Small Bowel Resection - Colectomy Rating Form
Evaluator:
Subject:
Status:
Program:
Please rate this resident's performance during this operative procedure. The
caption above each item provides descriptive anchors for 3 of the 5 points on the
rating scale. "N/A" (Not applicable) should only be selected when the resident did
not perform that part of the procedure.
Patient Location
MMC Inpatient
MMC Outpatient
(23 hour )
St. John’s
Inpatient
O
O
O
St John’s
Outpatient
(23 hour )
O
Hospital Medical Record Number
Date of Procedure
MM/DD/YY
OPRS Case Difficulty
Indicate the difficulty of the case:
1
Straightforward anatomy, no
related prior surgeries or
treatment
O
2
Intermediate difficulty
O
3
Abnormal anatomy, extensive
pathology, related prior
surgeries or treatment (for
example radiation), or obesity
O
1
Degree of Prompting or Direction
1
2
Substantial direction
by attending. Resident
performs all steps but
the attending provides
constant direction to
the resident and
surgical team.
3
Some direction by
attending. Resident
performs all steps but
the attending provides
occasional direction to
the resident and /or to
the surgical team.
O
Minimal direction by
attending. Resident
performs all steps and
directs the surgical
team independently
with minimum or no
direction from the
attending, to either the
resident or to the
surgical team.
O
O
Procedure Specific Criteria
Abdominal Exploration
5
Excellent
Performed
complete,
efficient &
systematic
abdominal
exploration
O
4
Very Good
3
Good
O
Performed
complete
abdominal
exploration
but somewhat
disorganized
O
2
Fair
1
Poor
NA
Performed
disorganized
& incomplete
abdominal
exploration
O
O
O
1
Poor
NA
Suture Placement (Hand Sewn Anastomosis)
5
Excellent
Excellent
spacing of
sutures (25mm) &
consistent
bites into
submucosa
O
4
Very Good
3
Good
2
Fair
Occasional
lapses in
good spacing
& depth of
anastomotic
sutures
O
O
Poor spacing
& depth of
anastomotic
sutures
O
O
O
2
Use of Stapling Device (Stapled Anastomosis)
5
Excellent
Excellent
understanding
of stapling
devices,
appropriate,
efficient use
O
4
Very Good
3
Good
2
Fair
Understanding
of stapling
devices, less
than efficient
use
O
1
Poor
NA
Poor
knowledge,
inefficient use
of device
O
O
O
O
3
Good
2
Fair
1
Poor
NA
Extent of resection
5
Excellent
Excellent
understanding
of resection
margins &
extent of
lymph node
excision
O
4
Very Good
Fair
understanding
of margins &
extent of
nodal
resection
O
O
O
3
Good
2
Fair
Poorly
understood
resection
margins &
extent of
nodal tissue
excision
O
O
Prevention of contamination
5
Excellent
Excellent
understanding
& utilization of
measures to
prevent
intraperitoneal
contamination
O
4
Very Good
Aware of
measures,
but utilized
somewhat
inefficiently
O
O
1
Poor
NA
Poor utilization
of measures to
prevent
peritoneal
contamination
O
O
O
3
General Criteria
Instrument Handling
5
Excellent
4
Very Good
Fluid
movements
with
instruments,
no stiffness or
awkwardness
3
Good
2
Fair
Competent
use of
instruments
occasionally
appeared
awkward
O
O
1
Poor
NA
Tentative or
awkward
movements or
inappropriate
instrument
use.
O
O
O
O
3
Good
2
Fair
1
Poor
NA
Respect for Tissue
5
Excellent
4
Very Good
Consistently
handled tissue
carefully
(appropriately),
minimal tissue
damage
Frequent
unnecessary
tissue force or
damage by
inappropriate
instrument
use.
Careful tissue
handling,
occasional
inadvertent
damage
O
O
O
O
O
O
4
Very Good
3
Good
2
Fair
1
Poor
NA
Time and Motion
5
Excellent
Clear
economy of
motion, and
maximum
efficiency
O
Efficient time
& motion,
some
unnecessary
moves
O
O
Many
unnecessary
moves
O
O
O
4
Operation Flow
5
Excellent
4
Very
Good
Obviously
planned
course of
operation and
anticipation of
next steps.
3
Good
2
Fair
1
Poor
Some
forward
planning,
reasonable
procedure
progression
NA
Frequent
lack of
forward
progression;
frequently
stopped
operating
and seemed
unsure of
next move
.
O
O
O
O
O
O
Overall Performance
5
Excellent
4
Very
Good
3
Good
2
Fair
1
Poor
NA
O
O
O
O
O
O
Please indicate the weaknesses in this resident’s performance:
Please indicate the strengths in this resident’s performance:
5