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REILLY-GRAM #5—EVALUATION OF CLINICAL PERFORMANCE

We have totally revised the end of rotation E*Value form you will be completing on each resident, to bring it into line with the Milestones reports

that we have to submit twice a year on each resident. We will happily use your feedback to revise and improve these, but unfortunately we cannot

make the form any shorter (all fields are required by the ACGME). I have attached a copy of the new evaluation form and strongly urge you to read

it completely. The more familiar you are with the areas of evaluation (fields) and descriptors, (performance anchors) the faster the evaluation process

goes.

HOW TO COMPLETE THE NEW EVALUATION FORM

1. As you assess each of the 14 performance areas, you can select any of the descriptors in any of the boxes (1 thru 6) that you feel are

representative of the resident’s performance. Of course, generally it would not be rational to check something that describes a critical

deficiency (Box #1) and then check off a descriptor at a skilled level of performance (Box #6).

2. Indicate one overall score (1 thru 6) by clicking the appropriate circle. Note: this overall score for each performance area is not

supposed to be an arithmetic average of all the little checked boxes, but a global assessment. 3. Enter comments in the comments boxes (7 points where comments are required). If you feel the individual checked boxes completely

describe the resident’s performance, you may enter “see above”.

4. Check the appropriate box for “Overall Performance”

5. Check the appropriate box for “Unanimous Opinion”, with comments as needed.

6. We expect that all the residents’ scores will generally be lower (probably many PGY 1 scores will start in the 3-4 range) because level 6

represents a very advanced performance.

[Attach copy of New E-Value evaluation form]

To access previous Reilly-Grams use the link below:

https://residentportal.surgery.ucsf.edu/education/reilly-grams/faculty--resident-reilly-grams.aspx

Release date 7/15

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THIS FORM IS A PREVIEW ONLY!

SENIOR Resident of JUNIOR Resident

Form # 155959

PERFORMANCE RATING SCALE

1

Critical deficiency that requires correction to pass

the rotation and allow advancement

2

Unsatisfactory performance that requires improvement to pass the

rotation and allow continued advancement

3

Minimal level of performance that can be

considered adequate.

Improvement expected to insure eligibility for a

license or Board examination.

4

Competent level of performance

5

Advanced level of

performance

6

Skilled level of

performance

NR

No performance rating due to insufficient

opportunity to observe and assess

MEDICAL KNOWLEDGE

(Question 1 of 24 )

MEDICAL KNOWLEDGE

(1) 1 2 3 4 5 6 NR

About Surgical Diseases and Conditions

Does not have basic medical knowledge about common surgical conditions that a medical student would learn during a core clerkship.

Some familiarity with common surgical conditions but significant gaps in understanding of pathophysiology, usual presentation and clinical course.

Knowledge of diagnostic tests and treatment approaches is at a level below most Time magazine articles.

Has a basic understanding of the pathophysiology, usual presentation and course of some of the most common surgical diseases and conditions.

Knows common diagnostic tests.

Knows most common treatment approaches

Knows pathophysiology of most common and a few complex surgical diseases.

Knows there are some variations in clinical presentation and course.

Knows basic evaluation and diagnostic

Knows pathophysiology of all common and some complex

surgical diseases.

Has evidence-based knowledge of --diagnostic approaches --prioritized treatment options for the same spectrum of surgical diseases and conditions.

Knows pathophysiology of all common and many complex surgical diseases

Knows many atypical clinical presentations and courses and their implications.

Has evidence-based knowledge of

Unable to Assess

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approaches and their appropriate sequential use.

Knows broad categories of treatment options.

risks and benefits of most treatment options.

Knows potential treatment complications, preventive steps and rescue management.

Overall:

(Question 2 of 24 )

MEDICAL KNOWLEDGE

(3) 1 2 3 4 5 6 NR

About Operations and Procedures

Does not have basic medical knowledge about common operations that a medical student would learn during a core clerkship.

Incomplete knowledge of basic preoperative and postoperative care.

Incomplete knowledge of the most common postoperative developments and the management options.

Familiar with some common operations but significant gaps in medical knowledge.

Has a basic understanding of the fundamentals of preoperative and postoperative care.

Knows the management options for the most common postoperative events needing assessment.

Knows the basic steps of the most frequently performed “essential common” operations, including the usual postoperative course and care.

Knows the procedural steps for many “essential common” operations and some “essential

uncommon” operations, including some of the variations in procedural steps.

Knows the usual postoperative course and care, the more common complications and their management for this same spectrum of procedures.

Detailed knowledge of the procedural steps for most “essential” operations, including most variations, and the rationale for choosing a variation.

Detailed knowledge of the postoperative course, care, potential complications and management for this same spectrum of procedures

Basic knowledge of the procedural steps of some “complex” operations.

Detailed knowledge of most “essential”

operations, including variations, and many “complex” operations, including variations.

Knows the factors that influence a choice between procedural variations.

Knows the usual postoperative course and care for the same spectrum of procedures, as well as the common complications, their management and preventive steps.

Unable to Assess

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Overall:

Comments About Medical Knowledge in Both Spheres: (Question 3 of 24 )

PATIENT CARE

(Question 4 of 24 )

PATIENT CARE (1)

1 2 3 4 5 6 NR

Preoperative Patient Care

Unable to perform an accurate and appropriately complete history and physical examination.

History and physical examination is often incomplete, does not reflect a systematic approach or knowledge of the condition.

Selection of diagnostic tests is often incorrect, seemingly random and not progressive.

Selection of treatment approach is often incorrect, seemingly random, not matched to the clinical circumstances

Cannot prioritize patient clinical needs well.

Performs an accurate and appropriately complete history and physical examination for most common surgical diseases and conditions.

Usually correctly chooses the initial diagnostic approach.

Usually correctly selects the most likely first choice for treatment.

Selects appropriate diagnostic tests for most common surgical diseases and conditions.

Integrates the results of the clinical assessment (history, physical and test results) to accurately diagnose most common surgical conditions.

Develops and initiates appropriate management plans for some common surgical diseases and conditions

Accurately diagnoses (selects optimal evaluation plan, correctly interprets test results) for all common and some complex surgical diseases and conditions.

Identifies, analyzes and balances risks and benefits of treatment approaches, develops and initiates appropriate management for all common surgical conditions and some complex conditions independently

Accurately and efficiently diagnoses and manages all common and most

complex surgical diseases and conditions.

Recognizes atypical presentations or clinical course of both common and complex surgical diseases and conditions

Anticipates the patient’s clinical course and adjusts management plans proactively.

Unable to Assess

5

Overall:

(Question 5 of 24 )

PATIENT CARE (2)

1 2 3 4 5 6 NR

Postoperative Patient Care

Unable to recognize or manage common postoperative problems such as fever, hypotension, hypoxia, confusion, oliguria.

Does not recognize the significance of common postoperative problems

Occasionally misses the development of a postoperative change in status.

Occasionally fails to recognize the clinical significance of a postoperative change in status.

Evaluation of postoperative status is usually neither systematic nor prioritized.

Usually recognizes common postoperative problems.

Initiates appropriate evaluation of most postoperative changes in status.

Usually implements appropriate management plan for common postoperative problems.

Recognizes, evaluates and effectively manages most common

postoperative problems, usually independently.

Recognizes, evaluates and effectively manages most complex postoperative problems such as sepsis, systemic inflammatory response syndrome, and multiple system organ failure, usually independently

Anticipates potential postoperative problems, both simple and complex, and implements preventive plans to reduce risk.

Unable to Assess

Overall:

Comments About Patient Care in Both Spheres: (Question 6 of 24 )

TECHNICAL SKILLS

(Question 7 of 24 )

PATIENT CARE (3)

1 2 3 4 5 6 NR

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Performance of Operations and Procedures

Unable to competently (safely and successfully) perform basic surgical tasks (knot tying, simple suturing, simple dissection of structures) or basic simple common procedures (I&D, excision of minor skin or soft tissue lesions) even with supervision.

Does not learn from instruction or practice.

Inconsistently and unpredictably able to perform common surgical tasks and basic, simple common procedures

Requires repeated re-teaching of the same techniques or procedures.

Technical skill progress is inconsistent and not always sustained.

Limited ability to transfer skills.

Competently performs most basic surgical tasks.

Can perform all the operative steps in some "essential-common" procedures.

Demonstrates respect for tissue, and is developing skill in instrument handling.

Can move through parts of common operations without coaching and make straightforward intra-operative decisions.

Can perform some of the "essential" operations/ procedures with minimal assistance

Mastered the handling of most instruments and exhibits efficiency of motion during procedures.

Moves through the steps of many

“essential” operations without much coaching.

Makes intra-operative decisions, adjusting for unanticipated or aberrant findings.

Can perform many of the "essential" operations and is beginning to gain experience in the "complex" operations

Demonstrates mastery of instruments & equipment for “essential” operations.

Guides the conduct of most operations and makes independent intraoperative decisions.

Can perform all of the “essential” operations and has significant experience in the “complex” operations.

Can work out of a complication.

Can effectively guide other residents in many “essential” operations.

Unable to Assess

Overall:

Comments About Technical Skills: (Question 8 of 24 )

PROFESSIONALISM

(Question 9 of 24 )

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PROFESSIONALISM (1)

1 2 3 4 5 6 NR

Regarding Others

Displays undesirable behavior—not polite, respectful or collegial

Does not demonstrate integrity.

Unreliable, does not take responsibility.

No insight into deficiencies.

Occasionally displays undesirable behavior with some contentious, difficult interactions.

Occasional lapses in taking responsibility.

Occasional unreliability.

Usually polite and respectful to all

Usually responds promptly to pages and consults.

Takes personal responsibility

Reliable.

Maintains composure in stressful circumstances

Demonstrates compassion and empathy.

Recognizes limits and obtains help appropriately

Assists others in interactions with patients, families and others involved in patient care.

Insures that patient care responsibilities are fulfilled and maintains continuity of care.

Role model for interactions with others, and positively affects the work environment.

Unable to Assess

Overall:

(Question 10 of 24 )

PROFESSIONALISM (3)

1 2 3 4 5 6 NR

Regarding Administrative Tasks

Consistently fails to perform assigned administrative tasks, or always very late.

Always requires multiple, repetitive reminders

Intermittently performs assigned administrative tasks, but commonly late and needs excessive reminders

Timely entry of duty hours, cases (including critical care and non-operative trauma).

Timely completion of license applications, educational modules, with few/no reminders.

On time for rounds, the OR, conferences, meetings, etc.

Responds promptly to requests from departmental staff.

Assures that residents under supervision respond to administrative requirements in a prompt fashion

Provides leadership in timely completion of administrative tasks.

Performs scheduling responsibilities on time

Unable to Assess

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Overall:

Comments About Professionalism in Both Spheres: (Question 11 of 24 )

INTERPERSONAL AND COMMUNICATION SKILLS

(Question 12 of 24 )

INTERPERSONAL & COMMUNICATION

SKILLS (1) 1 2 3 4 5 6 NR

With Patients and Families

Unable to clearly, accurately, effectively, respectfully and compassionately communicate with patients and families

Has difficulty communicating with patients and families, in terms of both content and manner.

Uses a variety of techniques to ensure that communication of basic health care information with patients and families is effective, respectful and understandable.

Understands the basic elements of informed consent

Customizes communication, taking into account patient characteristics.

Provides timely updates to patients and families during hospitalizations

Can obtain informed consent in routine circumstances

Can negotiate and manage conflict among patients, families, and care providers.

Can obtain informed consent for more complex procedures, in more challenging clinical situations.

Can negotiate communicating emotionally difficult information, such as withdrawal of care, end of life, disclosure of adverse events, medical errors.

Unable to Assess

Overall:

(Question 13 of 24 )

INTERPERSONAL & COMMUNICATION

SKILLS (2) 1 2 3 4 5 6 NR

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With Others Caring for the Patient

Displays disrespectful or resentful behaviors when asked to evaluate a patient or participate in a care conference with other members of the health care team.

Does not participate in hand-offs or is late and not engaged.

Intermittently not appropriately responsive to the need for communication with the team.

Inaccurate or incomplete hand-offs.

Willingly exchanges patient information with team members.

Responds politely and promptly to requests for consults and care coordination activities.

Performs effective and accurate face-to-face hand-offs

Exhibits behaviors that invite information sharing with team members.

Delivers timely, complete, organized information to referring physicians & PCPs.

Demonstrates hand-off best-practices.

Regularly discusses and updates care plans with the team.

Negotiates and manages conflict among care providers.

Takes responsibility to ensure that clear hand-offs occur at transitions of care

Assumes overall leadership of a health care team.

Resolves differences in proposed care plans, involving all team members and consultants.

Unable to Assess

Overall:

(Question 14 of 24 )

INTERPERSONAL & COMMUNICATION

SKILLS (3) 1 2 3 4 5 6 NR

In the Operating Room

Does not communicate effectively with nurses, anesthesiologists and/or other surgeons in the operating room.

Has difficulty communicating with the OR team members, in terms of both content and manner.

Communicates basic facts about the planned procedure effectively with anesthesiologists, nurses, and/or other surgeons in the operating room.

Discusses case-specific issues with nurses, anesthesiologists, and/or other surgeons in the operating room.

Effectively problem-solves with the OR team members.

Effectively leads the pre-operative "time out".

Demonstrates leadership and communicates effectively with nurses anesthesiologists, and/or other surgeons during times of stress.

Unable to Assess

Overall:

Comments About Interpersonal & Communication Skills in All Spheres: (Question 15 of 24 )

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PRACTICE-BASED LEARNING

(Question 16 of 24 )

PRACTICE-BASED LEARNING &

IMPROVEMENT (1) 1 2 3 4 5 6 NR

Teaching

Does not communicate effectively as a teacher.

Does not create an appropriate environment for learning.

Does not teach.

Makes an occasional effort to teach, but usually requires prompting to do so.

Willing to teach students and other health care team members.

Makes a reasonable effort to find time to teach.

Communicates subject material accurately, clearly and succinctly, including case conference presentations.

Adjusts teaching approach for different settings and levels of learner.

Effectively assumes responsibility for organizing educational activities, such as conferences. Assists more junior residents or students in preparing their presentations, discussions

Demonstrates special commitment to teaching -frequency -style (engaging, interactive, constructive, respectful) -effectiveness -use of literature and evidence-based -includes all involved in the care of the patient

Unable to Assess

Overall:

(Question 17 of 24 )

PRACTICE-BASED

LEARNING & IMPROVEMENT

(3)

1 2 3 4 5 6 NR

Improvement of Care

Does not demonstrate interest or ability to

Inconsistently demonstrates interest or ability to learn from

Accepts responsibility to prevent errors and

In M&M, identifies causes of complications and

Systematically evaluates his/her surgical results and outcomes,

Leads activities to identify patterns and look for opportunities

Unable to

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learn from mistakes in his/her own practice.

Does not accept responsibility for errors or error prevention.

mistakes and/or accept responsibility for errors or error prevention.

continuously improve.

In M&M accurately presents patients and recognizes at least some of the key issues.

deaths, and steps to prevent repetition of the error/event.

Changes behavior in response to feedback

compares to established norms, identifies areas for and approaches to improvement.

to systematically reduce errors and adverse events

Assess

Overall:

Comments About Practice-Based Learning & Improvement in Both Spheres: (Question 18 of 24 )

SYSTEMS-BASED PRACTICE

(Question 19 of 24 )

SYSTEMS-BASED

PRACTICE (1) 1 2 3 4 5 6 NR

Coordination of Care

Lacks basic understanding of resources available for coordinating patient care (e.g. role/use of social workers, case workers, visiting nurses, PT/OT)

Does not participate in coordinating patient care.

Some awareness that appropriate patient care requires coordinating various components.

Knows at least some of those components.

Only intermittently and incompletely effective in arranging these

Knows resources and how to access them.

Knows the required components of most discharges and transfers

Efficiently arranges dispositions, discharge planning for his/her patients.

Takes responsibility for coordinating discharge or transfer.

Incorporates specialized services (home TPN, IV

Coordinates residents, nurses, social workers, other team members as appropriate for patient needs

Anticipates discharge needs, leads team, can direct and advise others in optimizing coordination of care

Unable to Assess

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components of care.

antibiotics)

Overall:

(Question 20 of 24 )

SYSTEMS-BASED

PRACTICE (2) 1 2 3 4 5 6 NR

Improvement of Care

Does not demonstrate that he/she recognizes how hospital and healthcare systems affect practice.

Is not aware of variations in practice within or across health care systems

Has only a basic understanding of how health systems operate.

Only intermittently recognizes the relationship of systems factors to medical errors and quality of care.

Knows systems factors that contribute to medical errors and is aware of variations between systems.

Understands how patient care is delivered in this system and understands system failures that affect patient care.

Follows protocols and guidelines, e.g. timeouts

Makes suggestions for changes in systems that can improve patient care

Participates in systems-based projects and activities to reduce errors and improve outcomes.

Participates in creating protocols and standardized approaches

Unable to Assess

Overall:

Comments About Systems-Based Practice in Both Spheres: (Question 21 of 24 )

(Question 22 of 24 - Mandatory )

Pass Borderline Fail

OVERALL PERFORMANCE

(Question 23 of 24 - Mandatory )

Yes No

DOES THIS REPRESENT A UNANIMOUS OPINION?*

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*If No, Provide Other Comments Here: (Question 24 of 24 )

Review your answers in this evaluation. If you are satisfied with the evaluation, click the SUBMIT button below. Once submitted, evaluations are no longer available for you to make

further changes.