Expectation: Knows Knows How Shows How Assists Does

Image-Guided Paracentesis (IGP) Entrustable Professional Activity (EPA) Checklist: Residents must document 3 successful Paracenteses prior to performing with indirect supervision (with direct supervision immediately available). Guidance (circle): CT US The Resident has successfully completed RESIDENT: ______Level: R1 R2 R3 R4 3 Image-Guided Paracenteses using US EXPECTATION: KNOWS KNOWS HOW SHOWS HOW ASSISTS DOES or CT and is competent to perform this procedure with indirect supervision (with direct supervision immediately Miller’s Pyramid available). Medical Knowledge Yes No N/A 1. The resident knows (states) what a Paracentesis is, why it is being performed and the indications/contraindications; knows how (describes) how to perform the procedure, including Faculty Signature: risks and benefits; shows how to perform the procedure? ______Yes No N/A ______Date______Interpersonal & Communication Skills 2. The resident introduces her-/himself to the patient, explains the procedure adequately, Faculty Name/Title: answers all patient and family’s questions and obtains informed consent? ______Yes No N/A ______Patient Care & Procedural Skill 3. The resident checks pertinent history, exams, and indications? The resident examines the patient prior to prep for appropriate entry site? Yes No N/A

4. The resident performs (does) the procedure in a technically competent manner? Scrubbed? Local anesthesia? Enter post-op orders? Time out? Ensure sample is labeled & labs Sterile technique? ordered properly? Identify appropriate Confirm dressing location, avoiding bowel? placement? Yes No N/A Medical Knowledge (& Communication Skills) 5. The resident creates an appropriate dictation which includes significant findings and pertinent negatives? Yes No N/A Practiced based learning and improvement 6. The resident selects appropriate additional views or maneuvers to accomplish proper puncture location? Yes No N/A Systems Based Practice 7. The resident uses principles of ALARA to minimize radiation dose? Yes No N/A Professionalism 8. The resident effectively communicates with patient, technologists and all others present before, during and after the procedure? Yes No N/A

The Resident performed the procedure/examination at the following level (circle one): KNOWS KNOWS HOW SHOWS HOW ASSISTS DOES

The resident performed this procedure in a competent manner? Yes No (If No is selected, faculty must provide written formative feedback in the box below.) PROVIDE FEEDBACK IN THE BOX BELOW: