Click your status in the sequence of feedback
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1. I am resident and informing attending of my goals
2. I am resident and did case - now will self reflect
3. I am attending directing resident reflections
4. I am resident reviewing my attending comments
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Resident e-mail
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Date Surgery is Planned
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Month
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Day
Year
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Attending e-mail
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PGY
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As a Resident my goals for this next case are:
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% case Resident did
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< 25%
25-50%
50-75%
> 75%
Case Complexity
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routine
-1- complex feature
>1 complex feature
Skill level shown
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1 shown and told
2 active help
3 passive help
4 supervise only
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Assess skill levels Resident shows
Global Surgery Skills - Endoscopic Botox injection (intramuscular)
well done, no improvement needed
some improvement needed
much improvement needed
unacceptable performance intense improvement needed
N/A
knows surgery procedure steps
knows names of instruments used
posture at OR table
did huddle with anesthesia
did huddle with OR nurse staff
Professional:respectful & effectively communicates
Basic Surgery Skills - Endoscopic Botox injection (intramuscular)
well done, no improvement needed
some improvement needed
much improvement needed
unacceptable performance intense improvement needed
N/A
position patient in lithotomy
calibrate meatus
assemble cystoscope and cords
urethroscopy
cystoscopy
inject Botox into detrusor
assure hemostasis
empty bladder
instill xylocaine PRN
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Resident
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Attending
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I am the attending and certify this information is correct
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