Video observation of procedural skills for assessment of trabeculectomy performed by residents

Purpose: The efficacy and sufficiency of a healthcare system is directly related to the knowledge and skills of graduates working in the system. In this regard, many different assessment methods have been proposed to evaluate various skills of the learners. Video Observation of Procedural Skills (VOPS) is one newly-proposed method. In this study we aimed to compare the results of the VOPS method with the more commonly used Direct Observation of Procedural Skills (DOPS). Methods: In this prospective study conducted in 2012, all 10 ophthalmology residents of post graduate year 4 were selected for participation. Three months into training in the glaucoma ward, these residents performed trabeculectomy surgery on patients, and their procedural skills were assessed in real time by an expert via the DOPS method. All surgeries were also recorded and later evaluated via the VOPS method by an expert. BlandeAltman plot also was used to compare the two methods and calculating the mean and 95% limit of agreement. Results: Residents have been done a mean of 14.9 ± 3.5 (range 10e20) independent trabeculectomy before the assessments. DOPS grade was positively associated with number of independent trabeculectomy during glaucoma rotation (b¼0.227, p ¼ 0.004). The intra-observer reproducibility of VOPS measurements was 0.847 (95% CI: 0.634, 0.961). The mean VOPS grade was significantly lower than the mean DOPS grade (8.4 vs. 8.9, p ¼ 0.02). However, a good correlation was observed between the grades of VOPS and DOPS (r ¼ 0.89, p ¼ 0.001). BlandeAltman analysis demonstrated that all data points fell within the 95% limits of agreement (1.46, 0.46). Conclusion: The present study showed that VOPS might be considered a feasible, valid, and reliable assessment method for procedural skills of medical students and residents that can be used as an alternative to the DOPS method. However, VOPS might underestimate DOPS in evaluating surgical skills of residents.