EPA: Other condition (Lower extremity ischemia)

EPA: Other condition (Lower extremity ischemia)

Resident Name (Last, First)*

Enter resident starting with last name. Once a form has been submitted, the resident will receive a copy of the evaluation.

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Evaluator Name*

Please type as Last Name, First Initial

(Example: Kenzo Hirose would be Hirose, K)

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Rotation*

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Date of Assessment*

Other Surgical condition*

Phase of Care*

UPDATE! You can only select one phase of care. Complete an assessment for each phase of case separately.

Preoperative/Nonoperative

Postoperative

Preop: Medical Knowledge*

Preoperative Phase of Care: Fund of Knowledge (Anatomy and Pathophysiology)

Basic understanding

Advanced understanding, including varying presentations

Preop: Evaluation*

Preoperative Phase of Care: History taking and Physical exam skills

Limited history and physical examination, missing appropriate elements.

Able to perform focused, efficient, and accurate history and physical examination.

Preop: Work up*

Preoperative Phase of Care: Work-up

Does not initiate expected cost-effective work-up

Rely on supervision to initiate expected cost-effective work-up.

Can initiate cost-effective workup of for straightforward presentation independently, still requires supervision for advanced or unusual presentation.

Independently initiate workup for all presentations.

Preop:Evid(Other)*

Preoperative Phase of Care: Fund of Knowledge (literature)

Unfamiliar with published literature regarding management of surgical condition

May be unfamiliar with published literature regarding management of surgical condition

Familiar with most published literature regarding management of surgical condition

Preop:CommPt(Other)*

Does not include the relevant risks, benefits, and alternatives when performing informed consent for operation.

Able to communicate the basic facts and understands the key components of informed consent.

Customize communication to patient based on individual characteristics. Clearly conduct informed consent for straightforward procedure.

Customize communication to patient based on individual characteristics and anticipate logistic problems in optimizing the patient for surgery. Clearly conduct informed consent for complex or emergent procedure.

Not applicable

Postop:Compl(Other)*

Postoperative Phase of Care: Complications

Does not recognize concerning signs of common postoperative complications.

Recognize concerning signs of common postoperative complications, but does not recognize complications specific to operation. Unable to synthesize plan without input from supervising physician.

Recognize concerning signs of common postoperative complications and complications specific to operation. Initiate management of postoperative complications, needs assistance to synthesize management plan for more severe complications.

Recognize and independently manage common postoperative complications, complications specific to operation, and more severe complications.

Not applicable/not observed

Postop:CommPt(Other)*

Postoperative Phase of Care: Communication

Does not provide specific postoperative instructions to patient.

Can communicate specific postoperative instructions to patient.

Communicate customized postoperative instructions to patient and provide updates in timely manner throughout hospital course.

In addition, can effectively deliver bad news and discuss unexpected findings or changes to patient and family members in sensitive and caring manner.

Ensures that team members communicate customized postoperative instructions to patient/family and provide updates in timely manner throughout hospital course.

Overall Performance*

Based on your observation, what level of autonomy would you trust the resident to manage this surgical condition at the next encounter?

Limited Participation: Learner has basic knowledge and skills, attending does show and tell

Direct Supervision: Attending provides active help

Indirect Supervision: Attending provides passive help

Practice Ready: Attending is available but is not needed for routine cases/presentations, but input may be needed for complex cases

Comment*

Please add comment on why you selected the answer above. Specifically note what steps the resident can take to achieve the next level of autonomy.

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