Trainee Name: …………………………………………………………………Year of training: ………………………………………….Hospital: ..…………………………………………………………………………………………………
Training Supervisor: …………………………………………………………………..Procedure being assessed: …………………………………………………………………………………………………………………………………………….
Assessment Criteria / Assessment Descriptors(please circle one rating per criterion)
1 2 3 4 5
Pre operative consent and counselling / Failed to obtain appropriate
pre operative consent and undertake patient counselling / Obtained appropriate
pre operative consent and undertook patient counselling with a major omission / Obtained appropriate
pre operative consent and undertook patient counselling with a minor omission / Obtained appropriate
pre operative consent and undertook patient counselling / Excellent approach and appropriately obtained
pre operative consent and undertook patient counselling
Preparation for theatre including where appropriate antibiotic prophylaxis, antibiotic DVT/prophylaxis and patient positioning / Failed to appropriately prepare patient for theatre / Prepared the patient appropriately for theatre but with a major omission / Prepared the patient appropriately for theatre but with a minor omission / Prepared the patient appropriately for theatre / Excellent approach and appropriately prepared patient for theatre
Respect of tissue / Frequently used unnecessary force / caused damage to tissue by inappropriate use of instruments / Occasionally used unnecessary force / caused damage to tissue by inappropriate use of instruments / Sometimes handled tissue appropriately / occasional damage to tissue by inappropriate use of instruments / Nearly always handled tissue appropriately with minimal damage / Consistently handled tissue appropriately with minimal damage
Time and motion / Inefficient use of time and many unnecessary moves / Occasional inefficient use of time with some unnecessary moves / Sometimes efficient time/motion but some unnecessary moves / Nearly always efficient time/motion with minimal unnecessary moves / Consistent clear economy of movement and maximum efficiency
Instrument handling/knowledge of instruments & sutures / Inappropriate use of instruments (including tentative or awkward moves) and/or frequently requested wrong instrument / Occasional inappropriate use of instruments (including tentative or awkward moves) and/or occasionally requested wrong instrument / Sometimes used fluid moves with instruments, sometimes tentative, familiar with some instruments and their names / Nearly always used fluid moves with instruments, minimal awkwardness, familiar with most instruments and their names / Consistently fluid moves with instruments, no awkwardness; familiar with all the instruments and their names
Surgical Skills Assessment Criteria Form SummativePage 1 of 3CGO 1 – 08
Assessment Criteria / Assessment Descriptors(please circle one rating per criterion)
1 2 3 4 5
Flow of operation / Frequently stopped procedure and seemed unsure of next move / Occasionally stopped procedure and hesitant about next move, requests for instruments rarely timely / Some planning with reasonable progression of procedure, some timely request for instruments / Nearly always planned course of procedure with reasonable progression, nearly always timely requests for instruments / Consistently planned course of procedure, effortless flow from one move to the next, timely request for instruments
Professional behaviour with theatre staff / Underutilised assistants, consistently inappropriate professional interactions / Occasionally underutilised assistants, some inappropriate professional interactions / Sometimes used assistants to best advantage, some appropriate and professional interactions with staff / Nearly always used assistants to best advantage, nearly always appropriate and professional interactions with staff / Comprehensive and strategic use of assistants, effective and appropriate professional interactions
Surgical anatomy / Deficient knowledge. Unable to identify or name critical anatomical landmarks relevant to the procedure / Occasionally able to identify and name surgical anatomy for procedure and occasional critical anatomical landmarks / Sometimes able to identify and name surgical anatomy for procedure including some critical anatomical landmarks / Nearly always able to identify and name surgical anatomy for procedure including nearly all common anatomical anomalies / Comprehensive ability to identify and name all surgical anatomy for the procedure, including common anatomical anomalies
Knowledge of specific procedure, including positioning of the patient and setting up equipment / Deficient knowledge, Needed specific instruction at most steps / Basic knowledge. Required specific instruction for some of the steps / Basic knowledge. Familiar only with important steps of procedure with minimal instruction / Good familiarity with nearly all aspects of procedure with only minimal instruction / Comprehensive familiarity with all aspects of operation
Wound closure / Deficient knowledge of appropriate suture materials and techniques, high levelinstruction required / Basic knowledge of appropriate suture materials and techniques, high levelinstruction required / Basic knowledge of appropriate suture materials and techniques, minimal instruction required / Good knowledge of suture material and techniques, minimal instruction required / Comprehensive knowledge of suture materials and techniques
Post-operative management / Deficient knowledge of post operative management and prevention of complications / Basic knowledge of post operative management and prevention of complications, high level instruction required / Basic knowledge of post operative management and preventing complications, minimal instruction required / Good knowledge of post-operative management and prevention of complications, minimal instruction required / Comprehensive knowledge of post operative management and prevention of complications
Global rating scale developed from Moorthy et al, BMJ 2003; 327:1032-7; originally from Reznick et al, Am J Surg 1997; 173: 226-30
To be assessed as competent to perform the procedure independently, the trainee must score a 4 or 5 assessment descriptor rating in each of the assessment criteria.
Trainee is (please tick):
□ Competent to perform the procedure independently
□Not yet Competent to perform the procedure independently
Each procedure must be assessed on a separate form. The assessor MUST discuss this assessment with the trainee following the procedure and upon completion of the form to this point.
THE FORM SHOULD NOT BE SIGNED IF THIS HAS NOT OCCURRED
Assessor name: ………………………………………………………………………………………Assessor signature: ………………………………………………………Date: ……………………………………………………………….
Trainee has passed this Summative Surgical Skills Assessment and can perform this procedure independently.
Trainee Supervisor Signature: …………………………………………………………………Date: ……………………………………………………………
Trainee Signature:…………………………………………………………………………………..Date: ……………………………………………………………
Surgical Skills Assessment Criteria Form SummativePage 1 of 3CGO 1 – 08