Operative Performance Rating System (OPRS)

CREATION OF ARTERIOVENOUS (AV) FISTULA

Evaluator: Resident: Resident Level: Program:

Date of Time Procedure Procedure: Was Completed: Date Assessment Was Time Assessment Completed: Was Initiated:

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

Straightforward anatomy, no Intermediate difficulty Abnormal anatomy, extensive related prior surgeries or pathology, related prior surgeries treatment or treatment (for example radiation), or obesity

☐ ☐ ☐

Degree of Prompting or Direction 1 2 3

Minimal direction by attending. Some direction by attending. Substantial direction by Resident performs all steps Resident performs all steps but attending. Resident performs all and directs the surgical team the attending provides occasional steps but the attending provides independently with minimum direction to the resident and /or constant direction to the resident or no direction from the to the surgical team. and surgical team. attending, to either the resident or to the surgical team.

☐ ☐ ☐ Creation of AV Fistula – Page 2

Procedure-Specific Criteria Placement of Incisions 5 4 3 2 1 Excellent Very Good Good Fair Poor NA Proximal incision Position of No concept of slightly distal to incision is functional needs antecubital crease functional but of procedure – – graft to radial not optimal for graft too short or side of arm; loop exposure of too long length 2/3 of distal target vessels to wrist ☐ ☐ ☐ ☐ ☐ ☐

Dissection of Vessels 5 4 3 2 1 Excellent Very Good Good Fair Poor NA Excellent Exposes brachial Disregard for independent artery sufficiently superficial veins; dissection of all for anastomosis injury to brachial vessels; mindful with guidance. artery or deep of plans Preserves most vein for anastomosis significant superficial veins ☐ ☐ ☐ ☐ ☐ ☐

Suturing Graft 5 4 3 2 1 Excellent Very Good Good Fair Poor NA Independently Generally pierces Sutures from sews with correct graft and vessels adventitia to needle angle and at 90 degrees intima on artery; at the correct and passes from inappropriate orientation intimal surface thickness/spacing throughout the out of artery of bites anastomosis ☐ ☐ ☐ ☐ ☐ ☐

Tunnel Graft 5 4 3 2 1 Excellent Very Good Good Fair Poor NA No kinks; Able to position Kinks; too deep appropriate depth graft adequately placement; graft; proximal to with guidance directly below distal suture line distal incision ☐ ☐ ☐ ☐ ☐ ☐ Creation of AV Fistula – Page 3

General Criteria Instrument Handling 5 4 3 2 1 Excellent Very Good Good Fair Poor NA Fluid movements Competent use Tentative or with instruments of instruments, awkward consistently occasionally movements, using appeared often did not appropriate awkward or did visualize tips of force, keeping not visualize instrument or tips in view, and instrument tips clips poorly placing clips placed securely ☐ ☐ ☐ ☐ ☐ ☐

Respect for Tissue 5 4 3 2 1 Excellent Very Good Good Fair Poor NA Consistently Careful tissue Frequent handled tissue handling, unnecessary carefully occasional tissue force or (appropriately), inadvertent damage by minimal tissue damage inappropriate damage instrument use ☐ ☐ ☐ ☐ ☐ ☐

Time and Motion 5 4 3 2 1 Excellent Very Good Good Fair Poor NA Clear economy Efficient time and Many of motion, and motion, some unnecessary maximum unnecessary moves efficiency moves ☐ ☐ ☐ ☐ ☐ ☐

Operation Flow 5 4 3 2 1 Excellent Very Good Good Fair Poor NA

Obviously Some forward Frequent lack of planned course planning, forward of operation and reasonable progression; anticipation of procedure frequently stopped next steps progression operating and seemed unsure of next move ☐ ☐ ☐ ☐ ☐ ☐ Creation of AV Fistula – Page 4

Overall Performance Rating of 4 or higher indicates technically proficient performance (i.e., resident is ready to perform operation independently, assuming resident consistently performs at this level)

5 4 3 2 1 Excellent Very Good Good Fair Poor NA ☐ ☐ ☐ ☐ ☐ ☐

Please indicate the weaknesses in this resident’s performance:

Please indicate the strengths in this resident’s performance: