<p> Operative Performance Rating System (OPRS)</p><p>TOTAL/SKIN-SPARING MASTECTOMY WITH AXILLARY MANAGEMENT</p><p>Evaluator: Resident: Resident Level: Program: </p><p>Date of Time Procedure Procedure: Was Completed: Date Assessment Was Time Assessment Completed: Was Initiated:</p><p>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.</p><p>Case Difficulty 1 2 3 4 5</p><p>Straightforward anatomy, no Intermediate difficulty Abnormal anatomy, related prior surgeries or extensive pathology, related treatment prior surgeries or treatment (for example radiation), or obesity ☐ ☐ ☐ ☐ ☐</p><p>Degree of Prompting or Direction</p><p>Substantial Direction Some Direction Minimal Direction 1 2 3 4 5</p><p>Unable to direct team, Actively assists and Performs all steps and use/choose instruments, or anticipates own and directs team with minimal anticipate next steps as attending’s needs, performs direction from attending to surgeon or as first assistant basic steps with occasional either resident or team, i.e., without constant attending attending direction to anticipates needs, sets up prompting resident and/or surgical exposure for self and team. Somewhat hesitant assistant, transitions fluently and slow to anticipate or between steps, gives clear recognize aberrant direction to first assistant, anatomy, unexpected maintains situation findings, and/or “slowing awareness, calmly recovers down” moments from error and recognizes when to seek help/advice</p><p>☐ ☐ ☐ ☐ ☐ Total / Skin-Sparing Mastectomy with Axillary Management – Page 2 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.</p><p>Placement of Incision Poor Fair Good Very Good Excellent 1 2 3 4 5 NA Poor incision Adequate Marked incision planning incision planning to allow appropriate orientation, adequate tumor clearance and skin excision ☐ ☐ ☐ ☐ ☐ ☐</p><p>Substantial Some Minimal Direction Direction Direction 1 2 3 4 5 NA ☐ ☐ ☐ ☐ ☐ ☐</p><p>Elevation of Flaps Poor Fair Good Very Good Excellent 1 2 3 4 5 NA Poor technique in Efficient flap Rapid and flap elevation elevation with efficient flap occasional elevation with 3 failures to stay in to 8 mm flap proper plane thickness ☐ ☐ ☐ ☐ ☐ ☐</p><p>Substantial Some Minimal Direction Direction Direction 1 2 3 4 5 NA ☐ ☐ ☐ ☐ ☐ ☐</p><p>Sentinel Node Identification & Dissection Poor Fair Good Very Good Excellent 1 2 3 4 5 NA Poor technique in Utilized Rapid and SLN mapping scintigraphy to efficient SLN identify SLN(s) mapping but with some inefficiencies ☐ ☐ ☐ ☐ ☐ ☐</p><p>Substantial Some Minimal Direction Direction Direction 1 2 3 4 5 NA Total / Skin-Sparing Mastectomy with Axillary Management – Page 3 ☐ ☐ ☐ ☐ ☐ ☐</p><p>Anatomic Dissection of Borders Poor Fair Good Very Good Excellent 1 2 3 4 5 NA Poor dissection Hesitant Rapid Level and inadequate dissection, but 1-2 dissection; identification of adequate excellent borders identification of identification of borders borders ☐ ☐ ☐ ☐ ☐ ☐</p><p>Substantial Some Minimal Direction Direction Direction 1 2 3 4 5 NA ☐ ☐ ☐ ☐ ☐ ☐</p><p>Identification of Nerves Poor Fair Good Very Good Excellent 1 2 3 4 5 NA Failed to clearly Some unprompted Clearly identified identify nerves nerve identification and preserved and preservation nerves during dissection ☐ ☐ ☐ ☐ ☐ ☐</p><p>Substantial Some Minimal Direction Direction Direction 1 2 3 4 5 NA ☐ ☐ ☐ ☐ ☐ ☐</p><p>Flap Closure Poor Fair Good Very Good Excellent 1 2 3 4 5 NA Poor flap closure Good flap closure Excellent flap without attention and attention to closure and to appropriate appropriate flap attention to tension tension appropriate flap tension without redundancy ☐ ☐ ☐ ☐ ☐ ☐ Total / Skin-Sparing Mastectomy with Axillary Management – Page 4 Substantial Some Minimal Direction Direction Direction 1 2 3 4 5 NA ☐ ☐ ☐ ☐ ☐ ☐</p><p>General Criteria Instrument Handling Poor Fair Good Very Good Excellent 1 2 3 4 5 NA Tentative or Competent use Fluid movements awkward of instruments, with instruments movements, occasionally consistently using often did not appeared appropriate force, visualize tips of awkward or did keeping tips in instrument or not visualize view, and placing clips poorly instrument tips clips securely placed ☐ ☐ ☐ ☐ ☐ ☐</p><p>Respect for Tissue Poor Fair Good Very Good Excellent 1 2 3 4 5 NA Frequent Careful tissue Consistently unnecessary handling, handled tissue tissue force or occasional carefully damage by inadvertent (appropriately), inappropriate damage minimal tissue instrument use damage ☐ ☐ ☐ ☐ ☐ ☐</p><p>Time and Motion Poor Fair Good Very Good Excellent 1 2 3 4 5 NA Many Efficient time and Clear economy unnecessary motion, some of motion, and moves unnecessary maximum moves efficiency ☐ ☐ ☐ ☐ ☐ ☐</p><p>Operation Flow Poor Fair Good Very Good Excellent 1 2 3 4 5 NA Frequent lack of Some forward Obviously forward planning, planned course progression; reasonable of operation and frequently stopped procedure anticipation of operating and progression next steps seemed unsure of next move ☐ ☐ ☐ ☐ ☐ ☐ Overall Performance (not included in calculation of mean score) Total / Skin-Sparing Mastectomy with Axillary Management – Page 5 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)</p><p>Poor Fair Good Very Good Excellent</p><p>☐ ☐ ☐ ☐ ☐</p><p>Please indicate the weaknesses in this resident’s performance:</p><p>Please indicate the strengths in this resident’s performance:</p>