American Board of Surgery



Operative Performance Rating System (OPRS)

CREATION OF ARTERIOVENOUS (AV) FISTULA

|Evaluator: | |Resident:   | |

|Resident Level: | |Program: | |

|Date of Procedure: |

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|Time Procedure Was Completed: |

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|Date Assessment Was Completed: |

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|Time Assessment Was Initiated: |

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Please rate this resident's performance during this operative procedure. For most criteria, the caption above each checkbox provides descriptive anchors for 3 of the 5 points on the rating scale. "NA" (not applicable) should only be selected when the resident did not perform that part of the procedure.

Case Difficulty

|1 |2 |3 |4 |5 |

| | | | | |

|Straightforward anatomy, no related prior | |Intermediate difficulty | |Abnormal anatomy, extensive pathology, |

|surgeries or treatment | | | |related prior surgeries or treatment |

| | | | |(for example radiation), or obesity |

Degree of Prompting or Direction

|Substantial Direction |2 |Some Direction |4 |Minimal Direction |

|1 | |3 | |5 |

| | | | | |

|Unable to direct team, use/choose | |Actively assists and anticipates own and| |Performs all steps and directs team with|

|instruments, or anticipate next steps as | |attending’s needs, performs basic steps | |minimal direction from attending to |

|surgeon or as first assistant without | |with occasional attending direction to | |either resident or team, i.e., |

|constant attending prompting | |resident and/or surgical team. Somewhat | |anticipates needs, sets up exposure for |

| | |hesitant and slow to anticipate or | |self and assistant, transitions fluently|

| | |recognize aberrant anatomy, unexpected | |between steps, gives clear direction to |

| | |findings, and/or “slowing down” moments | |first assistant, maintains situation |

| | | | |awareness, calmly recovers from error |

| | | | |and recognizes when to seek help/advice |

|☐ |☐ |☐ |☐ |☐ |

Procedure-Specific Criteria

Please assess performance and indicate the degree of prompting for each item. The assessment score for each item may differ from the prompting score for that item.

Placement of Incisions

|Poor |Fair |Good |Very Good 4 |Excellent | |

|1 |2 |3 | |5 |NA |

|No concept of functional | |Position of incision is | |Proximal incision slightly | |

|needs of procedure –graft | |functional but not | |distal to antecubital | |

|too short or too long | |optimal for exposure of | |crease – graft to radial | |

| | |target vessels | |side of arm; loop length | |

| | | | |2/3 of distal to wrist | |

|Substantial Direction | |Some | |Minimal Direction |NA |

|1 |2 |Direction |4 |5 | |

| | |3 | | | |

Dissection of Vessels

|Poor |Fair |Good |Very Good 4 |Excellent | |

|1 |2 |3 | |5 |NA |

|Disregard for superficial | |Exposes brachial artery | |Excellent independent | |

|veins; injury to brachial | |sufficiently for | |dissection of all vessels;| |

|artery or deep vein | |anastomosis with | |mindful of plans | |

| | |guidance. Preserves most | |for anastomosis | |

| | |significant superficial | | | |

| | |veins | | | |

|Substantial Direction | |Some | |Minimal Direction |NA |

|1 |2 |Direction |4 |5 | |

| | |3 | | | |

Suturing Graft

|Poor |Fair |Good |Very Good 4 |Excellent | |

|1 |2 |3 | |5 |NA |

|Sutures from adventitia to | |Generally pierces graft | |Independently sews with | |

|intima on artery; | |and vessels at 90 degrees | |correct needle angle and | |

|inappropriate | |and passes from intimal | |at the correct orientation| |

|thickness/spacing of bites | |surface out of artery | |throughout the anastomosis| |

|Substantial Direction | |Some | |Minimal Direction |NA |

|1 |2 |Direction |4 |5 | |

| | |3 | | | |

Tunnel Graft

|Poor |Fair |Good |Very Good 4 |Excellent | |

|1 |2 |3 | |5 |NA |

|Kinks; too deep placement; | |Able to position graft | | No kinks; appropriate | |

|directly below distal | |adequately with guidance | |depth graft; proximal to | |

|incision | | | |distal suture line | |

|Substantial Direction | |Some | |Minimal Direction |NA |

|1 |2 |Direction |4 |5 | |

| | |3 | | | |

General Criteria

Instrument Handling

|Poor |Fair |Good |Very Good 4 |Excellent | |

|1 |2 |3 | |5 |NA |

|Tentative or awkward | |Competent use of | |Fluid movements with | |

|movements, often did not | |instruments, | |instruments consistently| |

|visualize tips of | |occasionally appeared | |using appropriate force,| |

|instrument or clips poorly | |awkward or did not | |keeping tips in view, | |

|placed | |visualize instrument | |and placing clips | |

| | |tips | |securely | |

Respect for Tissue

|Poor |Fair |Good |Very Good 4 |Excellent | |

|1 |2 |3 | |5 |NA |

|Frequent unnecessary | |Careful tissue handling, | |Consistently handled | |

|tissue force or damage by| |occasional inadvertent | |tissue carefully | |

|inappropriate instrument | |damage | |(appropriately), minimal | |

|use | | | |tissue damage | |

Time and Motion

|Poor |Fair |Good |Very Good 4 |Excellent | |

|1 |2 |3 | |5 |NA |

|Many unnecessary moves | |Efficient time and | |Clear economy of motion, | |

| | |motion, some unnecessary | |and maximum efficiency | |

| | |moves | | | |

Operation Flow

|Poor |Fair |Good |Very Good 4 |Excellent | |

|1 |2 |3 | |5 |NA |

|Frequent lack of forward | |Some forward planning, | |Obviously planned course | |

|progression; frequently | |reasonable procedure | |of operation and | |

|stopped operating and | |progression | |anticipation of next steps| |

|seemed unsure of next move | | | | | |

Overall Performance (not included in calculation of mean score)

Rating of very good or higher indicates technically proficient performance (i.e., resident is ready to perform operation independently, assuming resident consistently performs at this level)

|Poor |Fair |Good |Very Good |Excellent |

|☐ |☐ |☐ |☐ |☐ |

Please indicate the weaknesses in this resident’s performance:

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Please indicate the strengths in this resident’s performance:

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Published with permission of Southern Illinois University Department of Surgery

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