DOAP Checklists

Below are concise, student-friendly checklists you can adapt to your logbook. Always follow your hospital’s protocols.

A) Simple Interrupted Suturing of a Superficial Wound

1. Pre-procedure

• Confirm indication (clean, superficial laceration; depth checked)
• Allergies, tetanus status, consent
• Equipment: sterile gloves, 3-0 or 4-0 nylon, needle holder, toothed forceps, scissors, sterile gauze, saline, LA, dressing

2. Asepsis and LA

• Hand hygiene, sterile gloves
• Clean and irrigate wound thoroughly (copious saline)
• Infiltrate LA (aspirate before injection, dose limit)

3. Technique

• Evert edges; enter skin ~0.5–1 cm from edge at 90°
• Follow needle’s curvature; symmetric bites
• Tie secure square knots; cut tails ~5–7 mm
• Spacing: ~5–10 mm between sutures depending on tension

4. Post-procedure

• Hemostasis check; apply sterile dressing
• Documentation: size, location, number of sutures, material, LA used
• Advice: keep dry 24–48 h, review for removal (face: 3–5 days; trunk/upper limb: 7–10 days; lower limb: 10–14 days), warning signs

Common pitfalls: poor irrigation, inverted edges, crushing tissue, over-tightening causing ischemia.

B) Incision and Drainage (I&D) of a Small Abscess

1. Pre-procedure

• Confirm fluctuation; rule out deeper involvement
• Check diabetes/anticoagulants; consent
• Equipment: scalpel, forceps, hemostat, saline, gauze, iodoform/pack if used, LA

2. Asepsis and LA

• Prepare skin; LA infiltration around abscess (avoid injecting pus cavity)
• Adequate analgesia; consider systemic analgesic

3. Technique

• Incise over most fluctuant area (usually along skin crease or Langer’s lines)
• Break loculations with hemostat; express pus safely
• Irrigate cavity; pack loosely if indicated (institutional practice varies)

4. Post-procedure

• Dressing; send pus for culture if indicated
• Documentation and advice: dressing changes, analgesia, glycemic control, red flags

Common pitfalls: too small incision, inadequate drainage, missing loculations, tight packing causing pain/ischemia.

C) Nasogastric (Ryle’s) Tube Insertion

1. Pre-procedure

• Indication (decompression, feeding, aspiration)
• Contraindications (base of skull fracture, severe facial trauma), consent/explanation
• Equipment: NG tube, lubricant, stethoscope, tape, syringe

2. Technique

• Measure NEX (Nose–Earlobe–Xiphoid); mark length
• Sit patient up; lubricate; insert via most patent nostril
• Ask patient to sip water; advance with swallowing
• Confirm position (aspirate gastric contents; pH if available; air insufflation + epigastric auscultation; institutional radiograph policy if required)

3. Post-procedure

• Fix tube; check patency
• Document size, side, length at nostril, confirmation method
• Explain care and warning signs

Common pitfalls: coiling in mouth, misplacement, inadequate confirmation.

D) Suture Removal and Dressing

1. Assess wound healing; signs of infection/dehiscence
2. Equipment: sterile scissors, forceps, antiseptic, dressing
3. Remove alternate sutures first; support wound; cut suture near skin to avoid dragging externalized suture inside
4. Apply steri-strips if tension
5. Document and advise return if redness/discharge

Sample DOPS Walkthroughs

DOPS Example 1: Suturing a 2-cm Forearm Laceration in Casualty

• Pre-brief: Student states plan using ICSAFE.
• Observation focus:
  • Checks consent, allergy, tetanus
  • Irrigates adequately
  • Correct needle holder grip (thumb–ring finger or thumb–middle finger per faculty preference)
  • Eversion achieved, knots flat, appropriate spacing
  • Communicates with patient, reassures during LA and suturing
  • Avoids crossing sterile fields; safe sharps disposal
• Feedback:
  • Strengths: Gentle tissue handling, good eversion
  • Improvements: Slightly wider bites near wound end; verbalize post-procedure advice more clearly
  • Plan: Practice two more sutures on pad focusing on bite width; next case attempt full closure again

DOPS Example 2: I&D of Small Gluteal Abscess in Minor OT

• Observation focus:
  • Adequate LA, tests for analgesia before incision
  • Incision length appropriate, direction along crease
  • Breaks loculations; irrigates until clear
  • Loose packing and clear home-care instructions
• Feedback:
  • Strengths: Asepsis and patient comfort
  • Improvements: Incision initially too small—needed extension for complete drainage
  • Plan: In next sim practice, mark expected incision length before cutting

How Many DOPS Do You Need?

• There’s no universal magic number; many programs aim for multiple low-stakes DOPS across different skills and contexts to ensure reliability.
• Practical tip: Aim for 2–3 DOPS per core skill across the posting, spaced over time. Your department will set the exact requirement.

Common Pitfalls and How DOAP/DOPS Help

• Skipping irrigation before suturing → DOAP emphasizes wound preparation; DOPS catches the lapse in real time.
• Inverted wound edges → DOAP demo shows needle angle and eversion; DOPS feedback corrects technique.
• Poor consent or communication → DOPS explicitly rates communication; you’ll get concrete feedback.
• Weak aseptic technique → Both DOAP checklists and DOPS ratings keep asepsis front and center.
• Incomplete drainage in I&D → DOAP teaches incision length/loculation breaking; DOPS validates completeness.

Tips to Excel (Student Playbook)

• Before the case:
  • Revise steps using ICSAFE; visualize the procedure.
  • Check equipment yourself—don’t assume it’s all there.
  • Introduce yourself to the patient; gain trust early.
• During the case:
  • Narrate key steps briefly to your assessor (“Now I’ll irrigate with copious saline…”).
  • Mind ergonomics: patient height, your posture, instrument handling.
  • Be gentle, respect tissues, and be safe with sharps.
• After the case:
  • Give clear post-procedure advice in simple language.
  • Document concisely but completely.
  • Ask for one actionable improvement if time is short.
• Practice routine:
• 10–15 minutes daily on knot tying and suturing on a pad improves your DOPS performance dramatically.
• Video yourself (if allowed) on a task trainer; compare to faculty demo.

Short Templates You Can Use

DOAP Session Note (Student)

• Skill: Simple interrupted suturing
• Date, Faculty:
• Key points learned:
  • Needle angle and depth for eversion
  • Irrigation volume
  • Knot security (square knots, 3–1–1)
• Practice plan:
  • 20 sutures on pad this week
  • Next: supervised suturing in minor OT

DOPS Quick Log

• Procedure: NG tube insertion
• Setting: Ward
• Complexity: Routine
• Feedback (strengths): Calm communication; correct NEX measurement
• Feedback (improve): Confirm placement verbally with pH method if available
• Action plan: Carry pH strips; memorize documentation template
• Assessor signature:

Frequently Asked Questions

• Is DOAP only for simulators?
  • No. It often begins in the skills lab, but the Assist and Perform stages transition to real patients under supervision.
• Is DOPS pass/fail?
  • It’s primarily formative. Repeated DOPS build a reliable picture of your competence. Some programs also use it summatively—check your local policy.
• What if I get nervous in DOPS?
  • Everyone does at first. Use ICSAFE as your mental checklist, narrate calmly, and focus on safety. Assessors are there to help you improve.
• Can I choose the case for DOPS?
  • Often yes (within reason). Pick appropriately challenging cases at your level.
• What counts most in DOPS—speed or safety?
  • Safety and systematic technique. Efficiency comes with practice, but never at the cost of asepsis or patient comfort.

Bringing It All Together: A Student-Centered View

• DOAP is your roadmap for learning a procedure safely and correctly.
• DOPS is your chance to show you can do it with a patient—and to get targeted coaching.
• In general surgery postings, combine both:
  • Learn in the lab → assist in minor OT → perform under supervision → get observed and coached via DOPS.
• Keep your learning active: checklists, reflections, and small daily practice add up to big gains.

Take-Home Messages

• Use ICSAFE for any procedure: Indications, Consent, Setup, Asepsis/Analgesia, Focused steps, End with aftercare and documentation.
• Treat DOAP as your practice ladder and DOPS as your performance mirror.
• Focus on asepsis, tissue respect, communication, and documentation—they’re universally assessed.
• Build confidence with repetition on task trainers, then transfer to patients under supervision.
• Ask for feedback; own your action plan; track progress in your logbook.

You’ve got this. With DOAP to build your skills and DOPS to refine them, CBME becomes practical, patient-centered, and achievable—one safe, well-executed procedure at a time.