Thyroidectomy - 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
O
St. John’s Inpatient
MMC Outpatient
(23 hour )
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
Exposure
5
Excellent
4
Very Good
Excellent
incision
planning &
precise flap
elevation in
correct plane
O
O
3
Good
Satisfactory
incision
planning &
appropriate
tissue plane
for flap
elevation
most of the
time.
O
2
Fair
1
Poor
NA
Poor planning
of incision &
flap
elevation
O
O
O
2
Fair
1
Poor
NA
Mobilization of Thyroid
5
Excellent
4
Very Good
Precise &
efficient
mobilization
w/careful
handling of
vessels
O
O
3
Good
Satisfactory
mobilization
of lobe
w/occasional
inefficient
handling of
vessels.
O
Poor
technique
demonstrated
in mobilization
of thyroid
lobe
O
O
O
2
Recurrent Laryngeal Nerve
5
Excellent
Demonstrates
excellent
knowledge of
anatomy,
shows caution
in
Identification
/protection of
nerve;
O
4
Very Good
3
Good
2
Fair
Some lapses
in technique
to avoid nerve
injury;
O
O
1
Poor
NA
Demonstrates
poor
knowledge of
anatomy &
technique in
nerve
protection
O
O
O
2
Fair
1
Poor
NA
Identification of Parathyroid Glands
5
Excellent
4
Very Good
3
Good
O
Demonstrates
satisfactory
knowledge of
anatomy,
occasionally
insufficient
and/or
aggressive
dissection
O
O
O
O
3
Good
2
Fair
1
Poor
NA
Demonstrates
excellent
knowledge of
glands, and
careful,
meticulous
dissection;
O
Demonstrates
poor
knowledge of
anatomy &
dissection
technique
Utilization of Pathology
5
Excellent
Excellent
demonstration
of role of
pathology in
intraoperative
management
O
4
Very Good
Some lapses
in ability to
utilize
pathology
findings
O
O
Demonstrates
poor
understanding
of role of
pathology
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
1
Poor
Competent
use of
instruments
occasionally
appeared
awkward
O
O
O
NA
Tentative or
awkward
movements or
inappropriate
instrument
use.
O
O
O
Respect for Tissue
5
4
3
2
1
Excellent
Very Good
Good
Fair
Poor
Consistently
handled tissue
appropriately,
minimal tissue
damage
Careful tissue
handling,
occasional
inadvertent
tissue damage
O
O
NA
Frequent
unnecessary
tissue force or
damage by
inappropriate
instrument use
O
O
O
O
Time and Motion
5
Excellent
4
Very Good
Clear economy
of motion, and
maximum
efficiency
O
3
Good
2
Fair
1
Poor
Efficient time &
motion, some
unnecessary
moves
O
O
NA
Many
unnecessary
moves
O
O
O
4
Operation Flow
5
Excellent
4
Very Good
Obviously
planned course
of operation, and
anticipation of
next steps
O
3
Good
2
Fair
Some forward
planning,
reasonable
procedure
progression
O
1
Poor
NA
Frequently
stopped
operating and
seemed unsure
of next move
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