A: Medical Knowledge



Trainee: ________________________________ Observer: ________________________________ Date: ______________

Training venue:

___ Family medicine RH clinic ___ Family medicine continuity clinic ___ High volume clinic: ______________________

|RESIDENT to complete/discuss: | |

|Number of PREVIOUS IUD insertion cases | |

|What is my learning goal for today? | |

|Overall RESIDENT impression of skill level |1 |

| |Beg |

| |2 |

| |Int |

| |3 |

| |Dev Comp |

| |4 |

| |Comp |

| |5 |

| |Adv Comp |

| | |

|What has been going well? | |

|What can be improved? | |

| | |

|FACULTY to complete: | |

|Number of observed resident cases today | |

|Overall FACULTY impression of skill level |1 |

| |Beg |

| |2 |

| |Int |

| |3 |

| |Dev Comp |

| |4 |

| |Comp |

| |5 |

| |Adv Comp |

| | |

|Were there any issues or problems? Did the trainer | |

|intervene at any time? | |

|What went well? | |

|What can be improved? | |

| | |

|Was this feedback discussed with the trainee? |_____ Yes _____ No |

|Interpersonal and Communication skills |N/A |1 |2 |3 |4 |5 |

| | |Beg |Int |Dev Comp |Comp |Adv Comp |

|Describes procedure using patient-centered language | | | | | | |

|Elicits, listens, and responds thoughtfully to patient’s questions and concerns | | | | | | |

|Communicates effectively with staff | | | | | | |

|Patient Care: I. IUD insertion – General |N/A |1 |2 |3 |4 |5 |

| | |Beg |Int |Dev Comp |Comp |Adv Comp |

|Discusses with patient what role (if any) a support person might play in this | | | | | | |

|process | | | | | | |

|Performs pregnancy test if needed | | | | | | |

|Uses supportive language to communicate to patient throughout the procedure | | | | | | |

|Accurately estimates uterine size and position from pelvic examination | | | | | | |

|Consistently uses no-touch technique | | | | | | |

|Inserts speculum gently for adequate visualization of the cervix | | | | | | |

|Endocervical GC/CT testing performed | | | | | | |

|Correct application of tenaculum | | | | | | |

|Demonstrates ability to sound uterus and identify appropriate depth for IUD | | | | | | |

|insertion | | | | | | |

|Inserts IUD/inserter through os with good traction on tenaculum | | | | | | |

|Cuts string to appropriate length | | | | | | |

|Reviews post-insertion instructions sheet with patient | | | | | | |

|Counsels patient regarding warning signs and when to contact the office for | | | | | | |

|follow up | | | | | | |

|II. Copper IUD |N/A |1 |2 |3 |4 |5 |

| | |Beg |Int |Dev Comp |Comp |Adv Comp |

|Sets flange to appropriate distance from tip | | | | | | |

|After insertion, withdraws insertion tube while holding stabilizing rod steady | | | | | | |

|thereby releasing IUD | | | | | | |

|Withdraws stabilizing rod and insertion tube from cervical canal | | | | | | |

|III. Liletta single-handed IUD |N/A |1 |2 |3 |4 |5 |

| | |Beg |Int |Dev Comp |Comp |Adv Comp |

|Pushes blue slider (1) away from self while pulling strings towards self so that | | | | | | |

|IUD arms load horizontally into insertion tube | | | | | | |

|Fixes threads into cleft | | | | | | |

|III. Liletta single-handed IUD (continued) |N/A |1 |2 |3 |4 |5 |

| | |Beg |Int |Dev Comp |Comp |Adv Comp |

|Advances handle until flange is 1.5–2 cm from external os | | | | | | |

|Slides blue slider (1) back gently until it is merged flush with the green slider| | | | | | |

|(2) while holding inserter steady and gives 15 seconds for arms to open | | | | | | |

|Advances IUD until flange are flush with cervix or IUD is at uterine fundus | | | | | | |

|Holds inserter in position and slides both sliders together all the way down | | | | | | |

|until it clicks. | | | | | | |

|Observes strings automatically releasing and if this does not happen, removes | | | | | | |

|them from cleft | | | | | | |

|Withdraws IUD inserter from uterus | | | | | | |

|IV. Levonorgestrel IUD (Bayer products) |N/A |1 |2 |3 |4 |5 |

| | |Beg |Int |Dev Comp |Comp |Adv Comp |

|Sets flange to appropriate distance from tip | | | | | | |

|Keeps thumb on blue slider while putting insertion tube through os | | | | | | |

|Advances handle until flange is 1.5–2 cm from external os | | | | | | |

|Pulls slider back to mid-mark while holding inserter steady and gives 10 seconds | | | | | | |

|for arms to open | | | | | | |

|Advances IUD until flange are flush with cervix or IUD is at uterine fundus | | | | | | |

|Holds inserter in position and moves slider all the way down | | | | | | |

|Withdraws IUD inserter from uterus | | | | | | |

|Knowledge |N/A |1 |2 |3 |4 |5 |

| | |Beg |Int |Dev Comp |Comp |Adv Comp |

|Can identify contraindications (CDC MEC) to both Copper T IUD and | | | | | | |

|Levonorgestrel-IUD | | | | | | |

|Can identify all needed supplies for the procedure | | | | | | |

|Can describe the correct order of steps of an IUD insertion | | | | | | |

|Can list criteria to be reasonably certain that a patient is not pregnant | | | | | | |

|Demonstrates knowledge of appropriate management of difficult insertions and/or | | | | | | |

|complications of IUD insertion | | | | | | |

Definitions

|N/A |Not Assessed | |MEDICAL KNOWLEDGE |INTERPERSONAL & PATIENT CARE |

|Beg |Beginner |Minimal experience |Possesses a limited understanding of relevant |Requires immediate supervision at all times and |

| | | |concepts and related protocols |specific hand-on-hand instruction to be able to |

| | | | |perform the stated task. |

|Int |Intermediate |Some prior experience |Has a fair understanding of relevant concepts |Requires close attention and frequent verbal |

| | | |and protocols. Asks appropriate questions |redirection to perform the stated task. |

|Dev Comp |Developing |Moderate prior |Has a strong understanding of relevant concepts|Requires intermittent supervision, but can perform the|

| |Competence |experience |and protocols. Knows limitations and seeks |stated task without detailed instruction. Recognizes |

| | | |guidance when needed |complications as they arise, but may not be able to |

| | | | |identify the associated management options |

|Comp |Competent |Significant prior |Has an extensive understanding of relevant |Competent for independent provision of this step. |

| | |experience |concepts and protocols |Infrequently requires assistance. Describes or |

| | | | |demonstrates comprehension of the management options |

| | | | |for atypical cases. |

|Adv Comp |Advanced Competency |Extensive prior |Able to teach others about relevant concepts |Competent for independent provision of this step AND |

| | |experience |and protocols |is able to teach this step to new learners. Able to |

| | | | |anticipate, recognize, and manage complications and |

| | | | |handle atypical or difficult cases; able to teach or |

| | | | |role model at a faculty level. |

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download