Download University of Arizona-Tucson Hopspitals Surgical Residency Program

Mercy Catholic Medical Center Surgical Residency Program
Surgical Resident Evaluation Form (PGY IV)
Resident:
Rotation: GENERAL SURGERY
Name of Evaluator:
Rotation Evaluation Dates:
Mercy Fitzgerald
MHOP
Please evaluate the above resident on the basis of performance during this specific rotation. Rank each
resident on a 1-5 scale with 5 being the highest. In general, a “1” would be unsatisfactory, the average
resident is a “3”. If there is inadequate information, please check “not applicable”.
General:
Evaluation (1-5):
Not Applicable:
1. Initiative, self-motivated.
2. Dependability, can be counted on to complete tasks.
3. Interacts well with patient and staff.
4. Self-confident but will seek help from others.
5. Teaching of medical students.
Please place check in appropriate box:
Knowledgeable
COGNITIVE KNOWLEDGE:
Demonstrates understanding of the basic
science foundation of the specialty
Knowledgeable
and Able To
Teach
Learning But
Incomplete
Absent or
Inadequate
A) Physiology, fluid and electrolytes.
B) Pathology of malignant and vascular
disease.
C) Pharmacology of antibiotics,
chemotherapy, cardiotonic drugs,
etc..
D) Wound healing and wound
management.
Please place check in appropriate box:
Knowledgeable,
CLINICAL PERFORMANCE:
Confident, and
Effective
Knowledgeable,
But Not
Independent
Learning But
Below
Expectations
Absent or
Inadequate
E) Able to completely coordinate the
care of the patient in the outpatient
setting.
F) Able to direct the care of multiple
pre- and post-operative patients.
G) Understands and is able to apply
the principles of surgical critical
care, direct a surgical critical care
team.
H) Understands all operative
approaches to general surgical and
vascular problems and is able to
pick the most appropriate.
Please place check in appropriate box:
Knowledgeable,
OPERATIVE ABILITIES:
Confident, and
Effective
I) Generally facile with abdominal
incision and exploration (including
laparoscopy).
J) Understands principles of
gastrointestinal and vascular
anastamosis.
Knowledgeable,
But Not
Independent
Learning But
Below
Expectations
Unsatisfactory
Please place check in appropriate box:
Knowledgeable,
OPERATIVE ABILITIES:
Confident, and
Effective
Knowledgeable,
But Not
Independent
Learning But
Below
Expectations
Unsatisfactory
K) Understand and manages
intraoperative emergencies (ie.,
bleeding, enterotomy).
L) Generally facile with vascular and
laparoscopic instruments.
M) Able to provide exposure in difficult
procedures.
Based on the experience in this rotation do you think the resident would be able to:
Please place check in appropriate box:
Independent,
Confident,
Effective, and
Safe
Needs
Direction, But
Understands
Principles
Needs
Much
Assistance
N) Perform a splenectomy …or … fem-pop bypass.
O) Perform a right colectomy with primary anastamosis
for a cancer invading adjacent tissues … or … expose
a carotid artery gaining proximal/distal control.
P) Perform a colostomy takedown … or … an AV fistula.
Q) Initiate and monitor complex ventilator strategies and
cardiotropic drugs.
R) Perform a mastectomy with node sampling … or … a
popliteal embolectomy.
S) Discuss complex surgical problems and prognosis with
patient and family..
T) Interact with multiple medical consultants and nursing
staff.
Overall Evaluation (Compare with the last 10 resident at this level on this rotation):
Please place check in appropriate box:
Top 20%
Middle 60%
Lower 20%
Please place check in appropriate box:
Do you think this resident should be advanced to the next clinical year?
Yes
No
Needs more
evaluation
Comments (required):
Signed:
Date:
Please return the completed form to Program Director, MCMC General Surgery
Residency Program,1500 Lansdowne Ave, Darby, PA 19023. Thank you for your assistance. Rev 6/00
No