Male and female catheterisation
- Basic wound care, closure, and dressing
- NG tube
- Local anaesthetics
- Advanced CPR
- Temporary cardiac pacing using external device
- Ascitic tap
- Lumbar puncture
- NG tube
- Pleural aspiration
- Obtain femoral or IO access for resuscitation
- Central venous cannulation (internal jugular or subclavian)
- Intercostal drain for pneumothorax
- Intercostal drain for effusion
- DC cardioversion
- Abdominal paracentesis
- Effective hand-washing, gloving, and gowning
- Local anaesthetic
- Preparation and maintenance of an aseptic field
- Incision of skin and subcutaneous tissue
- Closure of skin and subcutaneous tissue
- Completion of WHO check list
- Breast examination
- Rectal examination
- Prostate examination
- Male genital examination
- Female genital examination
- Cervical cytology
- Pleural aspiration of air
- Chest drain - Seldinger and open techniques
- Establish invasive monitoring (CVP and arterial line)
- Vascular access in emergency (IO and femoral line)
- Lumbar puncture
- Fracture/dislocation manipulaiton
- External pacing
- Point of care ultrasound - vascular access and fascia iliaca block
- Image-guided biopsy
- Image-guided drainage
- Image-guided vascular access and basic catheter/wire manipulaiton
- Contrast studies of lines and tubes
- Contrast studies of the adult and paediatric GI and GU tracts
- Endometrial biopsy
- Cervical smear
- Vulval biopsy
- Insertion/removal of IUCD/IUS
- Surgical and medical management of miscarriage or surgical and medical termination of pregnancy
- Endometrial ablation
- Diagnostic laparoscopy
- Simple operative laparoscopy
- Laparoscopic management of ectopic pregnancy
- Ovarian cystectomy
- Transabdominal ultrasound examination of early pregnancy
- Ultrasound examination of early pregnancy complications
- Ultrasound examination in gynaecology
- Perineal repair
- 3rd degree tear perineal repair
- non-rotational instrumental delivery
- Rotational instrumental delivery
- Caesarean section
- Manual removal of placenta
- Surgical management of PPH
- Surgical management of retained products of conception
- Transabdominal ultrasound scan examination of late pregnancy
- Transabdominal ultrasound examination of normal fetal anatomy and biometry
- Appropriate examination of baby, child, and young person.
- Neonatal airway maintenance including use of adjuncts
- Umbilical venous cannulation
- Lumbar puncture
- Peripheral venous cannula
- EEG interpretation
- BGC vaccination and Mantoux testing
- Oxygen therapy using administration devices
- Endotracheal suction
- Defibrillation and cardioversion
- NG tube insertion and confirmation of placement
- Urinary catheterisation in babies and young children
- Collect respiratory samples for microbiology
- Aseptic technique
- Blood pressure management
- Needle thoracocentesis
- Collect microbiology samples
- Interpret CSF results
- Interpret x-ray results
- Collect urine sample
- Intrepret urine sample results
- Ocular surface foreign body removal
- Ocular irigation
- Lacrimal function assessment
- Corneal scrape
- Removal of sutures
- Perform / teach lid hygeine
- Local anaesthesia
- Fit a bandage contact lens
- Laser for retinal problems
- Intraocular/periocular drugs
- Punctal occlusion
- Botox injection
- Corneal glue
- Prepare biopsy
- Forced duction test
- Biometry skills
- Administration of IM rapid tranquilisation
- Managing aggression and violence
- Curette and cautery
- Cryotherapy of benign or pre-malignant lesions
- Cryotherapy of superficial basal cell cancer
- Dog ear repair
- Excision of lesion on trunk, limbs, head, or neck with direct closure using deep (subcuticular) and surface (percutaneous) sutures
- Incisional skin biopsy
- Punch biopsy
- Shave excision
- Small flap repair
- Genital/mucosal biopsy
This is by no means an exhaustive list but gives a general idea of the scope of skills that can be covered in a DOPS assessment.
Why should I do a DOPS?
DOPS are a great way of getting feedback on your procedural skills and getting skills signed off. As part of a routine shift, you may be expected to do a number of DOPS skills anyway, so getting feedback and a sign-off can make those events more meaningful and beneficial for your long-term learning and development.
How do I do a DOPS?
If you want to do a DOPS, then you should first confirm with your assessor that they are able to observe and feedback on your procedure, and then check that the patient is happy for you to have the procedure done by you under supervision.
You should let your assessor know which capabilities you would like to be assessed on in advance of starting and provide them with a blank DOPS assessment template.
Your assessor should be competent in the skill themselves, as they will be responsible for ensuring that the procedure is performed in a safe manner. Patient safety and well-being remain paramount throughout the DOPS, and the patient should suffer no increased risk or discomfort. The supervisor retains responsibility for patient care throughout and must intervene as the situation requires.
The procedure itself should take no more than 20 minutes, and you should give yourself 5 minutes for feedback afterward.
Once the procedure is completed you may wish to reflect on your performance with the assessor. This should not be done in the presence of the patient. The assessor should then provide you with both verbal and written feedback, including suggestions on agreed actions moving forward.
You should aim to collect multiple DOPS assessments from a variety of trainers and should reflect on their feedback and insight.
Do I need to inform the patient before I do a DOPS?
Yes, you should inform the patient that you would like to do a procedure that is observed by your assessor. It is within the patient's right that you either don’t do the procedure at all if they are not comfortable with your level of experience, or that you don’t have the procedure assessed if they are not comfortable with it.
If the patient does give verbal consent, then you can proceed with the DOPS. You should keep the patient details confidential and ensure that no clinical information that could identify the patient is shared or written down on the DOPS feedback form.
Who can sign me off for a DOPS?
A DOPS should be signed off by an expert in the procedure you are performing. Depending on the procedure this may be a member of the nursing team or physiotherapy team, a junior doctor, a senior registrar, or a consultant. When you and your trainer complete the DOPS form you should include information on the grade/experience of the person who has assessed you.
Your trainer does not need to know you in advance though you should have a discussion before the DOPS takes place to set your expectations for the assessment.
It is important to note that different training colleges or Trusts have different criteria on who can sign a DOPS and some stipulate that the assessment won’t count unless signed by an ST3 or above.
How do I approach a senior for a DOPS?
Predicting when you will encounter opportunities for particular DOPS skills is very difficult, particularly if you are not working in one department consistently. As a locum doctor, supervisors may be hard to find if they don’t know you well.
If you are a locum doctor working in a unit for a short time and are asked to perform a particular skill, it is worth asking the usual team whether someone can supervise you and provide you feedback. If they have time, they may be happy to do a DOPS with you, however, they may also choose to ask someone else to perform the skill if they are busy. If this happens, ask to observe the procedure and try and establish a rapport with the person who performed it. Ask them to explain out loud what they are doing (if appropriate) and whether they would mind doing a DOPS with you next time.
Be prepared to be flexible, stay late, and for unexpected emergencies to result in canceled assessments.
If you are in a substantive post (contracted) then you may have more opportunities to get DOPS done. Try to agree with your clinical or educational supervisor at the start of your employment or in supervision about which skills you’d like to practice (and what is realistic to achieve) over the period of your employment and ask them in advance whether they can support you by helping you identify opportunities to practice skills. If they know what you want, they may remember to contact you when they come across an opportunity to practice the DOPS skill.
Can I get all my DOPS sign-offs from the same person?
If you are in a substantive post and will be working within the same team for a long time, then it is reasonable to conclude that many of your WBAs will be signed off by the same person. However, it is best practice to find a variety of assessors to give you feedback as it shows that you are seeking input from multiple team members and reduces the possibility of selection bias.
How many DOPS assessments do I need to do per year?
If you are collecting the DOPS for a training portfolio, there may be a minimum requirement for the number of assessments you should do. For example, surgical trainees are required to do a minimum of 40 DOPS assessments per year.
If you are a non-training doctor then your appraisal will not require a specific number of DOPS assessments in order to ‘pass’ though you should aim to do them regularly out of training anyway.
Regularly doing DOPS assessments can help you to refresh your technical ability in old skills, or get valuable feedback and learning for new ones. It can be useful to include these in your portfolio, but make sure they do not include any patient-identifiable information.
Where do I put my DOPS in my MAG?
The MAG form (Medical Appraisal Guide) is the document that non-training doctors in England use for their medical appraisals.
If you are preparing for an appraisal, you may want to use evidence of your case discussions in your MAG to demonstrate your ongoing commitment to the principles outlined in the GMC’s Good Medical Practice document.
Your DOPS can be uploaded into the CPD section of the portfolio (section 7 of the MAG).
You can upload your DOPS in any format that works best for you. It can be summarised directly on the MAG document, uploaded as a photo, screenshot, or scan of the hand-completed mini-CEX, or uploaded as a word document, or PDF. It doesn’t really matter how you upload your CPD so long as you can provide some evidence that you’ve done some, and learned from it.
Template & Worked Example
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- 💉 Directly Observed Procedural Skills (DOPS)
- What is a DOPS?
- When should I do a DOPS?
- What are some common DOPS skills?
- Why should I do a DOPS?
- How do I do a DOPS?
- Do I need to inform the patient before I do a DOPS?
- Who can sign me off for a DOPS?
- How do I approach a senior for a DOPS?
- Can I get all my DOPS sign-offs from the same person?
- How many DOPS assessments do I need to do per year?
- Where do I put my DOPS in my MAG?
- Template & Worked Example