Title: Implementing a modified Direct Observation of Procedural Skills (mDOPS)

What problem was addressed: Medicine residents are required to be proficient in a number of procedures, including central venous catherization (CVC). The educational strategy for developing procedural competence, “see one, do one ” is becoming a less acceptable practice. Currently only a log book is used for assessing procedural competence in residencies throughout Pakistan1, which records the quantity but not quality of performance and does not provide feedback. Introducing a content specific instrument and multiple, periodic formative assessments may help improve residents ’ procedural competence and ultimately impact patient safety. Our objective was to develop an intervention and an instrument, to assess the performance of residents in CVC in order to credential them at a higher quality standard. What was tried: CVC was used as the prototypical procedure to develop simulation based workshops for training and assessment of procedural skills in Medicine residents as it is critical for patient care and threatens patient safety. A modified DOPS instrument was developed by combining a standard DOPS with an OSATS (Objective structured assessment of technical skills), to combine the strengths of DOPS (actual work place performance and multiple observations) and OSATS (good inter-rater reliability and construct validity i