| Name: | |
| PASSS Membership No: | |
| NIC No: | |
| Phone: | |
| Email: | |
| Name of the City: | |
| Stamp of PASSS on Completion of Fellowship: |
Dear Fellows:
Please make sure to complete this logbook as requested and to have Supervisor sign for the skills you have acquired, as this logbook will be collected, checked and evaluated by us.
We are always grateful for constructive feedback to help us improve these logbooks and our teaching goals and would therefore be grateful if you could complete the evaluation at the end.
Thank you
Dr. Khalid Mahmud Shah
President, PASSS.
INSTRUCTIONS FOR THIS LOGBOOK:
The logbook is designed for carrying it with you and enables you to continuously document your progress. It is divided into a general and a specialized sections.
Please evaluate your skills at the beginning of the fellowship and fill in the corresponding column (see general section: defining the levels of competence). At the end of your fellowship you need to achieve 70% of the total score.
SUPERVISOR:
On your first working day one of the consultants will be allocated to you as your personal mentor for the duration of the fellowship. His responsibility will be to support your training and document on this logbook. He should enable you to achieve the required learning objectives and be accessible for your questions and problems during your fellowship. Once every two months there should be a feedback discussion with your mentor.
| My Supervisor’s: |
| First talk: |
Date and signature of your Supervisor
| Second talk: |
Date and signature of your Supervisor
| Final talk: |
Date and signature of your Supervisor
| Supervisor’s Signature Key: | ||
| Name of Supervisor: | Signature: | Initials: |
| 1. | ||
| 2. | ||
| 3. | ||
| 4. | ||
| 5. |
GENERAL SECTION
| EDUCATIONAL OBJECTIVES AND EXPERTISES |
| GENERAL OBJECTIVES: |
- To develop the ability to independently care for individual patients under the supervision of consultant.
- To show accountability to patients and colleagues.
- To develop practical skills in the context of the relevant theoretical knowledge.
- To further develop communicative, social and emotional skills.
- To integrate relevant differential diagnoses in your daily routine.
- To develop problem-oriented approaches.
- To learn to establish a clinically founded working diagnosis.
- To independently establish an appropriate treatment plan
| PERSONAL OBJECTIVES: |
Please define your personal educational objectives in the following table:
| Personal Objectives | Achieved |
| DEFINING THE LEVELS OF COMPETENCE: |
The Varying levels of competence are defined as follows:
Level 1: Factual knowledge (1 point)
The fellow has theoretical knowledge relevant to the surgical procedure.
Level 2: Practical Knowledge (2 points)
The fellow has seen the surgical procedure being done, either on a patient or during a demonstration. He or she should be able to elaborate on some facts concerning this procedure and be able to place it into its clinical and/or scientific context.
Level 3: Competence to act under supervision (3 points)
The fellow has completed the procedure him/herself under supervision, either on a patient or in a simulation on a model.
Level 4: Competence to act autonomously (4 points)
The fellow has competed the surgical procedure independently and in an appropriate situation, with appropriate knowledge of the indication(s) and possible complications/consequences.
In this context please note that the levels of competence in the right column admittedly are meant as objective targets, but we regrettably cannot ensure you to achieve the target in every single expertise because of that you get the acknowledgement of successfully concluding your fellowship by achieving ≥ 70% of the target score.
| PRACTICAL SKILLS | ||||
| The column “beginning of fellowship is to be completed by yourself, try and judge your skills before starting this fellowship. The other columns have to be signed by your Supervisor.” | Beginning of Fellowship | End of fellowship | Signature of Supervisor | Goal |
| General Medical Skills | ||||
| Structured patient history incl. presentation | 4 | |||
| Structure physical examination incl. neurological evaluation and documentation | 4 | |||
| Presenting patients incl. differential diagnosis and treatment options during the round | 4 | |||
| Hygienic and surgical disinfection of hands | 4 | |||
| Adequately and safely scrubbing in, putting on sterile clothing and working sterilely | 4 | |||
| Appropriate and sterilely changing of bandages | 4 | |||
| Appropriate removal of sutures and stitches | 4 | |||
| Removal of drains | 4 | |||
| Writing doctor’s letters and case discussions | 4 | |||
| Interpretation of X-ray | 4 | |||
| Interpretation of CT and MR scans | 3 | |||
| Apply local anesthesia | 3 | |||
| Request a council for patients | 3 | |||
| Leading ward rounds of own patients | 3 | |||
| Writing prescriptions and incapacity certifications | 3 | |||
| Conduct a pre-operation discussion | 2 | |||
| Practical Skills | ||||
| Conduct a pain history (including the use of a visual analogue scale) | 4 | |||
| Specific orthopedic examination of the knee | 4 | |||
| Specific orthopedic examination of the shoulder | 4 | |||
| Applying a sterile bandage in the OR | 3 | |||
| Description and evaluation of a lesion | 3 | |||
| Punction of a joint or a retention | 2 | |||
| Infiltration of a joint | 2 | |||
| Sonography of joints | 2 | |||
| Administration of blood transfusion (incl. Bloodtyping) | 2 | |||
| Dealing with coagulation factors | 2 | |||
| Principles of acute perioperative pain therapy | 2 | |||
| Management of chronic pain | 2 | |||
| Substances and their dosages in the pain therapy scheme of WHO | 2 | |||
| Surgeries | ||||
| Knee arthroscopy | 2 | |||
| Shoulder arthroscopy | 2 | |||
| Technique of patient positioning | ||||
| Adequately place a patient in the supine position | 3 | |||
| Adequately place a patient in the beach-chair position | 3 | |||
| Properly secure and cushion a patient | 3 | |||
| Sum of each column | 104 |
| Total score: | 104 |
| Number of points at half term: Date/Signature of supervisor | |
| Number of points at the end of term: Date/Signature of supervisor |
| EVALUATION OF THE FELLOW’S PERFORMANCE BY THE SUPERVISOR |
| Expert Knowledge | Very Good | Good | Satisfactory | Fragmentary | Inadequate |
| Contact with patients | Very Good | Good | Satisfactory | Fragmentary | Inadequate |
| Accuracy and dependability | Very Good | Good | Satisfactory | Fragmentary | Inadequate |
| Work scheduling | Very Good | Good | Satisfactory | Fragmentary | Inadequate |
Supervisor Name:
Signature & date
| Readiness for work | Very Good | Good | Satisfactory | Fragmentary | Inadequate |
| Cogitation and sagacity | Very Good | Good | Satisfactory | Fragmentary | Inadequate |
| Work pace | Very Good | Good | Satisfactory | Fragmentary | Inadequate |
Supervisor Name
Signature & date
| Procedure | Fellow Sign | Supervisor Sign | Date |
| Unit 1-Basic Principles of Arthroscopy | |||
| Unit 2-Basic Triangulation Skills | |||
| Unit 3-Basic Interventional Arthroscopy, Knee and Shoulder | |||
| Unit 4-Suture Anchors, Passing Suture through Tissue, Arthroscopic Knot Tying | |||
| Unit 5-Research, Paper writing and Presentation |
| SPECIALIZED SECTION | |||||||||
| Specific Arthroscopic Procedures “CODE-A” Procedure’s Observed/Assisted | |||||||||
| Procedure | PT Initial | Date | Supr. Sign | PT Initial | Date | Supr. Sign | PT Initial | Date | Supr. Sign |
| Acute Haemarthrosis Arthroscopy | |||||||||
| Arthroscopy knee diagnostic | |||||||||
| Arthroscopic removal loose bodies knee | |||||||||
| Arthroscopic menisectomy | |||||||||
| Arthroscopic lateral release | |||||||||
| Arthroscopic synovectomy | |||||||||
| Arthroscopic saucerisation +/- stabilization discoid meniscus | |||||||||
| Arthroscopic arthrolysis of knee | |||||||||
| Meniscal repair (arthroscopic: all inside, inside out, outside in) | |||||||||
| ACL reconstruction – arthroscopic | |||||||||
| Arthroscopic Microfracture | |||||||||
| Arthroscopic chondroplasty | |||||||||
| Arthroscopic repair of osteochondral fragments | |||||||||
| Specific Arthroscopic Procedures “CODE-A” Procedure’s Observed/Assisted | |||||||||
| Procedure | PT Initial | Date | Supr. Sign | PT Initial | Date | Supr. Sign | PT Initial | Date | Supr. Sign |
| Arthroscopic harvest of articular cartilage for Stage | |||||||||
| Irrigation and debridement native joint for infection (arthroscopic) – Knee | |||||||||
| Irrigation and debridement prosthesis for infection (arthroscopic) – knee | |||||||||
| Arthroscopy Diagnostic – Shoulder | |||||||||
| Shoulder – arthroscopic thermal capsular shrinkage | |||||||||
| Arthroscopic subacromial decompression | |||||||||
| Arthroscopic capsular release for capsulitis of shoulder | |||||||||
| Arthroscopic removal loose body – shoulder | |||||||||
| Arthroscopic biceps tenodesis | |||||||||
| Rotator cuff repair (Open or arthroscopic) +/- acromioplasty | |||||||||
| Specific Arthroscopic Procedures “CODE-A” Procedure’s Observed/Assisted | |||||||||
| Procedure | PT Initial | Date | Supr. Sign | PT Initial | Date | Supr. Sign | PT Initial | Date | Supr. Sign |
| Irrigation and debridement native joint for infection (arthroscopic) – shoulder | |||||||||
| Irrigation and debridement prosthetic joint for infection (arthroscopic) – shoulder | |||||||||
| Specific Arthroscopic Procedures “CODE-S” Procedure’s performed under Supervision | |||||||||
| Procedure | PT Initial | Date | Supr. Sign | PT Initial | Date | Supr. Sign | PT Initial | Date | Supr. Sign |
| Acute Haemarthrosis Arthroscopy | |||||||||
| Arthroscopy knee diagnostic | |||||||||
| Arthroscopic removal loose bodies knee | |||||||||
| Arthroscopic menisectomy | |||||||||
| Arthroscopic lateral release | |||||||||
| Arthroscopic synovectomy | |||||||||
| Arthroscopic saucerisation +/- stabilization discoid meniscus | |||||||||
| Arthroscopic arthrolysis of knee | |||||||||
| Meniscal repair (arthroscopic: all inside, inside out, outside in) | |||||||||
| ACL reconstruction – arthroscopic | |||||||||
| Arthroscopic Microfracture | |||||||||
| Arthroscopic chondroplasty | |||||||||
| Arthroscopic repair of osteochondral fragments | |||||||||
| Arthroscopic harvest of articular cartilage for Stage | |||||||||
| Specific Arthroscopic Procedures “CODE-S” Procedure’s performed under Supervision | |||||||||
| Procedure | PT Initial | Date | Supr. Sign | PT Initial | Date | Supr. Sign | PT Initial | Date | Supr. Sign |
| Irrigation and debridement native joint for infection (arthroscopic) – Knee | |||||||||
| Irrigation and debridement prosthesis for infection (arthroscopic) – knee | |||||||||
| Arthroscopy Diagnostic – Shoulder | |||||||||
| Shoulder – arthroscopic thermal capsular shrinkage | |||||||||
| Arthroscopic subacromial decompression | |||||||||
| Arthroscopic capsular release for capsulitis of shoulder | |||||||||
| Arthroscopic removal loose body – shoulder | |||||||||
| Arthroscopic biceps tenodesis | |||||||||
| Rotator cuff repair (Open or arthroscopic) +/- acromioplasty | |||||||||
| Irrigation and debridement native joint for infection (arthroscopic) – shoulder | |||||||||
| Specific Arthroscopic Procedures “CODE-S” Procedure performed under Supervision | |||||||||
| Procedure | PT Initial | Date | Supr. Sign | PT Initial | Date | Supr. Sign | PT Initial | Date | Supr. Sign |
| Irrigation and debridement prosthetic joint for infection (arthroscopic) – shoulder | |||||||||
| Specific Arthroscopic Procedures “CODE-I” Procedure’s performed Independently | |||||||||
| Procedure | PT Initial | Date | Supr. Sign | PT Initial | Date | Supr. Sign | PT Initial | Date | Supr. Sign |
| Acute Haemarthrosis Arthroscopy | |||||||||
| Arthroscopy knee diagnostic | |||||||||
| Arthroscopic removal loose bodies knee | |||||||||
| Arthroscopic menisectomy | |||||||||
| Arthroscopic lateral release | |||||||||
| Arthroscopic synovectomy | |||||||||
| Arthroscopic saucerisation +/- stabilization discoid meniscus | |||||||||
| Arthroscopic arthrolysis of knee | |||||||||
| Meniscal repair (arthroscopic: all inside, inside out, outside in) | |||||||||
| ACL reconstruction – arthroscopic | |||||||||
| Arthroscopic Microfracture | |||||||||
| Arthroscopic chondroplasty | |||||||||
| Arthroscopic repair of osteochondral fragments | |||||||||
| Arthroscopic harvest of articular cartilage for Stage | |||||||||
| Specific Arthroscopic Procedures “CODE-I” Procedure’s performed Independently | |||||||||
| Procedure | PT Initial | Date | Supr. Sign | PT Initial | Date | Supr. Sign | PT Initial | Date | Supr. Sign |
| Irrigation and debridement native joint for infection (arthroscopic) – Knee | |||||||||
| Irrigation and debridement prosthesis for infection (arthroscopic) – knee | |||||||||
| Arthroscopy Diagnostic – Shoulder | |||||||||
| Shoulder – arthroscopic thermal capsular shrinkage | |||||||||
| Arthroscopic subacromial decompression | |||||||||
| Arthroscopic capsular release for capsulitis of shoulder | |||||||||
| Arthroscopic removal loose body – shoulder | |||||||||
| Arthroscopic biceps tenodesis | |||||||||
| Rotator cuff repair (Open or arthroscopic) +/- acromioplasty | |||||||||
| Irrigation and debridement native joint for infection (arthroscopic) – shoulder | |||||||||
| Specific Arthroscopic Procedures “CODE-I” Procedure’s performed Independently | |||||||||
| Procedure | PT Initial | Date | Supr. Sign | PT Initial | Date | Supr. Sign | PT Initial | Date | Supr. Sign |
| Irrigation and debridement prosthetic joint for infection (arthroscopic) – shoulder | |||||||||
| S.no | Task | Description | Date | Supervisor Signature |
| 1 | Attended sports tournament as sport physician | |||
| 2 | Attended sports tournament as sport physician | |||
| 3 | Presentation in Conference | |||
| 4 | Publication in Journal | |||
| DOP’s Proforma Fellow First Name: | Surname: | |||||||||
| Assessment date: | ||||||||||
| Hospital: | ||||||||||
| Name of Procedure: | ||||||||||
| Difficulty of Procedure: | ||||||||||
| Easier than usual | ||||||||||
| Average | ||||||||||
| More difficult than usual | ||||||||||
| Number of times this procedure has been performed by this fellow prior to this occasion: | ||||||||||
| Assessors Position: | ||||||||||
| Consultant | ||||||||||
| Other health care professional | ||||||||||
| How to use this form: | ||||||||||
| DOP’s are used to facilitate developmental feedback during routine surgical practice in wards, outpatient clinics or operating theatre. This is a criterion-based tool to determine competence and facilitate appropriate feedback. | ||||||||||
| Fellows are encouraged to choose a different assessor for each assessment, but one of the assessors must be the current assigned educational supervisor. Most assessment take 15-20 minutes to complete including feedback. | ||||||||||
| Multiple scores of “Borderline” or a single score of “Below Expectation” indicates a need for significant improvement in performance. Fellow should be counseled and given opportunity to improve in the relevant skills before being reassessed. This process may be repeated until significant improvement is demonstrated. | ||||||||||
| Instruction for fellow: | ||||||||||
| Choose a major case in your repertoire that you are going to carry out with a consultant. | ||||||||||
| Speak to the consultant and make sure that the consultant is available. | ||||||||||
| Make sure the consultant/supervisor is happy to do the case with you and complete the forms appropriately. | ||||||||||
| Speak to the consultant regarding feedback about how you might improve on any deficiencies noted. | ||||||||||
| The fellow should keep a copy of this evidence in their portfolio. | ||||||||||
| DIRECT OBSERVATION OF PROCEDURAL SKILLS (DOPS) FORM | ||||||||||
| Scoring | ||||||||||
| Fellow Name: | Not Competent | Competent | Excellent | N/A | ||||||
| Procedure to be assessed: | ||||||||||
| Date: | ||||||||||
| Before the Operation | ||||||||||
| Demonstrates knowledge of Indications/contraindicationsComplications | ||||||||||
| Explain to patient/relatives as above and checks understanding, especially side and site | ||||||||||
| Explains to patient likely outcome including time frame. Checks understanding | ||||||||||
| In Theatre | ||||||||||
| Checks | ||||||||||
| Equipment | ||||||||||
| Limb Marking | ||||||||||
| Any implant required; and choice appropriate | ||||||||||
| X-rays/imaging | ||||||||||
| Demonstrates safe aseptic technique & safe use of instruments (sharps) | ||||||||||
| Demonstrates appropriate liaison with anesthetist/theatre staff, e.g. positioning, antibiotics | ||||||||||
| During Surgery demonstrates | ||||||||||
| Knowledge of skin incision | ||||||||||
| Knowledge of exposure | ||||||||||
| Care with soft tissues | ||||||||||
| Knowledge and use of instruments | ||||||||||
| Knowledge of procedure | ||||||||||
| Good use of assistant | ||||||||||
| Ability to control bleeding | ||||||||||
| Ability to adapt procedure to any unexpected event | ||||||||||
| Ability to close wound and apply dressing | ||||||||||
| Manual dexterity required to carry out procedure | ||||||||||
| Ability to adapt procedure to accommodate unexpected events | ||||||||||
| After the Operations | ||||||||||
| Remains responsible until patient in recovery | ||||||||||
| Documents the operation and post-operative plan | ||||||||||
| Communicates the outcome to patient/relatives | ||||||||||
| Analyses own clinical performance for continuous improvement | ||||||||||
| Name of Consultant | ||||||||||
| Signature of Consultant | Signature of Fellow | |||||||||
| Suggestion for development |
| Agreed Action |
| Self-reflection – what did you learn from this assessment experience? |
| Assessor’s Signature: | |
| Assessor’s Name: | |
| Fellow’s Name: | |
| Signature of Fellow: |
FEEDBACK FORM
Please take a few moments to provide us with some important feedback about your professional development fellowship program. Information will be used to improve the fellowship program.
| Fellowship city: | Peshawar | Islamabad/RWP | Lahore | Karachi |
- Of the following considerations, please select up to three (3) that were most important in your decision to select this fellowship.
- Supervisors facilitating the fellowship.
- Fellowship syllabus.
- Length of the fellowship.
- Description of teaching/learning methods to be employed.
- Other (please specify) .
| Please indicate the extent to which you agree or disagree with the following Statement (mark N/A if the statement is not applicable | Strongly Disagree | Neither agree nor disagree | Strongly Agree | N/A |
| The supervisor(s) were well organized. | ||||
| The supervisor(s) made good use of the time allotted. | ||||
| The supervisor(s) seemed knowledgeable about the topics. | ||||
| The supervisor(s) presentation style was effective in helping me learn. | ||||
| The teaching/training methods used were appropriate. | ||||
| The materials provided were useful to me. | ||||
| I enjoyed the fellowship. | ||||
| I understood the concepts as presented in the fellowship. | ||||
| The fellowship improved my understanding of Arthroscopy and Sports Surgery | ||||
| The fellowship improved my ability to utilize skills related to Arthroscopy and Sports Surgery. | ||||
| The knowledge and skills I learned will be useful to me in my career. | ||||
| I would recommend this fellowship to other. |
- What one thing would you recommend be done to improve this fellowship for future participants.
- Please share any other comments you have regarding this fellowship (use the back of this form if needed).
Thank you. Please return this form by placing it in the envelope provided to the facilitator.