Has Not Achieved Level 1 Level 1 Level 2 Level 3. With indirect supervision, Fellow. Has Not Achieved Level 1 Level 1 Level 2 Level 3
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1 Preview Form Printed on Apr 15, 2016 Anesthesiology Critical Care Medicine: CTICU Perormance Evaluation Form B (MILESTONES) Insuicient contact evaluate (delete evaluation) Tracking rom Level 1 is synonymous with moving rom novice expert in the sub-specialty. Selection o a level implies that the ellow substantially demonstrates the milesnes in that level, as well as those in lower levels To see detailed descriptions o each level, please click the EXPAND butn - Has not achieved level 1: Below expectations or an incoming ellow. Level 1: The ellow demonstrates milesnes expected o an incoming ellow. Level 2: The ellow is advancing and demonstrates additional milesnes, but is not yet perorming at a mid-ellowship level. Level 3: The ellow continues advance and demonstrate additional milesnes, consistently including the majority o milesnes targeted or ellowship. : The ellow has advanced so that he or she now substantially demonstrates the milesnes targeted or ellowship. This level is designed as the graduation target. : The ellow has advanced beyond perormance targets set or ellowship and is demonstrating "aspirational" goals which might describe the perormance o someone who has been in practice or several years. It is expected that only a ew exceptional ellows will reach this level. Medical Knowledge - Pharmacology (MK-1) Please evaluate the ellow's ability demonstrate the ollowing objectives: ( ) demonstrates applies the applies consultant in 1. Demonstrates proper use o inotropes and pulmonary vasodilars.* Incoming Mid-ellowship Medical Knowledge - Medical Knowledge o Critical Care Medicine (MK-2) Please evaluate the ellow's ability demonstrate the ollowing objectives: ( ) knowledge o Applies a understanding the knowledge o 2. Prioritizes patient's disease related states, issues and designs a care plan accordingly, anticipates potential complications and prevention.* Incoming Mid-ellowship ( ) knowledge o th h i l d d t di Applies a understanding the t hi th t i k l d i t knowledge o iti l ill t 3. understanding o VA and VV ECMO and can manage alterations in physiology or patients undergoing ECMO.* Incoming Mid-ellowship ( ) knowledge o Applies a understanding the knowledge o 4. Decisions regarding perioperative medications are supported with evidence-based guidelines Incoming Mid-ellowship 11:13:51 AM]
2 (anticoagulation, DVT prophylaxis, stress ulcer prophylaxis, and antibiotics).* ( ) knowledge o th h i l d d t di Applies a understanding the t hi th t i k l d i t knowledge o iti l ill t 5. n understanding o basic transesophageal echocardiography or moniring o posperative status.* Incoming Mid-ellowship Patient Care - Patient Assessment and Development o a Care Plan (PC-1) Please evaluate the ellow's ability demonstrate the ollowing objectives: ( ) identiies disease identiies identiies, 6. Provides an adequate assessment o critically ill cardiothoracic patients through the evaluation and interpretation o appropriate laborary data.* Incoming Mid-ellowship ( ) identiies disease identiies identiies, 7. Manages physiologic derangements rom cardio-pulmonary bypass such as delirium, renal insuiciency, and hypotension.* Incoming Mid-ellowship Patient Care - Crisis Management (PC-2) Please evaluate the ellow's ability demonstrate the ollowing objectives: ( ) Recognizes acutely ill or ly d t i ti ti t Constructs prioritized di ti l identiies and manages li i l i i id tii d Sets clinicallyappropriate i iti 8. Eectively serves as the code leader and prioritizes the causes or cardiac arrest in these patients on the dierential diagnosis (arrhythmia, hemorrhage, tamponade, RV ailure.* Incoming Mid-ellowship Patient Care - Procedural Skills/Technical Abilities/Interpretation (PC-3) Please evaluate the ellow's ability demonstrate the ollowing objectives: ( ) identiies t i l th t perorms and supervises th i d d d consultant th h lth 9. dvanced 11:13:51 AM]
3 transthoracic echocardiography techniques assess volume status, valvular lesions, cardiac unction, and ejection raction.* Incoming Mid-ellowship ( ) identiies perorms and supervises consultant 10. Demonstrates basic transesophageal echocardiography technique evaluate volume status and cardiac unction in a posperative placement.* Incoming Mid-ellowship ( ) identiies perorms and supervises consultant 11. Placement o and/or management o pulmonary arterial catheters with indirect supervision.* Incoming Mid-ellowship Systems Based Practice - Interproessional and Transitions o Care (SBP-1) Please evaluate the ellow's ability demonstrate the ollowing objectives: ( ) Requires direct supervision manages the methods 12. Eectively and saely uses hando ols transition care rom the day shit the night shit.* Incoming Mid-ellowship ( ) Requires direct supervision ti l ll b t ti l manages the i t i l t l d th methods ti i d 13. Receives hand-o in a proessional manner and participates in bedside hand-o with the OR team.* Incoming Mid-ellowship Systems Based Practice - Incorporation o Patient Saety and Quality Improvement in Clinical Practice (SBP-2) Please evaluate the ellow's ability demonstrate the ollowing objectives: ( ) Needs prompting consistently incorporate Identiies common causes Identiies opportunities and activities optimize patient Substantially participates in a role model and 14. Learns use and recognizes the importance o ICU procols improve quality o care.* Incoming Mid-ellowship 11:13:51 AM]
4 Practice-based Learning and Improvement - Sel-directed Learning and Scholarly Activity (PBLI-1) Please evaluate the ellow's ability demonstrate the ollowing objectives: ( ) Completes assigned/recommended Critically evaluates the integrates evidence-based practices development o edirial reviews 15. Use inormation technology assimilate current literature as it relates the CVICU.* Incoming Mid-ellowship Practice-based Learning and Improvement - Education o Team Members and Other Health Care Providers (PBLI-2) Please evaluate the ellow's ability demonstrate the ollowing objectives: ( ) Understands the value o disseminating Seeks opportunities provide thoughtul and Actively promotes patient-oriented 16. Facilitates the learning o other team members including physician assistants, nurse practitioners, students, residents and coellows.* Incoming Mid-ellowship Proessionalism - Commitment Institution, Department, and Colleagues (PROF-1) Please evaluate the ellow's ability demonstrate the ollowing objectives: ( ) Complies with institutional policies and Serve as a role model other role model and responsible representative divisional, regional or 17. Works eectively with ICU nurses communicate care plan.* Incoming Mid-ellowship Proessionalism - Responsibility Maintain Personal Emotional, Physical, and Mental Health (PROF-3) Please evaluate the ellow's ability demonstrate the ollowing objectives: ( ) Demonstrates basic proessional Demonstrates the ability Reports concerns about the health or well-being o Teaches residents and resource or the 18. Relects upon the unique nature o the patient population in the CVICU and the stress that can have on physicians, amilies and care providers.* Incoming Mid-ellowship Interpersonal & Communication Skills - Communication with Patients and Families (ICS-1) Please evaluate the ellow's ability demonstrate the ollowing objectives: ( ) Eectively communicates routine i ti i Eectively uses appropriate ( With minimal manages patient and amily li t i l Consistently ensures eective i ti 11:13:51 AM]
5 19. Includes the patient and amilies in daily rounds or during key management plan decisions/discussions.* Incoming Mid-ellowship ( ) Eectively communicates routine i ti i Eectively uses appropriate ( With minimal manages patient and amily li t i l Consistently ensures eective i ti 20. Acts with sensitivity and responsiveness patient's culture, age, gender, and disabilities.* Incoming Mid-ellowship Overall Feedback and Comments Please provide speciic comments regarding the ellow's strengths: Please provide speciic comments regarding the ellow's areas or improvement: * Required ields Option description (place mouse over ield view) Submit completed evaluation 11:13:51 AM]
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