Professional Documents
Culture Documents
PCP Obe-Cbtp Dops Rtp-Acc Form#7
PCP Obe-Cbtp Dops Rtp-Acc Form#7
PCP Obe-Cbtp Dops Rtp-Acc Form#7
I. There are two (2) categories of procedural skills that the medical residents have to acquire and be assessed.
a. Mandatory skills (must be able to do competently without assist with a score of ‘satisfactory’):
i. NGT insertion
ii. Foley catheter insertion
iii. Technique for getting ECG tracing
iv. Arterial puncture for ABG
v. Abdominal paracentesis
vi. Thoracentesis
vii. Endotracheal intubation
viii. Setting up of Mechanical ventilator
b. Desirable skills (has 2 levels of competencies: able to do competently with or without assist with a score of
‘satisfactory’):
i. Central venous line insertion
ii. Joint aspiration
iii. Thyroid gland aspiration / FNAB
iv. Bone marrow aspiration
v. Pleurodesis
vi. Proctosigmoidoscopy
vii. Gram stain
viii. AFB smear
ix. Lumbar tap
x. Urinalysis (microscopic interpretation of sediments)
a. First step: Break down the procedure into its component parts:
i. Indications and contraindications for the procedure.
ii. Necessary equipment / instruments / consumables.
iii. Proper preparation and positioning of the patient.
iv. Individual steps of the actual procedure.
b. Second step: The teacher demonstrates the procedure to the resident slowly – talking through each step.
c. Third step: The teacher performs the procedure, but the resident will talk through each part of the procedure.
d. Fourth step: The resident actually perform the procedure, talking through each step that he is taking.
III. The resident can only undertake the summative assessment after undergoing the four-step
approach to teaching procedures (as describe above).
IV. It is preferable that summative assessment for all the procedural skills be done early during the
training, preferably YL I and II.
V. Only one (1) summative assessment with a score of 7 or better is recorded in the Workplace
Performance Assessment tool. The four-step approach to teaching procedures will serve as the
formative assessment.
1
Instruction: Assess the resident for each of the steps for DOPS utilizing the rating scale below. Provide
ample feedback. No step must be missed. MPL for each step is 5-7 or ‘satisfactory’. If for any reason a step
is missed, then the assessment must be repeated.
1 2 3 4 5 6 7 8 9 10
UNSATISFACTORY SATISFACTORY EXCELLENT
A. General assessment for DOPS (applicable for all the procedural skills).
Score
NG FOLEY ECG ABG Abdominal Thora- Endotracheal Mech
T CATH paracentesis centesis Intubation Vent
1. Conduct yourself in a
professional and appropriate
manner.
2. State the indications and
contraindications of the
procedure.
3. Explain procedure to
patient and ‘immediate
responsible person’ including
benefits and risks; get
consent; ensure patient’s
privacy.
4. Prepare all necessary
equipment / instruments /
consumables including
containers for specimen and
waste disposals.
5. Observe aseptic technique;
prepare and position the
patient.
6. Follow each step and
proper sequence of the
procedure. (see below).
7. Show dexterity and ease
during the procedure.
8. Able to perform the
procedure without causing
undue discomfort or
complications to the patient.
9. Show proper handling of
specimens and waste
material
10. Give adequate advice to
the patient on post-procedure
care and instruction on
possible complications.
Feedback
2
4. Lubricate the tip of the nasogastric tube.
5. Insert the NGT through either nostril – warn the patient prior to insertion.
6. Gently advance the NGT through the nasopharynx. Ask the patient to
swallow while inserting the tube. DO NOT force the NGT. If the patient is
becoming distressed or gagging, pause to allow the patient to relax.
Continue to advance the NGT down the esophagus.
7. Check the desired placement of the NGT by insufflating air through the tube
using asepto-syringe. Detect for gastric bubbling.
8. Secure NGT placement using a plaster.
3
5. Record the ECG according to standard guidelines.
6. Review the quality of the tracings and respond appropriately.
4
4. Select thoracentesis site in an interspace below the point of dullness to
percussion in the mid-posterior line or mid-axillary line.
5. Mark insertion point and prepare area with skin cleansing agent.
6. Administer local anesthetic agent (lidocaine 1%) over insertion point. Insert
needle over the top of the rib to avoid intercostals nerves and blood vessels. As
the needle is inserted aspirate back on syringe to check for pleural fluid. Once
fluid returns, note depth of the needle to give approximate depth for insertion of
thoracentesis needle.
7. Switch to a large bore needle (g16-19) and attach to a 3-way stopcock and
place a 30-50 ml syringe on one port of the stopcock.
8. Insert the needle along the upper border of the rib while aspirating and
advance it into the effusion.
9. Insert the catheter (or plastic cover) over the needle into the pleural space
when fluid is aspirated, and withdraw the needle, leaving the catheter (or plastic
cover) in the pleural space. While preparing to insert the catheter, cover the
needle opening during inspiration to prevent entry of air into the pleural space.
10. Withdraw fluid for testing and place in appropriate bottles.
11 Monitor patient’s symptoms and VS. Stop if with chest pain, dyspnea , cough
and hypotension. Do not drain more than 1500 ml.
12. Remove catheter while patient is holding breath.
13. Apply sterile dressing to insertion site.
14. Give post thoracentesis instructions.
5
21. Attach and secure the ETT with tape or appropriate device.
22. Attach the ETT to the mechanical ventilator.
23. Order and review ‘stat’ portable chest x-ray to evaluate the location of the
tip of the ETT.
24. Order and review arterial blood gas 30 minutes post intubation.
Signature of Assessor:
Signature of Assessor: