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Clinical Evaluation Instruction Tool

This tool was developed to assist the instructor on evaluation for the student. The score is based on a 1-5 rating scale. Please see the value listed for the appropriate scoring.

1= Critical Error
2= Unsatisfactory
3= Satisfactory
4= Good
5= Excellent
  • A score of 1 reflects a critical error was performed. It can also mean the patient could have been at risk for a bad outcome had you not intervened.  The student will fail the case if they perform (2) or more critical errors.
  • A score of 2 is considered unsatisfactory. The student can perform the task, but requires constant assistance.
  • A score of 3 is considered satisfactory. The student can perform the task with minimal assistance.
  • A score of 4 is considered good. The student can perform the task without assistance.
  • A score of 5 is considered excellent. The student can perform the task with more than acceptable speed and quality. The student took initiative and was able to adapt to special situations.
  • The total number of categories graded is calculated and it is expected that as the rotation progresses the student will receive a higher % of graded categories. If this is not occurring then you can put a score of (2) in those categories particularly if you are not seeing progression of skills as the student becomes more familiar with your practice. Please do not hesitate to call your rotation liaison if you experience any problems with the grading process. As always we appreciate your input and willingness to share in the educational process of our students.

Each section is section is graded on a scale of 1-5 as noted above.

Patient Work up (10%)                                                                    

  • Obtains complete and accurate history, able to identify important findings, shows knowledge of major and minor issues. Has essential data for history and physical, is well organized, clinical problems are well defined, understands impact of abnormal findings, and summarize or explains clinical data. Independently identifies and explains pathophysiological concepts related to defect. (1-5)
    • Demonstrates a good understanding of drugs used during CPB procedures. Able to discuss indications and contraindications of commonly used cardiac drugs.  Is capable of consistently selecting appropriate drugs and dosages even in unfamiliar situations. Uses appropriate consultation with instructor prior to administration of drugs into the ECC
  • Able to independently describe operation required, exhibits knowledge of surgeon, anesthesia and perfusion protocols. Perfusion care  plan reflects comprehensive understanding of the patient requirements (1-5)
    • Able to calculate needed parameters with accuracy and in a timely manner. Can explain significance of values. Able to recite drug dosages                                                  

Preparation of Circuit (20%)

  • Consistently is aware of sterile technique and performs duties without compromising sterility.  (1-5)
  • Able to differentiate between circuit components required, discusses best option for selection, and exhibits good judgment for final selection.  Articulates performance characteristics of circuit components  (1-5)
  • Is prepared for circuit set-up, has all supplies available and works efficiently. Routinely checks equipment/disposables for sterility and good function prior to set-up, reports that set up was completed with appropriate attention to sterility and observation of component integrity. Performs set up in logical organized fashion, able to complete setup within 15 minutes continually progressing toward faster set-up times. Primes and De-bubbling circuit independently.  (1-5)
  • Completes Pre-bypass Checklist accurately and completely within required time, no omission or inaccurate reporting of items. (1-5)

Initiation of Bypass (10%)

  • Demonstrates ability to initiate CPB within the time expected by surgical team and is able to do so without considerable change in patient status/ hemodynamics. Initiation of CPB should be with the appropriate steps of protocol. Initiates gas flow to the oxygenator and begins timing perfusion procedures. Successfully initiates alarms and safety devices at appropriate times during the procedure. Communicates well and respectful to surgeon and staff.  (1-5)
  • Consistently able to synthesize data from monitoring devices, identify and prioritize problems even in complex -multi problem scenarios. Student should be able to “multi-task” during initiation of bypass, and demonstrates an overall awareness of monitoring parameters required to safely initiate CPB. (1-5)

Conduct of Bypass (35%)

  • Consistently incorporates all available information to critically evaluate the adequacy and appropriateness of all monitored pressures. Selects appropriate actions needed to maintain within standard of practice. (1-5)
  • Demonstrates the ability to systematically analyze data from blood gases and electrolyte management. Recognizes abnormalities and interprets them appropriately. Consistent in ability to explain related pathophysiology even when faced with unfamiliar conditions.    (1-5)
  • Control and awareness of temperature management following consistent acceptable practices for cooling and rewarming to reach desired temperature. (1-5)
  • Proficient in performance of anticoagulation management and assessment of anticoagulation status, independently determines patient's anticoagulation needs according to standard of practice.  (1-5)
  • Follows appropriate procedures for cardioplegia administration throughout the procedure. Quick to assess when changes are needed to insure appropriate delivery. Shows comprehensive understanding of temperature, route of administration, and flow/pressure relationships during all phases of the procedure. (1-5)
  • Demonstrates surgical awareness by assessing adequacy of venous return, and consistently maintains vigilance to a safe operating level. Is able to articulate problems decreased venous return. Performs and exhibits surgical awareness by continuous scanning of the perfusion circuit. Is able to synthesize information received during the scan and evaluate/ modify perfusion technique.  (1-5)
  • Properly maintains perfusion record and charts appropriately per protocol. Perfusion record is free from errors and omissions. Charting is independently accomplished according to standard. (1-5)

Termination of Bypass (10%)

  • Follows appropriate steps for terminal of CPB. Accurately assesses venous reservoir volume and is able to communicate the need for additional volume when appropriate. Consistently maintains vigilance to a safe operating level. Demonstrates understanding of the P/F/V relationships by successfully weaning from bypass independently.
  • Independently assess patient's health status and monitors circuit during termination of CPB. Demonstrates ability to terminate CPB within the time expected by the surgical team. Is able to terminate CPB without considerable change in patient status/hemodynamics. (1-5)          

Professionalism (15%)

  • Is able to communicate effectively with the surgical team.  Communication is respectful and courteous, and appropriate.(1-5)
  • Demonstrates a Professional attitude. Is prompt, punctual, reliable, and dependable. Student establishes and maintains an atmosphere of mutual respect and dignity with co-workers. Is an active member of the team and works well with others. Student is respectful and courteous to all operating room personnel.  Student assumes the appropriate share of the workload, accepts work requests, volunteers, and follows through. ISs motivated to provide “best patient care”. (1-5)
  • Independently assess significant factors affecting patient's post-bypass health status and communicates changes to faculty when appropriate. Restocks perfusion supplies without reminders from faculty. Disposes of circuit without increased exposure to bloody waste.  All equipment is cleaned appropriately per protocols.  Completes all required paperwork (1-5)

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