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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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
*
Attending e-mail
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Date Surgery is Planned
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-
Month
-
Day
Year
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As a Resident my goals for this next case are:
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Repair of chordee - Assess Resident skill level shown
1 =
shown and told
2 =
active help
3 =
passive help
4 =
supervise only
Resident: % case I did
Please Select
<25%
25-50%
50-75%
>75%
Attending: % case trainee did
Please Select
<25%
25-50%
50-75%
>75%
Resident: Case complexity
Please Select
routine
-1- complex feature
-2- complex features
Attending: Case complexity
Please Select
routine
-1- complex feature
-2- complex features
Resident: skill level I showed
Please Select
shown and told
active help
passive help
supervision only
Attending: skill level trainee showed
Please Select
shown and told
active help
passive help
supervision only
Resident: self-assess the global surgery skills you showed
4
3
2
1
na
knows surgery procedure steps
knows names of tissues handled
tissue dissection
knows names of instruments used
knows sutures used
posture at OR table
respectful & communicates well
Attending: show which of your assessments differ from those of your Resident's above
4
3
2
1
na
knows surgery procedure steps
knows names of tissues handled
tissue dissection
knows names of instruments used
knows sutures used
posture at OR table
respectful & communicates well
Resident: self-assess the surgery skills you showed
4
3
2
1
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
Attending: show which of your assessments differ from those of your Resident's above
4
3
2
1
na
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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