Analysis of Clinical Skill Performance During Medical Internship at Department of Surgery, Debre Tabor University, Ethiopia

and their assessors during their surgical clinical attachments at the Department of Surgery, Debre Tabor University, Ethiopia. Methods: The research was based on the steps of an action research project. The test includes basic surgery procedures like securing a peripheral IV line and drawing blood for testing, as well as skills like suturing and knot tying, putting in a nasogastric tube (NGT), and putting in a trans-urethral urinary catheter. The data gathering instruments used were self-administered, semi-structured questionnaires for both interns and their evaluators. After the implementation of the DOPS interventions, the questionnaire was distributed to both students and instructors. The data were analyzed using SPSS version 26.0 software, calculating frequency and percentage values for comparison. Results: Most of participants believe that DOPS has the potential to enhance the objectivity of assessing students' skills. The majority of participants strongly agreed that DOPS enhances the relationship between students and teachers, provides valuable feedback to medical interns, should continue in other departments in the future, and is an effective teaching and learning tool. The DOPS performance showed a significant improvement between the first and second assessments in all four procedures. Conclusion: DOPS can serve as a standard tool for assessing fundamental practical abilities in the surgical fields. Given that action research involves a paradigm shift and necessitates ongoing reflection and improvement, it is advisable to conduct additional studies to evaluate the performance of interns in all other departments.

evaluations in medical education, these assessments are not conducted in artificial environments but rather occur as part of the regular job routine. 6PS are intended to assess the execution of a certain talent in the workplace rather than evaluating the individual.They aim to verify that the skill is performed accurately, following established criteria, and utilizing a predetermined checklist.8][9] The objective of this study was to implement DOPS as a method for assessing the clinical skills performance of medical interns.The study also aimed to investigate the opinions and satisfaction levels of both medical interns and their assessors during their surgical clinical attachments at the Department of Surgery, Debre Tabor University, in Debre Tabor, Ethiopia.

Methods
The study focused on final-year medical students, also known as medical interns, who were assigned to

Results
The participants consisted of 8 assessors, comprising 3 consultants and 5 general practitioners, as well as 12 medical interns.The average of the participants was 28 years, with a standard deviation of 3.7.The youngest participant was 22 years old, while the oldest participant was 35 years old.The number of male participants was almost double that of female participants, with a male-to-female ratio of 1.9:1 (Table 1).The DOPS ratings for procedural skills involved the evaluation of interns on four specific procedures during their surgery rotation.These procedures included securing an IV line and taking a blood sample, suturing, and knot tying, NG tube insertion, and trans-urethral catheterization.In total, four checklists were prepared for this purpose.Following the conclusion of the last DOPS performance, feedback from both interns and professors was promptly collected.The performance of DOPS-1 was regarded as a sort of formative assessment.Consequently, the students were provided with the results of the DOPS-1 examination.After a week of practice and procedure correction, the DOPS-2 evaluation was conducted for the pupils.However, the DOPS-2 findings will be incorporated into their portfolio as proof of the student's performance in the surgery department, serving as a conclusive judgment of whether they passed or failed.Interns who receive a score below 60% must retake the procedure until they achieve a passing grade.
Post-DOPS intervention assessment: Twelve medical interns successfully performed two procedures each, as outlined in one or more of the four checklists or procedures.We reported the results as 100%.The lowest and highest average scores recorded during the pre-DOPS exam were in suturing and knot tying (49.0%) and trans-urethral catheterization (81.0%), respectively.During the post-DOPS performance, the success rate for NG tube insertion was 76.0%, while the success rate for suturing and knot tying was 94.50%.The DOPS performance showed a significant improvement between the first and second assessments in all four operations, regardless of their nature.Therefore, the average DOPS score increased from DOPS-1 to DOPS-2, as indicated in Table 3.

Discussion
The Directly Observed Procedural Abilities (DOPS) assessment is a workplace-based evaluation that is specifically developed to assess clinical abilities and offer feedback.[12] Given that the practice of medicine encompasses various elements such as knowledge, procedural skills, communication skills, and clinical decisionmaking, it is essential to employ suitable assessment methodologies to assure the training of competent and skilled doctors. 13,14After implementing the direct observation of procedural abilities (DOPS) exercise in the Department of Surgery, we observed a notable enhancement in the clinical abilities of interns.This increase was achieved through the introduction and repetition of DOPS for common surgical procedures.
Furthermore, both the students and teachers responded positively to this method.Another discovery made in this study is that medical interns and their trainers perceived the DOPS assessment as an impartial and valuable evaluation tool within the Department of Surgery.The results also indicated that medical interns and department personnel provided favorable feedback regarding DOPS.
Medical interns and department personnel provided favorable feedback regarding the direct observation of procedural skills in this study.
Similarly, previous research found DOPS to be userfriendly and straightforward to use.The students expressed a high level of positivity regarding the feedback opportunity provided by DOPS for medical students.[17][18] Moreover, the participants of this study encountered significant obstacles in implementing this assessment approach, such as a lack of awareness and excessive workloads.This finding aligns with other research that has demonstrated comparable feedback mechanisms.Similar to prior studies, this study also found that DOPS satisfaction and practicality were regarded as favorable. 19,20However, our study has several limitations.Firstly, the assessment was conducted in a single center, which may limit the generalizability of the findings.
Additionally, the sample size was small, which may affect the statistical power of the study.Lastly, the investigation was only conducted in a single department, which may limit the applicability of the results to other departments or settings.Therefore, additional research is necessary with a larger sample size of participants.

Conclusion
DOPS can serve as a standard tool for assessing fundamental practical abilities in the surgical field.
Given that action research involves a paradigm shift figure out their strengths, weaknesses, and areas where they can improve.The last process required a score of at least 60% to pass.If the intern's performance is below the acceptable range (below 60%) on the second test (after getting feedback), they will have to do the process again.They added the outcome to their portfolio to demonstrate their proficiency in the surgery area.It was possible to tell the difference

Table 2 .
Perceptions of participants about DOPS.

Table 3 .
Pre-DOPS and post-DOPS performance of the medical intern.