DOI: https://doi.org/10.53350/pjmhs22165192 ORIGINAL ARTICLE 192 P J M H S Vol. 16, No. 05, May 2022 Effectiveness of Direct Observation of Procedural Skills (DOPS) for Improving the Mini-Implant Insertion Procedural Skills of Postgraduate Orthodontic Trainees MUHAMMAD AZEEM 1 , AMBREEN USMANI 2 , ABID ASHAR 3 1 Assistant Professor Orthodontics, de’Montmorency College of Dentistry, Lahore, Pakistan. 2 Professor & Head of Anatomy Department, Bahria University Medical and Dental College, Karachi, Pakistan. 3 Principal College of Dentistry & Professor of Oral & Maxillofacial Surgery, Fatima Memorial Hospital-College of Medicine & Dentistry, Lahore, Pakistan. Correspondence to Dr Muhammad Azeem, Email: dental.concepts@hotmail.com, Cell: 0345-8409007 ABSTRACT Background: College of Physicians & Surgeons Pakistan (CPSP) has recently introduced different WBA tools in various specialties, but Directly Observed Procedural Skills (DOPS) is still required to be implemented in orthodontics which will improve learning and skills of the learner. Aim: To determine the effect of applying DOPS for improving the mini-implant insertion procedural skills of postgraduate orthodontic trainees. Methodology: This quantitative, quasi-experimental study was conducted at orthodontic department of de’Montmorency College of Dentistry (DCD), Lahore, from 1 st July 2021 to 1 st November 2021. Twenty trainees were selected and assessed over a period of 3 months which included 3 DOPS encounters with one-month interval between each encounter for mini-implant insertion. The trainees were assigned to faculty for each DOPS encounter by randomization. At the end, the trainees’ and the faculty’ perception regarding feasibility and acceptability of DOPS were obtained by means of structured questionnaire. The pre-DOPS and post-DOPS mean scores of all the trainees were compared using paired t-test. Results: Mean scores of all the orthodontic trainees significantly improved in the post-DOPS as compared to the pre-DOPS encounter, which may be linked to the feedback of 2 nd DOPS session. As per results, the DOPS was perceived to be acceptable and feasible to both the faculty and trainees. Conclusion: DOPS is an effective tool for assessing and improving the mini-implant insertion procedural skills of postgraduate orthodontic trainees. Keywords: Direct Observation of Procedural Skills (DOPS); Mini-implants; Orthodontics. INTRODUCTION In 1990 psychologist Miller presented the framework for assessment of clinical competence, where knowledge (knows) is at the lowest level of pyramid while competence (knows how), performance (shows how), and action (does) are at the highest levels. 1 The ‘does’ level is most relevant for assessing clinical competence, therefore due to shift from knowledge based to competency based postgraduate clinical training the competence level of the trainee has been improved manyfolds 2 . Workplace-based assessment (WBA) assesses the resident in several ways from the assessment of resident’s procedural skills to behaviors at place of daily clinical practice, which generates evidence of daily clinical competences. 3 There are multiple tools of this assessment strategy, including direct observation of procedural skills (DOPS) 3 . College of Physicians & Surgeons Pakistan (CPSP) has recently started to sensitize supervisors about WBA and has introduced different WBA tools in some postgraduate medical specialties for competency assessment, 4 but DOPS has not been implemented in the specialty of orthodontics. Presently CPSP is assessing orthodontic competencies by TOACS, short and long clinical cases, own treated five cases and e-log book. Such assessment methods need to be monitored at a higher competence level, therefore it was in this background that orthodontic DOPS was implemented first at UK in 2010 3 . Assessment of clinical competencies of postgraduate trainees is essential part of medical and dental postgraduate education. In the past, the competency assessment of postgraduate dentistry residents was done mainly through traditional methods. There are few studies in literature on implementation of different assessment methods in dental education, which showed that 62% of all current assessment instruments implemented in dentistry are traditional methods and only 3% are procedural observation. 5 However, since the introduction of DOPS in 2003, their use has spread rapidly around ----------------------------------------------------------------------------------------- Received on 22-12-2021 Accepted on 19-05-2022 the world as an appropriate instrument to assess technical skills of dental students. 6 Studies are also limited on application of DOPS in different postgraduate specialties of dentistry including orthdontics 7-9 . Literature shows strengths, weakness, reliability and acceptability of DOPS used in medical and dental education 5,7 . Quality assurance is one of the weaknesses of DOPS 7 but there are several advantages such as: it is a procedural recording and assessment of trainee’s actual performance at workplace rather than in artificial exam environment, in addition to providing structured feedback, it is objective and time saving assessment tool 8 . Orthodontic DOPS can be applied to assess procedural skills of trainees’ in simpler orthodontic settings for basic and routine chair-side orthodontic procedures 9 . However, minimal published literature is available related to effectiveness of DOPS in the specialty of orthodontics 8,9 and very little, if any work has been done in this context in our country because of which it is not yet implemented at wide scale at postgraduate orthodontic centers 10-12 . Educational researches are required to generate evidence that will justify and strengthen the use of DOPS in postgraduate orthodontic training which in turn may result in improvement in skills of trainees, and in addition to standardization of orthodontic training programs across the country; it may result in improvement in orthodontic patient care. The rationale of present study was that currently assessment of postgraduate orthodontic trainees is mostly summative that includes SEQs, TOACS, and long cases, but these methods do not assess orthodontic procedural skills thus gap was identified in the present system of postgraduate orthodontic training. As DOPS in not in place for postgraduate orthodontic trainees thus gap was identified in literature about its implementation and effectiveness. Furthermore, this strategy was chosen as a tool to gather evidence about its effectiveness based upon the observation of growing interest of CPSP in this tool. More relevant studies may contribute to successful implementation of DOPS at postgraduate orthodontic centers, which ultimately can result in longitudinal development of trainees’ skills, increase interaction with supervisors and thus