EPA: Acute Abdomen

EPA: Acute Abdomen

Evaluatee Name (Last, First)*

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

Select or enter value

Evaluator Name (Last, First)*

Select or enter value

Date of Assessment*

Rotation*

Select or enter value

Phase of Care*

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

Intraoperative

Postoperative

Preoperative/Nonoperative

For each category, select the statement that best describes the resident behavior for this patient encounter.

Preoperative: Evaluation*

OBTAINS H&P with cultural humility and develops a LIMITED DIFFERENTIAL. Initiates diagnostic testing but in an unfocused way and without urgency.

Evaluates, recommends & INTERPRETS LAB & IMAGING STUDIES, & stratifies urgency of presentation. INITIATES RESUSCITATION & develops a plan.

MANAGES OTHERWISE HEALTHY pt with common causes of acute abd pain (diverticulitis, perf appy, free air from other perforation). DEVELOPS & IMPLEMENTS RESUSCITATION & OPERATIVE PLAN if needed.

MANAGES COMPLEX COMORBIDITIES OR ATYP PRESENTATION (frozen abd, carcinomatosis, mesenteric ischemia, internal hernia, comorbidities). Initiates resuscitation & develops plan including operation, based on urgency & complexity, seeks input from team.

Not applicable/not observed

Preoperative: Consent*

Communicates the elements of an informed consent discussion but OMITS SOME ELEMENTS when documenting the discussion.

Initiates informed consent for an operation, requiring help to ADDRESS BEST-AND WORST-CASE SCENARIOS FOR THE SHORT, MEDIUM, AND LONG TERm and ensure patient/caregiver comprehension.

OBTAINS GOAL-CONCORDANT INFORMED CONSENT w/ cultural humility; addresses best- & worst-case scenarios (short, medium, and long-term) but does not always ensure patient/caregiver comprehension by using applicable language services & audio/visual aids.

AS ABOVE and ENSURES PATIENT/CAREGIVER COMPREHENSION by using applicable language services and audio/visual aids.

Not applicable/not observed

Preoperative: Communication with Others*

Displays LIMITED ABILITY TO COMMUNICATE clearly with all care team members regarding the plan of care. Completes admitting documentation to a non-ICU level of care with assistance.

ARTICULATES ALL KEY FACTS to supervisors, INCLUDING THE URGENCY of the condition. Completes admitting documentation to the floor or ICU.

Discusses recommendations with the consulting team and VERIFIES UNDERSTANDING USING CLOSED-LOOP COMMUNICATION. Communicates respectfully and efficiently with all team members regarding the urgency of the patient's condition and the plan of care.

COMMUNICATES URGENCY OF PLAN & PRIORITY OF INTERVENTIONS to all team members, including attending, OR & anesthesia teams. Synthesizes information & identifies additional tests needed, expressing to others urgency & priority of testing in respectful way.

Not applicable/not observed

Case Difficulty*

Straightforward

Moderate

Complex

Intraoperative: Evaluation*

ASSISTS with adequate exposure.

PERFORMS THE BASIC STEPS of entering and systematically exploring the abdomen. Identifies the area of concern but has DIFFICULTY IDENTIFYING CAUSATIVE pathology.

Explores the abdomen and IDENTIFIES CAUSATIVE PATHOLOGY.

Performs an EFFICIENT EXPLORATION OF THE ABDOMEN and identifies causative pathology. EXECUTES INTRAOPERATIVE DECISIONS IN A COMPLEX situation (eg, need for bowel resection, repair of perforation, irrigation and drainage, damage control).

Intraoperative: Steps of Operation*

ASSISTS with surgical positioning and preparation of the patient.

Provides BASIC DESCRIPTION OF OPERATIVE PLAN but omits some steps. Requires coaching for most intraop decisions. Usually proceeds to next steps but sometimes requires direction. Anticipates some next steps and necessary instruments.

MAKES STRAIGHTFORWARD INTRAOPERATIVE DECISIONS, such as need for bowel resection, repair of perforation, or irrigation and drainage in common scenarios, but requires coaching in less common scenarios.

DEVELOPS OPERATIVE PLAN & PERFORMS INTERVENTIONS TO ADDRESS CAUSATIVE pathology. Devises & implements plan when initial plan deviates. MODIFIES AND PRIORITIZES INTERVENTIONS BASED ON OP FINDINGS & PT CONDITION, including need for 2nd-look procedure.

Intraoperative: Complications*

Maintains a sterile field.

Positions the patient for maximal operative exposure and takes precautionary measures to prevent iatrogenic injury. Controls bleeding only with direction.

Identifies most potential errors at the relevant portion of the procedure and takes steps to avoid them. Identifies when delayed closure of the abdomen is indicated due to difficulty in closing.

Devises a plan that includes minimizing potential postop complications.

Intraoperative: Technical Skills*

Handles instruments safely but tentatively; DISPLAYS A LACK OF COORDINATION between both hands; PERFORMS SUTURING AND KNOT TYING INEFFICIENTLY. Performs superficial wound closure.

INCONSISTENT TISSUE HANDLING, tissue trauma; req redirection to maintain optimal plane. Maintains but cannot independently enter plane of dissection; DEVIATES FROM CORRECT PLANE. Uses surgical energy safely. Safe abdominal entry and incisional closure

Demonstrates CAREFUL INSTRUMENT & TISSUE HANDLING, resulting in minimal tissue trauma, though DISSECTION TECHNIQUES MAY BE INEFFICIENT and result in EXCESS MANEUVERS; demonstrates difficulty with inflamed fields or altered anatomy.

FUNCTIONS AS TA FOR STRAIGHTFORWARD CASE. Identifies tissue planes that have not been previously dissected but NEEDS HELP TO MANAGE VARIABLE ANATOMY OR IDENTIFY TISSUE PLANES IN REOP FIELD to prevent iatrogenic injury.

Postoperative: Complications*

Performs a POSTOP EVALUATION and relays patient status, including abnormal status.

Initiates EVALUATION FOR BASIC POSTOP COMPLICATIONS (eg, fever, pain, wound issues). Manages basic postop considerations (eg, fluid status, electrolyte abnormalities, wound care, drains, tubes). Performs basic postop procedures (eg, VAC changes).

IDENTIFIES AND MANAGES ALL POSTOP COMPLICATIONS. Performs postop procedures, including decompression of abdominal compartment syndrome, delayed abdominal wall closure, and bedside control of bleeding.

DEVELOPS A POSTOP PLAN TO MINIMIZE ANTICIPATED COMPLICATIONS & treat them if they develop. Determines the postop care level & guides postop resuscitation & management (pressors use, advanced ventilator strategies, blood products, antibx, nutrition).

Not applicable/not observed

Postoperative: Communication with Patient*

Communicates BASIC ASPECTS of the operation and ongoing management plan, but NEEDS PROMPTING TO CLARIFY EXPECTED OUTCOMES and the anticipated treatment course.

Communicates details of the operative procedure and postop instructions with cultural humility but OMITS SOME ELEMENTS WHEN DISCUSSING EXPECTED OUTCOMES and the overall anticipated treatment course

Communicates customized postop instructions and updates using variety of methods to ENSURE UNDERSTANDING; DISCUSSES UNEXPECTED FINDINGS OR CHANGE TO THE INTENDED PLAN with cultural humility.

Communicates using teach-back to ensure understanding. CONVEYS INFO ABOUT PROGNOSIS & NEED FOR FURTHER THERAPY W/ CULTURAL HUMILITY; determines if plan can be carried out based on pt’s SDoH (transportation, living situation, insurance, access to pharmacy)

Not applicable/not observed

Postoperative: Documentation*

Documents brief operative notes and postop evaluation, with some errors or omissions

Documents postop plans for a patient, with some errors or omissions

Documents all components of a patient's course with few if any errors or omission

Reviews and provides feedback about documentation in the medical record

Not applicable/not observed

Postoperative: Care Coordination*

Writes routine postop orders for a patient being admitted to the floor

Writes postop orders for a patient being admitted to the ICU or receiving coordinated care from multiple services

Coordinates discharge of a patient with complex care needs, such as wound management, home TPN, and IV line or feeding tube maintenance

Identifies specific needs and coordinates care for a patient according to their socioeconomic context, including navigating challenges (eg, transportation, living situation stability/safety, insurance, pharmacy

Not applicable/not observed

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

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.

Send me a copy of my responses

Privacy Notice|Report Abuse