Drexel University College of Medicine Department of Anesthesiology

Evaluation of Resident by Faculty (Pain Management Rotation) XA1

Resident’s 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 gauge Communicate effectively with patients, their families,
subjective pain. [Objective #5]
E S M U N/A surgeons, and professional associates [Objective #1]
E S M U N/A

Develop therapeutic plan for patients with acute Manage intra- and inter-disciplinary issues arising on
post-surgical pain [Objective #6]
E S M U N/A the acute pain service. [Objective #11]
E S M U N/A

Medical Knowledge Professionalism

Apply theories of pain to evaluation, diagnosis

plan, 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 recurrent Sensitive to gender, ethnic, and personal diversity
pain and their treatments. [Objective #6]
E S M U N/A 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 guide E S M U N/A Consult successfully with behavioral, physical
patient diagnosis & management [Objective #12] medicine, and neurology associates. [Objective #8]
E S M U N/A

Teach medical students the fundamentals of pain E S M U N/A Explain how pre-emptive pain management impacts
management. [Objective #1] cost 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

Behavioral
Patient Evaluation
Modification

Peripheral Nerve
Physical Therapy
Block Procedures

Hypnosis, Stress
Epidural &
Management &
Subarachnoid
Relaxation
Injections
Techniques

Joint & Bursal Sac Trigeminal

Injections Ganglionectomy

Cryotherapeutic Sympathectomy
Techniques Techniques

Neurolytic Alternative Pain

Techniques Therapies

Electrical Stimulation Management of Local

Techniques Anesthetic Overdose

Emergency Airway
Implanted Devices Management &
Resuscitation

Acupuncture and
Other
Acupressure

Comments:

Version 02-February-2007

Evaluator’s Name PRINT:

E = Exceeds expectations
S = Satisfactory = always at expected level
M = Marginal = often meets expectations Evaluator’s Signature:
U = Unsatisfactory = frequently falls short of expectations
N/A = Not applicable
Date: