Nested EPA: Mobilization of Right Colon

Nested EPA: Mobilization of Right Colon

Mobilization of right colon along the white line of Toldt including the hepatic flexure off of the retroperitoneum

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Date of Assessment*

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Anatomy*

Names but requires prompting to identify anatomy including white line of Toldt, blood supply, and retroperitoneum

Demonstrates basic understanding of anatomy in straightforward cases

Demonstrates understanding of anatomy in straightforward cases. Identifies but cannot adapt to abnormal anatomy discovered intraoperatively including re-operative field, aberrant vascular anatomy, or advanced pathology.

Easily adapts to abnormal anatomy

Surgical Technique*

Handles instruments safely but tentatively. Follows intraoperative directions. Displays coordinated hand movements for simple maneuvers under direct instruction but inefficient w/ basic skills.

Displays some coordination of instruments, but tissue handling is inconsistent w/ both hands. Requires some prompting to stay in correct dissection plane and avoid injury to nearby structures.

Consistently displays careful tissue handling. Creates tension and counter tension during dissection. Gets into and stays in correct dissection plane and avoids injury to nearby structures. May require assistance in complex cases or re-operative fields.

Careful tissue handling and avoids injury in both straightforward and complex dissections

Steps of Procedure*

Requires prompting to articulate steps of mobilization

Articulates basic steps but needs direction to move case forward (ex: follow along white line of Toldt and stay superficial to retroperitoneum, avoid mobilizing duodenum). Distinguishes difference between medial to lateral vs lateral to medial dissection.

Mobilizes colon in straightforward case but requires guidance in complex case (re-operative, inflammation, scarring, large mass)

Mobilizes colon in complex case. Walks junior residents through straightforward case. Implements plan when deviation from initial operative plan is required.

Dealing with Potential Error / Complications*

Recognizes basic complications (oozing, deviation from plane). Does not articulate the techniques to minimize severe complications (injury to colonic mesentery, right ureter, or duodenum).

Manages basic complications. Articulates techniques to minimize severe complications.

Manages basic complications. Implements techniques to minimize severe complications.

Takes appropriate precautions to minimize common complications (ex: approaches mobilization at different angles). Implements early management plans for severe complications.

Overall Performance*

Limited Participation - Demonstrates understanding of information and has very basic skills

Direct Supervision - Demonstrates understanding of the steps of the operation but requires direction through principles and does not know the nuances of a basic case

Indirect Supervision - Can do a basic operation but will not recognize abnormalities and does not understand the nuances of an advanced case

Practice Ready - Can manage more complex patient presentations and operations and take care of most cases

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