EPA: Provide Surgical Consultation

Evaluatee Name*

(Last Name, First Name) Once a form has been submitted, the resident will receive a copy of the evaluation.

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Evaluator Name*

(Last Name, First Name)

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Rotation*

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Date of Assessment*

Reason for consult

Please enter the reason for the surgical consult

Medical Knowledge*

Demonstrates understanding of core surgical conditions. Recognizes an acute, potentially life-threatening surgical problem.

Demonstrates knowledge of pathophysiology and treatments for a patient with a complex surgical condition.

Demonstrates knowledge of the impact of patient factors on pathophysiology and the treatment of patients with surgical conditions.

Demonstrates comprehensive knowledge of the varying patterns of disease presentation and alternative and adjuvant treatments

Evaluation*

Respectfully receives consult, not recog urgency. Identifies potential barriers to consult completion & describes strategies to mitigate them. Obtains H&P w/ cultural humility. Develops differential w/ some omissions/extraneous info. Asks for timely help.

Responds to a consult in a timely manner, altering the pace of consultation for urgent problems. Evaluates a patient and recommends diagnostic tests as indicated. Seeks help when limits in the knowledge/skills of the team require it.

Responds to a consult in a timely manner with attention to detail in a complex situation. Demonstrates professional behavior in a complex or stressful situation.

Exhibits confidence in skills with self-awareness of limits in knowledge/skills. Recognizes a situation that may impact others’ ability to complete tasks and responsibilities in a timely manner and provides assistance

Evidence-based Practice*

Applies evidence for a routine condition. Incorporates a patient’s preferences and values into patient care.

Recommends management for a patient with a straightforward condition. Incorporates patient preferences/values to guide evidence-based care.

Manages a healthy patient with a straightforward condition and an evolving clinical condition. Applies evidence, integrated with patient preference, for complex condition to make a personalized care plan consistent with patient goals of care.

Makes recommendations for managing a patient with a complex surgical condition (eg, intra-abdominal sepsis) or associated comorbidities. Critically appraises the literature, considering nuanced clinical situations in its application.

Communication with Patient*

Respectfully communicates basic facts about the condition in a timely way but inconsistently uses applicable language services and audio/visual aids. Actively listens to elicit patient questions and expectations.

Respectfully communicates basic facts about the diagnosis, customizing communication to overcome barriers/cultural differences (using applicable language services and audio/visual aids).

Delivers complex and difficult information respectfully and clearly across language and cultural differences.

Negotiates and manages conflict between a patient, their caregiver(s), and the health care team. Facilitates a discussion productively, respectfully, and accurately across language and cultural differences in a caregiver conference.

Communication with other providers*

Uses language that values all members of the health care team

Clearly and concisely articulates the plan and next steps to the primary team, the ED team, and other team members

Verifies understanding of recommendations when communicating with other services. Adapts communication style to fit team needs. Communicates concerns and feedback (positive and negative) to peers and learners.

Coordinates recommendations from different members of the team and patient/caregiver(s) to develop a comprehensive care plan. Maintains effective communication with a patient/caregiver(s), other services, and team members in a crisis situation.

Documentation*

Accurately records information in the patient record, including use of documentation templates when indicated.

Documents the encounter efficiently in the EMR

Integrates and synthesizes all relevant data from outside systems and prior encounters into documentation and the plan of care

Overall Performance*

Based on your observation, what level of autonomy would you trust the resident to perform this task 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

Comments*

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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