Resident Surgical Evaluation Form Survey

1. Global Rating Score of Operative Performance

Dear Colleagues,
Thank you for taking the time to complete this resident surgical competence evaluation form. Your feedback is very important in helping us provide an outstanding educational experience to our residents.
Catherine Salva, MD
OBGYN Residency Director

*
1. Evaluator's Name:

Evaluator's Name:

*
2. Resident's Name

Resident's Name Mary Fleming Ackenbom

Laura Cooney

Bradley Corr

Lori Cory

Lindsey Davis

Ashley Ford

Ericka Gibson

Adi Hirshberg

Terry Huynh

Caroline Kelly

Holly Langmuir

Bat-Sheva Maslow

Michelle Mergenthal

Nyia Noel

Carter Owen

Priya Patel

Lily Pemberton

Joan Price

Andrea Roe

Amanda Rohn

Corina Tennant

Amy Turitz

Peter Vasquez

Samantha Weed

*
3. Select Procedure:

Select Procedure: C-Section CKC/LEEP D+E Hysteroscopy	Laparoscopy Laparotomy LAVH/RAVH/TLH NSVD	Surgery for Invasive CA TAH/SCH TVH Urogyn
Other (please specify)

*
4. Respect for Tissue

Respect for Tissue Frequently used unnecessary force on tissue or caused damage by inappropriate use of instruments

Careful handling of tissue but occasionally caused inadvertent damage

Consistently handled tissues appropriately with minimal damage

Additional Comments

*
5. Time and Motion:

Time and Motion: Many unnecessary moves

Efficient time/motion but some unnecessary moves

Clear economy of movement efficiency

Additional Comments

*
6. Instrument Handling:

Instrument Handling: Repeatedly makes tentative or awkward moves with instruments

Competent use of instruments but occasionally appeared stiff or awkward

Fluid moves with instruments and no awkwardness use of instruments

Additional Comments

*
7. Knowledge of Instrument:

Knowledge of Instrument: Frequently asked for wrong instrument or used inappropriate instrument

Knew names of most instruments and used appropriate instrument

Obviously familiar with the instruments and their names

Additonal Comments

*
8. Flow of Operation:

Flow of Operation: Frequently stopped operating and seemed unsure of next move

Demonstrated some forward planning with reasonable progression of procedure

Obviously planned course of operating with effortless flow from one move to the next

Additional Comments

*
9. Use of Assistants:

Use of Assistants: Consistently placed assistants poorly or failed to use assistants

Appropriate use of assistants most of the time

Strategically used assistants to the best advantage at all times

Additional Comments

*
10. Knowledge of Specific Procedure:

Knowledge of Specific Procedure: Deficient knowledge needed specific instructions at most steps

Knew all important steps of operation

Demonstrated familiarity with all aspects of operation

Additional Comments

Resident Surgical Evaluation FormExit this survey

1. Global Rating Score of Operative Performance

*1. Evaluator's Name:

*2. Resident's Name

*3. Select Procedure:

*4. Respect for Tissue

*5. Time and Motion:

*6. Instrument Handling:

*7. Knowledge of Instrument:

*8. Flow of Operation:

*9. Use of Assistants:

*10. Knowledge of Specific Procedure:

Resident Surgical Evaluation Form
Exit this survey

*
1. Evaluator's Name:

*
2. Resident's Name

*
3. Select Procedure:

*
4. Respect for Tissue

*
5. Time and Motion:

*
6. Instrument Handling:

*
7. Knowledge of Instrument:

*
8. Flow of Operation:

*
9. Use of Assistants:

*
10. Knowledge of Specific Procedure: