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Operation Room

Operation Room

Operation Room

WORK SETTING EXPERIENCE:

Question 

Proficiency 

Frequency

Inpatient Acute Care Facility
Trauma Center
Academic/Teaching Facility
Outpatient Care Facility
Long term care/Skilled Nursing
Clinic/Ambulatory
Home Health Setting

GENERAL SKILLS EXPERIENCE:

Awareness of HCAHPS
Cardiac arrest / adult CPR
Cardiac arrest / infant-child CPR
Advanced directives
Patient / family teaching
Lift / transfer devices
Specialty beds
Restrictive devices (restraints)
End of life care / palliative care
Automated Medication Dispensing System, Pyxis, Omnicell, or other
Bar coding for medication administration
Diabetic management in the OR
National Patient Safety Goals
Accurate patient identification
Effective communication
Time out protocol
Interpretation & communication of lab values
Medication administration
Labeling (medications & specimens)
Medication reconciliation
Anticoagulation therapy
Monitoring conscious sedation
Sedation / Anesthesia
Infection control
Universal precautions
Isolation
Minimize risk for falls
Prevention of pressure ulcers

CIRCULATE: GENERAL SURGERY EXPERIENCE:

Abdominal perineal resection
Adrenalectomy bariatric surgery (gastric bypass)
Bowel resection
Cholecystectomy / cholangiogram
Colostomy / ileostomy
Gastrectomy
Hemicolectomy
Hepatic resection
Herniorrhaphy- femoral / inguinal
Hiatal herniorrhaphy
Pancreatectomy
Organ procurement
Radical mastectomy
Saphenous vein ligation / stripping
Splenectomy
Thyroidectomy
Tracheostomy
Vagotomy
Familiarity with pediatric procedures

CIRCULATE: GYNECOLOGY EXPERIENCE:

Caesarean section
Dilation & curettage
Hysterectomy - vaginal
Hysterectomy - abdominal
Radium insertion
Salpingo - oophorectomy
Shirodkar procedure
Termination of pregnancy
Tubal ligation

CIRCULATE: ENDOSCOPIC PROCEDURES EXPERIENCE:

Bronchoscopy
Colonoscopy
Culdoscopy
Cystoscopy
Esophagoscopy
Gastroscopy
Hysteroscopy

CIRCULATE: ENDOSCOPIC PROCEDURES EXPERIENCE:

Appendectomy
Cholecystectomy
Colon resection
Gastric bypass
Hernia repair
Nephrectomy
Prostatectomy
Sinus surgery
Salpingo- oophorectomy
Splenectomy
Tubal ligation
Vaginal hysterectomy
Vitrectomy
Laryngoscopy
Mediastinoscopy
Pelviscopy
Sigmoidoscopy
Thoracoscopy
Whipple
Nissen fundoplication

CIRCULATE: NEUROLOGY EXPERIENCE:

Circumcision
Cystoscopy / ureteroscopy
Cystectomy
Hypospadias repair
Implants
Lithotripsy
Nephrectomy
Orchiectomy
Prostatectomy
Ureterolithotomy
TURP
PVP - Photo Vaporization of Prostate
Vasectomy
Implants

CIRCULATE: ORTHOPEDIC EXPERIENCE:

Achilles tendon repair
Amputation
Arthroscopy / anthrotomy
Closed pinning & reduction of extremities
External compression devices
Hip compression nails & lag screws
Total joint replacement - knee
Total joint replacement - hip
Total joint replacement - shoulder
Spica cast
ORIF - shoulder, hip, humerus
Repair of dislocation
Patellectomy
Tendon implants & reanastomosis

CIRCULATE: NEUROLOGY EXPERIENCE:

Kyphoplasty
A-V malformation
Laparoscopic spine procedures
Burr holes for subdural hematoma
Carotid ligation
Cervical sympathectomy
Cranioplasty
Craniotomy
Disectomy / laminectomy
Halo traction application
Insertion of nerve stimulator
Myelo- meningocele repair
Shunt procedure VP/VA/LP
Spinal fusions
Ventriculostomy

CIRCULATE: PLASTICS EXPERIENCE:

Abdominal lipectomy
Blepharoplasty
Face lift
Mammoplasty
Augmentation
Reduction
Liposuction
Otoplasty
Scar revisions
Skin grafting

CIRCULATE: OPHTHALMOLOGY EXPERIENCE:

Cataract extraction
IOL implants
Corneal transplant
Orbital implant
Enucleation
Repair orbital blowout fracture
Repair of retinal detachment
Scleral buckle

CIRCULATE: EAR, NOSE & THROAT EXPERIENCE:

Caldwell-luc
Cleft lip / palate repair
Laryngectomy
Radical neck
Tonsillectomy & adenoidectomy
Mandibulectomy
Mastoidectomy
Rhinoplasty / septoplasty
Sinusotomy
Angiography
A-V access graft
Aortic aneurysm: abdominal
Peripheral vascular bypass procedures
Endarterectomy: carotid
Thrombectomy
Embolectomy
Vena cava ligation

CIRCULATE: ENDOVASCULAR EXPERIENCE:

Endoluminal AAA
Carotid revascularization endarterectomy
Cerebral aneurysm repair

CIRCULATE: THORACIC / CARDIOVASCULAR EXPERIENCE:

Aortic femoral bypass graft
Femoral popliteal bypass
Pacemaker implantation / explanation
Care of patients with pacemaker
Care of patients with intra-aortic balloon pump
Septal defects, ASV, VSD
Coronary Artery Bypass & Graft (CABG) on pump
Coronary Artery Bypass & Graft (CABG) off pump
Valve replacement / repair
Aortic aneurysm
Thoracotomy / lobectomy
Endoscopic vein harvesting
Maze procedure
Thoracic aneurysm

CIRCULATE: TRAUMA EXPERIENCE:

Bone
Corneal
Harvesting
Heart/lung
Kidney
Liver
Multi organ
Pancreas
Skin

CIRCULATE: TRANSPLANT EXPERIENCE:

Burns
Gunshot / stab wounds
Motor vehicle accidents
Traumatic amputations

CIRCULATE: EQUIPMENT EXPERIENCE:

Argon beam coagulator
Camera / video systems
Cell saver
Cidex soak
Cryo-ophthalmic unit
Cavitron Ultrasonic Surgical Aspirator (CUSA)
Hypo / hyperthermia unit
Drill and saws
Electrosurgical unit
Fiber optic luminator
Cavitron
Autoclave
Fracture tables
Harmonic scalpel
Ligasure
Stapling devices
Mesh graft / dermatone
Microscopes
Nitrogen tank
Pneumatic tourniquet
Stealth
Steris unit
Pulsevac irrigation
Autotransfusion system
Laser equipment
Care of scopes & fiberoptic equipment
Venodyne robotics (Da Vinci)

CIRCULATE: AGE-SPECIFIC EXPERIENCE:

Newborn / neonate (birth-30 days)
Infant (31 days-1 year)
Toddler (ages 2-3 years)
Preschool (ages 4-5 years)
School age (ages 6-12 years)
Adolescent (ages 13-21 years)
Young adult (ages 22-39 years)
Adult (ages 40-64 years)
Older adult (ages 65-79 years)
Elderly (ages 80+ years)

Rank each of the following sections on a scale

No experience

Little Experience

High Experience

Master

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