DOPS (DIRECT OBSERVATION OF PROCEDURAL SKILLS) AND RENAL BIOPSY TRAINING AT LIVERPOOL HOSPITAL
Andrea Huang1, Olivia Chang1, Hareeshan Nandakoban1,2, Ananthakrishnapuram Aravindan1, Govind Narayanan1, Stephen Timothy Spicer1,2, Jeffrey Wong1 1Liverpool Hospital, Sydney, NSW, Australia2South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
Abstract
Aim
To Assess the impact of DOPs on renal biopsy complication rates by trainees at Liverpool Hospital following introduction in January 2012 to April 2023.
Background
The Direct Observation of Procedural Skills (DOPS) is a formalized evidenced- based assessment tool to guide trainee learning, competency and independence for procedures. DOPs was formally adopted by RACP in 2013.
Methods
A retrospective analysis of a database of renal biopsies performed by Liverpool Hospital renal department for the past 11 years.
Results
Of 1979 biopsies performed, with real time ultrasound guidance 1800 (91.0%) were by 51 trainees and 179 by 6 RACP fellows Native biopsies predominated with 1646 and 330 transplant biopsies. The majority were outpatient biopsies (1253) with 616 inpatient biopsies including a post-mortem biopsy.
Of the trainees, 26 (50.8%) were female. In total 65% biopsies were unsupervised. Forty four percent performed by female trainees were supervised, compared to 23.3% male trainees (p<0.05) without a significant complication rate difference (8.3% and 7.7% respectively, p>0.05). A total of 153 (7.7%) biopsies were complicated by bleeds, of which 84.9% bleeds were immediate (<4 hours). Five biopsies sampled tissue other than renal (spleen/colon/ureter). Prior to DOPs sign off novice trainees performed a mean number of 19 supervised biopsies with a mean complication rate of 4%. The complication rate after DOPs (unsupervised) was higher at 6% (p<0.05 by Wilcoxon rank sum test).
Conclusion
There was a small difference in complication rates for those pre- and post-DOPs sign off although the complication rates are still low and consistent with literature. The use of DOPs alone may not completely offset benefits of a supervised learning environment.
Biography
Dr Andrea Huang is a current second year Renal Advanced Trainee in the Central-Southwest-Regional network. She graduated from University of Sydney in 2017 and trained at both Nepean Blue Mountains LHD and Southwestern Sydney LHD.