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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resident
4
3
2
1
na
attending
4
3
2
1
N/A
% Case Resident/Trainee did
Case complexity
Skill level shown
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Assess skill levels Resident shows
Global Surgery Skills - Repair (Resident) chordee
4
3
2
1
N/A
knows surgery procedure steps
knows names of tissues handled
tissue dissection
knows names of instruments used
knows sutures used
posture at OR table
Professional:respectful & effectively communicates
Global Surgery Skills - Repair (Attending) chordee
4
3
2
1
N/A
knows surgery procedure steps
knows names of tissues handled
tissue dissection
knows names of instruments used
knows sutures used
posture at OR table
Professional:respectful & effectively communicates
Basic Surgery Skills - Repair (Resident) chordee
4
3
2
1
N/A
strategy
setup penis retractor
complex scrotoplasty
reconstruct normal appearance of skin
glans suture
urethrotomy
catheterize urethra
circumcise, release chordee, simple scrotoplasty
approximate glans wings
resurface ventrum
crede and dressing
Basic Surgery Skills - Repair (Attending) chordee
4
3
2
1
N/A
strategy
setup penis retractor
complex scrotoplasty
reconstruct normal appearance of skin
glans suture
urethrotomy
catheterize urethra
circumcise, release chordee, simple scrotoplasty
approximate glans wings
resurface ventrum
crede and dressing
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I am the attending and certify this information is correct
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resident self eval
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resident
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