A: Medical Knowledge



Trainee: ________________________________ Observer: ________________________________ Date: ______________Training venue: ___ Family medicine RH clinic ___ Family medicine continuity clinic ___ High volume clinic: _______________RESIDENT to complete/discuss:Overall RESIDENT impression of skill level(Circle appropriate level)1Beg2Int3Dev Comp4Comp5Adv CompNumber of cases completed previouslyLearning goal for todayWhat has been going well?What can be improved?FACULTY to complete: Overall FACULTY impression of skill level(Circle appropriate level)1Beg2Int3Dev Comp4Comp5Adv CompNumber of observed casesTotal______ #____ParaGard? #_____Liletta? #_____Mirena? #____Kyleena? #_____Skyla?What went well? What parts of the procedure does the resident need extra support on?Was this information discussed with the trainee?_____ Yes _____ NoInterpersonal and Communication skillsN/A1Beg2Int3Dev Comp4Comp5Adv CompDemonstrates respect for patient’s autonomy and preferences with regard to contraceptionUses patient-centered language Elicits, listens, and responds thoughtfully to patient’s questions and concernsCommunicates effectively with staffPre-ProcedureN/A1Beg2Int3Dev Comp4Comp5Adv CompAssesses and accommodates patient’s preferences regarding privacy and confidential contactDiscusses with patient what role (if any) a support person might play in this processPerforms pregnancy test if neededSets up all needed supplies Procedure Skills: General N/A1Beg2Int3Dev Comp4Comp5Adv CompUses supportive language to communicate to patient throughout the procedure Accurately estimates uterine size and position from pelvic examinationConsistently uses no-touch techniqueInserts speculum gently for adequate visualization of the cervixEndocervical GC/CT testing performedCorrect application of tenaculumDemonstrates ability to sound uterus and identify appropriate depth for IUD insertion Inserts IUD/inserter through os with good traction on tenaculumCuts string to appropriate lengthReviews post-insertion instructions sheet with patientCounsels patient regarding warning signs and when to contact the office for follow-upProcedure Skills: Copper IUD N/A1Beg2Int3Dev Comp4Comp5Adv CompLoads stabilizing rod and bends IUD arms down at opposite ends to load into insertion tubeSets flange to appropriate distance from tipAfter insertion, withdraws insertion tube while holding stabilizing rod steady thereby releasing IUDWithdraws stabilizing rod and insertion tube from cervical canalProcedure Skills: Liletta single-handed IUDN/A1Beg2Int3Dev Comp4Comp5Adv CompSets flange to appropriate distance from tipPushes blue slider (1) away from self while pulling strings towards self so that IUD arms load horizontally into insertion tubeProcedure Skills: Liletta single-handed IUD (continued)N/A1Beg2Int3Dev Comp4Comp5Adv CompFixes threads into cleftKeeps firm pressure on blue slider while putting insertion tube through osAdvances handle until flange is 1.5–2 cm from external osSlides 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 openAdvances IUD until flange is flush with cervix or IUD is at uterine fundusHolds 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 cleftWithdraws IUD inserter from uterusProcedure Skills : Levonorgestrel IUD (Bayer products)N/A1Beg2Int3Dev Comp4Comp5Adv CompPushes slider away from self so that IUD arms load into insertion tubeSets flange to appropriate distance from tipKeeps thumb on blue slider while putting insertion tube through osAdvances handle until flange is 1.5–2 cm from external osPulls slider back to mid-mark while holding inserter steady and gives 10 seconds for arms to openAdvances IUD until flange are flush with cervix or IUD is at uterine fundusHolds inserter in position and moves slider all the way down Withdraws IUD inserter from uterusKnowledgeN/A1Beg2Int3Dev Comp4Comp5Adv CompCan describe differences among IUDs regarding insertion technique, duration, and pharmacologyCan identify contraindications (CDC MEC) to both Copper T IUD and Levonorgestrel IUD Can identify all needed supplies for the procedureCan describe the correct order of steps of an IUD insertionCan list criteria to be reasonably certain that a patient is not pregnantDemonstrates knowledge of appropriate management of difficult insertions and/or complications of IUD insertionN/A Not AssessedMEDICAL KNOWLEDGEINTERPERSONAL & PATIENT CAREBegBeginnerMinimal experiencePossesses a limited understanding of relevant concepts and related protocolsRequires immediate supervision at all times and specific hand-on-hand instruction to be able to perform the stated task.IntIntermediateSome prior experienceHas a fair understanding of relevant concepts and protocols. Asks appropriate questionsRequires close attention and frequent verbal redirection to perform the stated task. Dev CompDeveloping CompetenceModerate prior experienceHas a strong understanding of relevant concepts and protocols. Knows limitations and seeks guidance when neededRequires intermittent supervision, but can perform the stated task without detailed instruction. Recognizes complications as they arise, but may not be able to identify the associated management optionsCompCompetentSignificant prior experienceHas an extensive understanding of relevant concepts and protocolsCompetent for independent provision of this step. Infrequently requires assistance. Describes or demonstrates comprehension of the management options for atypical cases.Adv Comp Advanced CompetencyExtensive prior experienceAble to teach others about relevant concepts and protocolsCompetent for independent provision of this step AND 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. Definitions ................
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