Resident: ___________________________________

Name of Rotation: Reproductive Health Continuity Procedures Elective

PGY 3 Number of aspiration abortion cases completed: ________

Number of IUDs inserted: ________

Evaluator name:___________________________________

Date: ________

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Use the following descriptors to assess the resident upon completion of the rotation on all 5 competencies listed below:

  1 2 3 4 5

EXPECTED COMPETENCY LEVEL
AT PGY YEAR

Beginning PGY 1=level 1
Middle/End of PGY 1=level 2
End PGY 1 and middle PGY 2=level 3
End of PGY 2 and
PGY 3=level 4
End of PGY 3/4=level 5

Beginner
(requires observation of every patient/ monitoring and constant assistance/
supervision)

Advanced Beginner
(requires intermittent observation with patients; intermittent assistance/
supervision; knows limitations and seeks guidance when needed)

Approaching Competence
(Developing independent thinking and needs occasional observation and intermittent assistance/
supervision; knows limitations and seeks guidance when needed)

Competent
(Independent; no need for observation; assistance and supervision is occasional; knows limitations and seeks guidance when needed; asks appropriate questions to attending; approaches task of supervision of others)

Advanced Competency
(No observation required; assistance and consultation is rare; knows limitations and seeks guidance when needed; discusses complex cases with attending; can supervise others and *when applicable teach others)

   NA= Not Applicable to the rotation and NO=Not Observable on the rotation

  1 2 3 4 *5 NA/
NO
Medical Knowledge            
Resident demonstrates knowledge of contraceptive options            
Describes the differences between an aspiration abortion and a medication abortion and know the indications and contraindications of each            
Describes the criteria for no-touch and sterile procedures            
Knows the elements of pre and post operative care            
Knows appropriate use of medications associated with abortion care            
Practice Based Learning            
Implements clinical guidelines and best evidence and/or practice into patient care management            
Demonstrates evidence of reading            
Attends and contributes to education rounds            
Documents accurately decisions that are made when patient must be referred            
Patient Care            
Manages contraceptive needs in a patient centered manner            
Physical exam: accurate, appropriate to the medical histor            
Uses the bimanual exam to describe the position of the uterus, estimate the GA and to identify normal and abnormal findings            
Demonstrates proficiency in the administration of a para-cervical block            
Applies the tenaculum and dilates the cervix without trauma            
Aspirates the uterine cavity effectively and completely            
Examines the tissue aspirate in order to identify the completeness of the procedure            
Provides options counseling in a patient-centered manner            
Able to perform and interpret sonograms for gestational dating, pregnancy location and completion of abortion procedure            
Systems Based Practice            
Able to compare and contrast the systems of health care provided in the family practice with that at Planned Parenthood’s family planning clinic system            
Understand the financial constraints on the provision of abortion care            
Uses referrals appropriately            
Practices cost-effective health care and considers resource allocation, without compromising quality of care            
Interpersonal and Communication Skills            
Presents cases effectively, that are clear, concise and thorough            
Establishes rapport with the woman            
Solicits questions from the patient prior to the procedure and answers them            
Asks the patient to position herself for the procedure without any physical handling            
Uses respectful language, establishes trust, demonstrates compassion            
Communicates with patients during the procedure with attention to her comfort            
Fosters sense of cooperation, team spirit, works effectively with other team members            
Professionalism            
Demonstrates desirable work habits: perseveres, takes initiative           YES/
NO
Demonstrates desirable work habits: responsible and reliable           YES/
NO
Demonstrate desirable work habits: able to prioritize, manage time efficiently            
Demonstrate desirable work habits: accepts and integrates constructive criticism/feedback            
Demonstrates commitment to ethical principles           YES/
NO
Demonstrates sensitivity and responsiveness to patients’ culture, age, gender, language and disabilities            
Demonstrates respect, compassion, integrity, and professional composure (esp. in high stress situations)            

   AT THIS POINT in the resident’s training, rate their overall clinical competence
   Check One:

Beginner Advanced
Beginner
Approaching
Competent
Competent Advanced
Competency

For preceptor/attending: AT THIS POINT in the resident’s training, did the resident meet your expectations?

 Yes _______      No _______

Please comment specifically on strengths and areas of improvement ad enhancement that the resident can incorporate into his/her learning plan below.

Comments: ___________________________________________________________________
_____________________________________________________________________________

Strengths: ____________________________________________________________________
_____________________________________________________________________________

Areas for improvement or enhancement:
(Specify learning plan, i.e. remediation or enhancement of knowledge and/or skills)
_____________________________________________________________________________
_____________________________________________________________________________

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These forms are not intended to provide legal, medical or other professional advice. They are not a substitute for consultation with a healthcare provider or for independent judgment by healthcare providers or other professionals regarding individual conditions and situations.