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Drexel University College of Medicine Department of Anesthesiology

Evaluation of Resident by Faculty (Pain Management Rotation) XA1

Residents Name:CA Level: CA1 CA2 Do Not Use for CA-3

Period Observed: Site (circle one): HUH

GENERAL COMPETENCIES [Objective numbers refer to Resident Manual]

Patient Care Interpersonal and Communication Skills

Successfully use a Likert scale to gaugesubjective pain. [Objective #5]

E S M U N/ACommunicate effectively with patients, their families,surgeons, and professional associates [Objective #1]

E S M U N/A

Develop therapeutic plan for patients with acutepost-surgical pain [Objective #6]

E S M U N/AManage intra- and inter-disciplinary issues arising on

the acute pain service. [Objective #11]E S M U N/A

Medical Knowledge Professionalism

Apply theories of pain to evaluation, diagnosisplan, and therapy plan. [Objectives #3, #4]

E S M U N/A Respectful and Altruistic [Objective # 2] E S M U N/A

Differentiate among acute, chronic, and recurrentpain and their treatments. [Objective #6]

E S M U N/ASensitive to gender, ethnic, and personal diversity

issues. [Objective #2]E S M U N/A

Practice Based Learning and Improvement Systems-Based Practice

Use materials in the literature and on-line to guidepatient diagnosis & management [Objective #12]

E S M U N/A Consult successfully with behavioral, physicalmedicine, and neurology associates. [Objective #8]

E S M U N/A

Teach medical students the fundamentals of painmanagement. [Objective #1]

E S M U N/A Explain how pre-emptive pain management impactscost effective patient care [Objective #7]

E S M U N/A

PAIN MANAGEMENT PROCEDURAL COMPETENCY [Objectives 9, 10]. Leave blank any that do not apply.

Procedure Still Learning Competent Procedure Still Learning Competent

Patient EvaluationBehavioralModification

Peripheral NerveBlock Procedures

Physical Therapy

Epidural &SubarachnoidInjections

Hypnosis, StressManagement &RelaxationTechniques

Joint & Bursal SacInjections

TrigeminalGanglionectomy

CryotherapeuticTechniques

SympathectomyTechniques

NeurolyticTechniques

Alternative PainTherapies

Electrical StimulationTechniques

Management of LocalAnesthetic Overdose

Implanted DevicesEmergency AirwayManagement &Resuscitation

Acupuncture andAcupressure

Other

Comments:

Version 02-February-2007

E = Exceeds expectations

S = Satisfactory = always at expected level

M = Marginal = often meets expectations

U = Unsatisfactory = frequently falls short of expectations

N/A = Not applicable

Evaluators Name PRINT:

Evaluators Signature:

Date: