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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
