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* 2. Resident Name

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* 3. Please enter the date of supervision

Date

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* 4. Case/day complexity

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* 5. Complete the scale below by considering an average of the resident’s performance during the day

  INTERVENTION: Frequent direction, significant hands-on involvement DIRECTION: Some guidance or coaching required MINIMAL GUIDANCE: Minimal coaching required AUTONOMOUS: No coaching or guidance required CONSULTANCY: Could teach or supervise others
1. Patient preoperative assessment
2. Basic airway management 
3. Appropriate monitoring of patient under sedation/GA
4. Familiarity with basic fluid resuscitation
5. Familiarity with appropriate pharmacologic agents for sedation and GA
6. Familiarity with basic principles of pain management
7. Appropriate charting and documentation

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* 6. Complete the scale below by considering the resident's CanMEDS Competencies

  NEEDS IMPROVEMENT PROFICIENT FOR LEVEL N/A
COMMUNICATOR: Establishes a therapeutic relationship and communicates well
COLLABORATOR: Establishes good relationships with peers and peri-op team. Effectively provides & receives info.
LEADER: Demonstrates effective time management, balancing educational needs with clinical service.
SCHOLAR: Reads around cases, is knowledgeable about own patients.
PROFESSIONAL: Demonstrates a commitment to excellence in patient care, and professional behaviours.

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* 7. Feedback and comments

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* 8. Areas for improvement

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