Nested EPA: Creation of Ostomy

Creation of loop, end ileostomy or colostomy.
Understands positioning of ostomy and length of bowel needed to reach abdominal wall.
Able to perform skin incision and dissection of subcutaneous tissue to the fascia.
Incises fascia with appropriate incision for size of bowel.
Places Brooke and in-between stitches at appropriate height and spacing on the bowel.

Evaluatee Name (Last, First)

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Evaluator Name (Last, First)

Date of Assessment

mm/dd/yyyy

Rotation

Anatomy

Names but requires prompting to identify layers of the bowel wall and the abdominal wall

Demonstrates basic understanding of layers of the bowel and abdominal wall, but unable to determine surgical plan such as ostomy site or type of ostomy required

Demonstrates understanding of anatomy and surgical plan in straightforward cases but requires assistance for abnormal anatomy (ex: re-operation, shortened mesentery, obesity, or devascularized bowel)

Understands anatomy. Independently identifies abnormal anatomy and pivots operative plan as needed to accommodate for unexpected findings. Walks junior resident through ostomy creation in straightforward cases.

Surgical Technique

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

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

Consistently displays careful tissue handling and atraumatic suturing/tying on the bowel. Stays in correct dissection plane. Avoids injury to nearby structures. May require assistance in complex cases or re-operative field.

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

Steps of Procedure

Requires prompting to articulate steps of operation including ostomy position, size of fascial defect, suture choice, type of stitch (Brooke or in-between), and stitch placement

Articulates basic steps such as ostomy position, different types of stitches (Brooke and in-between) but requires active direction for stitch placement, suture choice, and fascial defect size

Performs ostomy creation in straightforward cases. Requires guidance in complex cases (re-operation, shortened mesentery, obesity, or devascularized bowel).

Performs straightforward and complex cases with minimal guidance

Dealing with Potential Error / Complications

Evaluates basic complications (oozing, bleeding from bowel edges, or serosal injuries), but requires guidance to manage

Independently manages basic complications

Independently manages basic complications. Identifies severe complications (devascularization of bowel, full thickness injury to bowel, contamination, orientation of bowel, or incorrect size of facial defect), but requires guidance to manage.

Independently manages severe complications. Takes appropriate precautions to minimize common complications (ex: dissecting right on bowel) and adapts operative plan (re-do ostomy or re-site).

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

Comment

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