To the Editor: The method of postgraduate medical student evaluation in our country is restricted to an exit examination [1], where the students are assessed for their presentation and clinical skills [2]. Procedural skills are not assessed using any formative tool throughout the training period. Direct observation of procedural skills (DOPS) is a brief and rapid observation of clinical procedural skills [3] in which a student’s performance is evaluated during a procedure, followed by a focused feedback [1].

Given the fact that Neonatology involves provision of emergency care, and procedural skill acquisition is mandatory for the smooth functioning of the system, implementation of DOPS as a formative assessment tool becomes a need-based assessment tool in Neonatology. Hence, a prospective observational study was conducted in the resident doctors (N = 12) of the Department of Neonatology, in a tertiary care hospital after approval from the Institutional Ethics Committee.

The doctors were evaluated on four procedures—intubation, intravenous line insertion, umbilical line catheterization, and surfactant administration by the faculties of the department (N = 3) using DOPS global checklist. Written informed consent was obtained.

Fifty-seven DOPS encounters on four procedures were evaluated between 1st April and 30th September 2020. All the trainees were competent in intubation and surfactant administration and hence, repeat DOPS was not required; 42% and 25% residents required two attempts in intravenous line and umbilical line insertion, respectively during the initial DOPS. There was significant improvement in the trainees' performance in successive DOPS (80.11 ± 1.72 vs. 82.66 ± 2.74, p = 0.03) in intravenous line and umbilical line insertion. Feedback was taken from the trainees after each DOPS assessment and all were completely satisfied.

Thus, DOPS was feasible and well accepted as an assessment method for procedural skills in the Neonatology residents. Further studies are required, which would assess a trainee’s performance in all neonatal procedures for reaching a conclusion.