Resident Evaluation Tracking Sheet v2022-03

Surgeon name:

Resident name:

Date:

M1 = 1-20 days of KEI time M2 = 21-40 days of KEI time M3 = 41-60 days of KEI time M4 = 61-80 days of KEI time
M5 > 80 days of cataract Sx at KEI

Step 1: CLICK resident M training level to circle. Step 2: Enter # of KEI OR days at current M level. Step 3: Put vertical tick to evaluate resident.

Vertical tick mark can be placed anywhere on continuous scale for step 3 (overall performance) and step 4 (surgical steps)

/20

1st-yr-in-Practice

Residents usually between current and next level of competency at each stage of training. Minimum expected level of performance at BEGINNING of each M training level described below:

M1: Can complete routine cases partially. Incisions, IA and IOL can be completed with difficulty. Rhexis and phaco can be completed for some cases.

M2: Can complete competently some parts of routine cases (incisions, IA, IOL), other parts with some difficulty (rhexis, phaco). Can fully complete some cases with difficulty.

M3: Can complete some routine cases with some difficulty. Phaco and rhexis completely competently in some routine cases, with difficulty in other cases.

M4: Can complete most routine cases comfortably, other cases completed with some difficulty. ALL parts of routine cases and some parts of complex cases completed comfortably.

M5: Can complete routine full cases comfortably, can complete some complex cases with some difficulty. All residents expected to reach this level by end of training.

1st Yr in Practice: Can complete most complex cases, including intraoperative complication management. Should shift surgical training to areas of ophthalmology other than cataract.

Step 4: Put vertical tick mark to grade skill level of each surgical step relative to level of training (M1 to M5). Do not evaluate if step not performed.

One level belowAppropriate for levelOne level above

Comments:

Surgeon signature

Sign here

Resident signature

Sign here

KEI Cataract Resident Participation Tracking Sheet v2022-03

Surgeon name:

Resident name:

Date:

Case type: 1 = simple phaco, 2 = hypermature, 3 = small pupil/IFIS, 4 = zonular/PXE, 5 = other complex
Training level: M1 = 1-20 days @KEI OR, M2 = 21-40 days, M3 = 41-60 days, M4 = 61-80, M5 >80 days @KEI OR
Resident participation: 1 = 100% of case, 2 = >50%, 3 = <50%, 4 = 0%, NA = no resident present within KEI
Teaching target: M1 = 10%, M2 = 15%, M3 = 20%, M4 = 25%, M5 = 30% of cases done by resident

Notes: Level 2 participation must include attempt at both rhexis AND phaco, level 3 must include a) IA cortex AND IOL insertion b) rhexis attempt OR c) phaco attempt

#	Patient initials	Case type	Resident Attendance	Resident Participation	#	Patient initials	Case type	Resident Attendance	Resident Participation

Surgeon signature

Sign here

Resident signature

Sign here