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UCSF Technical Skills Assessment Form

The American Board of Surgery requires all residents to complete 6 operative assessments during the course of their residency.

Part 1: Resident & Case Details (may be completed by resident or evaluator)

Date of Procedure (MO/DD/YYYY)

Resident First Initial and Last Name

Resident UCSF Email Address:

Part 2: Evaluator Details & Assessment (MUST be completed evaluator)

Evaluator First Initial and Last Name:

Evaluator UCSF Email Address:

CASE DIFFICULTY

EASY

INTERMEDIATE

DIFFICULT

DEGREE OF PROMPTING AND DIRECTION

DEGREE OF PROMPTING AND DIRECTION
			Resident could not perform expected steps even with attending help	Resident performed all or most steps with the attending providing continuous direction	Resident performed almost all steps with the attending providing intermittent direction	Resident performed all steps and directed the surgical team members independently
Degree of Prompting and Direction

OPERATION FLOW

OPERATION FLOW
			Frequent lack of forward progression; frequently stopped operating and seemed unsure of next move	.	Some forward planning; reasonable procedure progression	.	Obviously planned course of operation and anticipates next steps	Unable to assess during this procedure.
Operation Flow

EXPOSURE

EXPOSURE
			Poor/inadequate exposure with frequent loss of vision	.	Adequate establishment and maintenance of exposure	.	Optimizes exposure of critical structures, allows safe visualization of structures for surgeon and assistant	Unable to assess during this procedure
Exposure

DISSECTION

DISSECTION
			Unsuccessful and unsafe; caused tissue damage	.	Adequate and successful but some inefficiency; careful tissue handling	.	Expedient and safe; tissue handled with finesse and no/minimal damage	Unable to assess during this procedure
Dissection

MANUAL DEXTERITY

MANUAL DEXTERITY
			Clumsy use of instruments; many unnecessary moves; poor suture placement; poor needle point control; bad knot tying (air knots, broken suture)	.	Generally uses instruments effectively; efficient motion, some unneeded moves; approximate suture placement; minimal need to redo sutures or knots	.	Adjusted instrument use for optimal effect; consistent economy of motion; optimal suture placement; precise needle point control; knots of appropriate tension	Unable to assess during this procedure
Manual dexterity

DURING THIS PROCEDURE THE RESIDENT FUNCTIONED PREDOMINANTLY AT WHICH LEVEL

DURING THIS PROCEDURE THE RESIDENT FUNCTIONED *PREDOMINANTLY* AT WHICH LEVEL
			Highly focused on individual technical skills; follows with some understanding of what is happening in a case	Developing a "working knowledge" of anatomy and planes of dissection; focusing on translating conceptual knowledge of anatomy into purposeful action while operating	Actively participates and engages in the stepwise progression of a case; is able to anticipate next steps; focusing on learning operative principles including exposure and set-up	Begins to visualize cases as a richly textured "big picture"; applies planning and strategy to the case in a deliberate, goal oriented fashion; exercises autonomy and agency; feels a strong sense of responsibility for the patient	Confident and efficient; aligns cognitive and material resources for contingencies; can fluidly coordinate all aspects of an operation; anticipates potential complications
Level of Functioning

OVERALL PERFORMANCE

Ratings with asterisk (*) indicate resident is capable of performing procedure independently.

OVERALL PERFORMANCE
Ratings with asterisk (*) indicate resident is capable of performing procedure independently.
			Poor	Fair	Good	Very Good*	Excellent*
Overall performance

Indicate the specific things the resident should work on:

Indicate the specific things the resident did especially well:

By clicking the SUBMIT button below, you are certifying that you are the attending physician who reviewed the resident's performance above. This action takes the place of your signature.