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					                          Thyroidectomy - Rating Form
                              Evaluator:                     Subject:

                              Status:

                              Program:

Please rate this resident's performance during this operative procedure. The caption
above each item provides descriptive anchors for 3 of the 5 points on the rating scale.
"N/A" (Not applicable) should only be selected when the resident did not perform that
part of the procedure.

Patient Location
   MMC Inpatient              MMC Outpatient           St. John’s Inpatient     St John’s Outpatient
                                (23 hour )                                           (23 hour )
          O                         O                           O                        O


Hospital Medical Record Number




Date of Procedure

MM/DD/YY




                                 OPRS Case Difficulty
Indicate the difficulty of the case:

               1                                   2                                  3
Straightforward anatomy, no       Intermediate difficulty             Abnormal anatomy, extensive
related prior surgeries or                                            pathology, related prior
treatment                                                             surgeries or treatment (for
                                                                      example radiation), or obesity
               O                                   O                                 O



                                                                                                       1
Degree of Prompting or Direction

                1                                   2                                     3

        Substantial direction by             Some direction by                     Minimal direction by
        attending. Resident                  attending. Resident                   attending. Resident
        performs all steps but               performs all steps but                performs all steps and
        the attending provides               the attending provides                directs the surgical team
        constant direction to the            occasional direction to               independently with
        resident and surgical                the resident and /or to               minimum or no direction
        team.                                the surgical team.                    from the attending, to
                                                                                   either the resident or to
                                                                                   the surgical team.

                O                                   O                                     O


                              Procedure Specific Criteria

Exposure

     5                  4                3                2                 1
  Excellent         Very Good           Good             Fair              Poor               NA

Excellent                           Satisfactory                       Poor planning
incision                            incision                           of incision &
planning &                          planning &                         flap
precise flap                        appropriate                        elevation
elevation in                        tissue plane
correct plane                       for flap
                                    elevation
                                    most of the
                                    time.
      O                O                   O              O                  O                O


Mobilization of Thyroid

     5                  4                3                2                 1
  Excellent         Very Good           Good             Fair              Poor               NA

Precise &                           Satisfactory                       Poor
efficient                           mobilization                       technique
mobilization                        of lobe                            demonstrated
w/careful                           w/occasional                       in mobilization
handling of                         inefficient                        of thyroid
vessels                             handling of                        lobe
                                    vessels.
      O                O                    O             O                  O                O




                                                                                                               2
Recurrent Laryngeal Nerve

     5                4            3            2          1          NA
  Excellent       Very Good       Good         Fair       Poor

Demonstrates                  Some lapses             Demonstrates
excellent                     in technique            poor
knowledge of                  to avoid nerve          knowledge of
anatomy,                      injury;                 anatomy &
shows caution                                         technique in
in                                                    nerve
Identification                                        protection
/protection of
nerve;
        O            O              O           O          O          O



Identification of Parathyroid Glands
     5                4            3            2          1          NA
  Excellent       Very Good       Good         Fair       Poor

Demonstrates                  Demonstrates            Demonstrates
excellent                     satisfactory            poor
knowledge of                  knowledge of            knowledge of
glands, and                   anatomy,                anatomy &
careful,                      occasionally            dissection
meticulous                    insufficient            technique
dissection;                   and/or
                              aggressive
                              dissection
       O             O               O          O          O          O



Utilization of Pathology

      5               4            3            2          1          NA
   Excellent      Very Good       Good         Fair       Poor

 Excellent                    Some lapses             Demonstrates
 demonstration                in ability to           poor
 of role of                   utilize                 understanding
 pathology in                 pathology               of role of
 intraoperative               findings                pathology
 management
        O             O             O           O          O          O




                                                                           3
                                      General Criteria
Instrument Handling

       5              4               3              2              1
    Excellent     Very Good          Good           Fair           Poor               NA
Fluid                          Competent                       Tentative or
movements                      use of                          awkward
with                           instruments                     movements or
instruments,                   occasionally                    inappropriate
no stiffness or                appeared                        instrument
awkwardness                    awkward                         use.
       O               O              O              O              O                 O


Respect for Tissue

5                  4             3                  2               1

Excellent          Very Good     Good               Fair            Poor                  NA

Consistently                     Careful tissue                     Frequent
handled tissue                   handling,                          unnecessary
appropriately,                   occasional                         tissue force or
minimal tissue                   inadvertent                        damage by
damage                           tissue damage                      inappropriate
                                                                    instrument use

        O                  O              O                O               O                   O

Time and Motion

5                  4             3                  2               1
Excellent          Very Good     Good               Fair            Poor                  NA



Clear economy                    Efficient time &                   Many
of motion, and                   motion, some                       unnecessary
maximum                          unnecessary                        moves
efficiency                       moves


        O                  O              O                O               O                   O




                                                                                                   4
Operation Flow

5                   4           3              2        1
Excellent           Very Good   Good           Fair     Poor            NA


Obviously                       Some forward            Frequently
planned course                  planning,               stopped
of operation, and               reasonable              operating and
anticipation of                 procedure               seemed unsure
next steps                      progression             of next move

O                   O           O              O        O               O



Overall Performance

5                   4           3              2        1
Excellent           Very Good   Good           Fair     Poor            NA


O                   O           O              O        O               O

Please indicate the weaknesses in this resident’s performance:




Please indicate the strengths in this resident’s performance:




                                                                             5

				
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posted:9/7/2012
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