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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Institution
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Fellow/Resident Trainee
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PGY
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Fellow
6
5
4
3
2
1
Fellow/Resident Trainee e-mail
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Attending
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Attending e-mail
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Date Surgery is Planned
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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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Please select
< 25%
25-50%
50-75%
> 75%
Case Complexity
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Please select
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 - Buried penis repair
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 tissues handled
tissue dissection
knows names of instruments used
knows sutures used
adjust seat for posture at OR table
effectively positions overhead lights
Basic Surgery Skills - Buried penis repair
well done, no improvement needed
some improvement needed
much improvement needed
unacceptable performance intense improvement needed
N/A
draw the template to release web
cut without skiving
cut without dog ears
sew with macro needle holder
sew with micro needle holder
hand tie
instrument tie
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I am the attending and certify this information is correct
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