Rater’s Evaluation of Resident

Pediatric Critical Care OSCE- end of Life Family Conference

(Master Checklist)

10/17/2018

Study # : ______Date : ______

Rater’s Evaluation of Resident

Pediatric Critical Care OSCE- end of Life Family Conference

(Master Checklist)

Please rate the resident in each of the following areas and provide comments at the end about his/her particular strengths and areas for improvement. When you are done, click the DISPLAY UNANSWERED button at the top of the pate. Complete any unanswered questions, and then click the SUBMIT button.

SET AN APPROPRIATE CONTEXT FOR DISCUSSION
1. How would you rate the resident on his/her ability to set an appropriate context for the discussion?
Outstanding / Very Good /  Good / Satisfactory /  Unsatisfactory
Point Value / 5:00 / 4:00 / 3:00 / 2:00 / 1:00
Category: 09 Set context for EOL discussion
Question Point Value: 5.00
2. Check the box if the resident:
Point Value
 Established rapport (e.g., introductions, eye contact, body positioning) / 1:00
 Explained the purpose of the meeting / 1:00
Category: 09 Set context for EOL discussion
Question Point Value: 2.00
3. How would you rate the resident on the ability to achieve a common understanding of the patient’s status?
Outstanding / Very Good /  Good / Satisfactory /  Unsatisfactory
Point Value / 5:00 / 4:00 / 3:00 / 2:00 / 1:00
Category: 10 Achieve common understanding of prognosis
Question Point Value: 5.00
4. Check the box if the resident:
Point Value
 Asked family members what their understanding of the patient’s status was / 1:00
 Explained patient status clearly, fully, without jargon / 1:00
 Checked for family members’ understanding of information / 1:00
 Answered family members questions clearly, directly / 1:00
 Talked through confusion, conflicts regarding meaning of “Futility” / 1:00
Category: 10 Achieve common understanding of prognosis
Question Point Value: 5.00
5. How do you rate the resident on empathy?
Outstanding / Very Good /  Good / Satisfactory /  Unsatisfactory
Point
Value / 5:00 / 4:00 / 3:00 / 2:00 / 1:00
Category: 11 Empathy with EOL decisions
Question Point Value: 5.00
6. Check the box if the resident:
Point Value
 Allowed family members to express emotions / 1:00
 Talked through fears, guilt, anger, anxiety / 1:00
 Provided words of comfort, arranged for other supports as needed / 1:00
Category: 11 Empathy with EOL decisions
Question Point Value: 3.00
EDUCATION ABOUT LIFE SUPPORT, DYING PROCESS
7. How would you rate the resident on providing education about life support and the dying process?
Outstanding / Very Good /  Good / Satisfactory /  Unsatisfactory
Point Value / 5:00 / 4:00 / 3:00 / 2:00 / 1:00
Category: 12 Clarify life support, dying process
Question Point Value: 5.00
8. Check the box if the resident:
Point Value
 Asked about family values, customs, beliefs about end-of-life / 1:00
 Asked family members what they thought DNR,DNI, comfort care meant / 1:00
 Addressed misconceptions of “heroic measures” / 1:00
 Explained shift in medical focus from intervention to comfort care / 1:00
Category: 12 Clarify life support, dying process
Question Point Value: 4.00
ESTABLISH CARE GOALS/CARE PLAN
9. How would you rate the resident on establishing care goals and a care plan?
Outstanding / Very Good /  Good / Satisfactory /  Unsatisfactory
Point Value / 5:00 / 4:00 / 3:00 / 2:00 / 1:00
Category: 13 Establish care goals/care plan
Question Point Value: 5.00
10. Check the box if the resident:
Point Value
 Focused on what patient /family would want / 1:00
 Clarified surrogate role, responsibilities; other circumstances / 1:00
 Addressed misconceptions of “heroic measures” / 1:00
 Assured follow-up (how to contact him/her, next communication) / 1:00
Category: 13 Establish care goals/care plan
Question Point Value: 4.00
FAMILY SATISFACTION
11. How well did this resident help the family members understand the choices and decision that needed to be made?
Extremely Well / Very Well / Well / Somewhat Well / Not Well / Not at All
Point Value / 5.00 / 4.00 / 3.00 / 2.00 / 1.00 / 0
Category: 14 Support for family process
Question Point Value: 5.00
12. How well did the resident meet the family’s needs for information?
Extremely Well / Very Well / Well / Somewhat Well / Not Well / Not at All
Point Value / 5.00 / 4.00 / 3.00 / 2.00 / 1.00 / 0
Category: 14 Support for family process
Question Point Value: 5.00
13. How well did the resident meet the family’s needs for support?
Extremely Well / Very Well / Well / Somewhat Well / Not Well / Not at All
Point Value / 5.00 / 4.00 / 3.00 / 2.00 / 1.00 / 0
Category: 14 Support for family process Question Point Value: 5.00
GLOBAL RATING
14. Overall, how would you rate this resident’s ability to lead an End-of-Life Family Conference?
Extremely Able / Very Able / Able / Somewhat Able / Marginally Able / Not at all Able
Point Value / 5.00 / 4.00 / 3.00 / 2.00 / 1.00 / 0
Category: 15 Overall EOL rating
Question Point Value: 5.00
15. Please comment on the resident’s strengths. This information will be shared with the resident

16. Please comment on the resident’s areas of improvement. This information will be shared with the resident

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