Rural Clinical School
Procedural Skills
in a Rural Setting
and using
D.O.P.S. to
assess them
A/Professor Deborah Wilson
Rural Clinical School
Associate Head – Acute
Medicine, Rural Clinical School
Tasmania
Rural Clinical School
Clinical Anaesthetist:
Skills teaching in Simulation and in the work place
Rural Clinical School
Objectives
•
Look at Procedural Skills performed in a rural
setting - Data collected 2012 at RCS
•
Look at how these skills are assessed - What
we do now and how we can improve
•
Discussion - What you do and Rural Skills
Curriculum
Rural Clinical School
2012 Procedural Skills Project
Aim: Measure level of procedural skills performed in a rural
clinical setting
•
Existing GP skills list
•
2011 Medical Deans: Proposed Procedural Skills for
Medical Graduate
Rural Clinical School
Medical Deans Procedural Descriptors
•
Eye, Ear, Nose & Throat - (8 skills)
•
General Procedure - (12 skills)
•
General Doctor & Patient - (5 skills)
•
Men’s Health - (1 skill)
•
Musculoskeletal Injury & Anaesthesia - (7 skills)
•
Women’s Health - (4 skills)
•
Emergency - (21 skills)
Rural Clinical School
2012 Procedural Skills Project
Methods: Student recorded skills using electronic log book
•
Skills evidenced to Clinical Cases
(Recorded using Medical Deans 4 point matrix)
•
Skills performed but not related to log book case
•
Year 4 Cohort = 32; Year 5 Cohort = 29
Rural Clinical School
Medical Deans 4 Point Matrix
Observed
Simulated
Participate
(Competent)
Participate
(Proficient)
Procedural
Skills linked
to Log Book
cases
Rural Clinical School
2012 Procedural Skills Outcomes
•
Results: 82,348 Skills
•
(Yr 4: 36,233 Yr 5: 46,115)
25,803 Medical Dean’s procedural skills
7,772 “evidenced”
•
56,545 RCS GP Skills List
25, 624 “evidenced”
Rural Clinical School
2012 YEAR 4 v YEAR 5
MEDICAL DEANS PROCEDURAL SKILLS
5,790
6,000
5,000
4,381
4,000
2,934
2,900
3,000
2,619
2,174
2,136
2,000
871
1,000
593
360
534
314
78
119
0
EYE, EAR, NOSE &
THROAT
GENERAL
PROCEDURE
GENERAL DOCTOR &
PATIENT
MEN'S HEALTH
YEAR 4
YEAR 5
MUSCULOSKELETAL
INJURY &
ANAESTHESIA
WOMEN'S HEALTH
EMERGENCY
Rural Clinical School
2012 MBBS YEAR 4 v 5 MEDIAN
MEDICAL DEANS PROCEDURAL SKILLS
EMERGENCY
68
7
WOMEN'S HEALTH
11 8
MUSCULOSKELETAL INJURY & ANAESTHESIA
58
59
TOTAL YEAR 4 MEDIAN
MEN'S HEALTH 2 3
TOTAL YEAR 5 MEDIAN
GENERAL DOCTOR & PATIENT
64
77
GENERAL PROCEDURE
203
112
EYE, EAR, NOSE & THROAT
8
0
21
50
100
150
200
250
300
350
Rural Clinical School
Rural Clinical School
Conclusions
•
Evidence UTAS Rural Clinical School students are
meeting Medical Deans list requirements
•
Log Book reliably evidenced skills acquisition
linked to cases
Rural Clinical School
Skills Assessment
Rural Clinical School
Rural Clinical School
The Skills Assessment Journey
Previously:
• 5 skills to be signed off – Simple form/ No criteria
• Skills tested using OSCE’s
• waste, expense and suitability
Way Forward 2013:
•Post Graduate move to WBA assessment
•DOPS - Direct Observation of Procedural Skills
Rural Clinical School
Current Assessment at RCS
Problem – No criteria to guide student learning or the assessor!
Rural Clinical School
Junior Doctors DOPS
Assessment Form
- Same form for all
procedures
- Unsatisfactory to
satisfactory
ANZCA DOPS
Assessment Form
- Same form for all
procedures
- Assessment related
to the level of
supervision
Rural Clinical School
2013: Skills Assessment at RCS
•
Separate form for each of the skills we want
the students to be proficient in
•
Related to the level of supervision
•
Clear Assessment Criteria: Used to guide
student learning and the assessor
•
Simulation and Real Patients
•
Supported by Resources: Video
Demonstration
Proposed Medical
Student DOPS
Assessment Form
(Airway Management)
Proposed Medical
Student DOPS
Assessment Form
(IV Cannulation)
Rural Clinical School
Rural Clinical School
Discussion Points
•
Do others use the Deans List?
•
Do others have mandatory sign off for some
skills?
•
What about Work Place Based Assessment
and the use of DOPS forms?
•
Should we have a “Rural Skills” Curriculum?