Nested EPA: Exposure and Control of Major Vessel

Nested EPA: Exposure and Control of Major Vessel

Dissection, exposure, and control of major vascular structure. May include suture ligation, over-sewing, or simple ligation

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Date of Assessment*

Rotation*

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Anatomy*

Names but requires prompting to identify intraop neurovascular structures

Identifies vascular structures prior to dividing them under normal conditions. Identifies relevant anatomy on pre-incision imaging without assistance in straightforward cases

Identifies but cannot adapt to abnormal anatomy discovered intraop (scarring, poor tissue quality, unusual position of branches). Identifies relevant anatomy on pre-incision imaging in complex cases.

Adapts to abnormal anatomy discovered intraop

Surgical Technique*

Handles instruments safely but tentatively. Follows intraop directions. Displays coordinated hand movements for simple maneuvers under direct instruction

Performs basic vascular skills (dissects/ligates small veins, performs suture ligation) w/ minimal assistance. Maintains dissection plane but frequently deviates from correct plane. Requires assist to control bleeding.

Performs more advanced vascular skills (dissects/exposes/controls deeper arteries, veins, and small side branches) in setting of normal anatomy and able to consistently maintain correct dissection plane.

Performs more advanced vascular skills of dissection/exposure/control in the setting of inflammation or scarring. Adapts tissue handling (blunt vs sharp dissection) based on tissue quality.

Steps of Procedure*

Requires prompting to articulate steps of vascular control

Articulates basic steps and requires active direction to move case forward (ex: needs prompting to ask for specific instruments/sutures)

Performs vascular dissection, control of vessel, ligation in straightforward cases but requires guidance in complex cases

Performs vascular dissection, control of vessels and ligation in complex cases. Walks junior residents through straightforward cases. Devises/implements plan when deviation from the initial operative plan is required.

Dealing with Potential Error / Complications*

Articulates the importance of proximal and distal vascular control to prophylactically anticipate bleeding complication.

Recognizes basic complications (oozing) but cannot distinguish among the different management strategies.

Independently manages basic complications (oozing). Requires assistance to manage complex complications (hemorrhage).

Anticipates times when the method of ligation is insufficient and requires additional reinforcement. Independently manages both oozing and hemorrhage 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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