ICO-Ophthalmology Surgical Competency Assessment Rubric: Lateral Tarsal Strip (ICO-OSCAR: LTS) Date ______ Resident __________ Evaluator __________ Novice (score = 2) Beginner (score = 3) Advanced Beginner (score = 4) Competent (score = 5) Not applicable. Done by preceptor score= 0 1 Local anesthetic administration: location & volume Inappropriate amount. Anaesthetic too deep or too superficial (i.e. scraping bone or periosteum or blanching). Wrong location leading to pain later in the procedure. Excessive amount of anaesthesia, causing chemosis and interfering with dissection or insufficient amount/suboptimal placement. Appropriate amount of anaesthetic applied in near optimal locations. Does not interfere with completion of case. Infiltration of local anesthetic (with epinephrine) extending from the lateral canthal angle down to the orbital rim periosteum avoiding larger vessels. Sufficient volume to deliver analgesia and assist hemostasis without inducing chemosis. 2 Preparation & Draping: clear surgical field Inadequate drape position. Hair sticking out. Poorly wrapped so unravels during procedure. Drape interfering with surgical access. Sudden, direct focusing of overhead lamp on patient’ face Drapes placed adequately, but exposure is not optimal and drapes become loose during the procedure. Light not angled optimally. Drapes placed adequately but exposure is not optimal. Light angled appropriately. Good access to the lateral canthus and lateral orbital rim. Light angled from above patient’s head, allowing gradual adjustment to brightness. Face exposed from hairline to below nose to allow comparison of right and left canthal positions during surgery. 3 Incision: Location, Length, direction, Orientation Poorly constructed incision. Too short/long or against relaxed skin tension line. Inappropriate depth. Anatomy not appropriately exposed. Incision is too long with poor respect for relaxed skin tension line. Incision is small, but surgeon realizes and lengthens it. Incision follows relaxed skin tension line. Incision extending from the canthal angle approximately laterally along the relaxed skin tension line to expose the orbital rim.
9 Suturing: canthus, muscle & skin closure Failure to reform lateral canthus. Poor suture technique and or result - difficulty mounting sutures, multiple attempts at placement, alignment of sutures poor. Canthal angle is misaligned. Inadequate wound closure or inappropriate orbicularis excision. Canthal angle is roughly in place but not perfectly aligned. Realizes mistake and corrects it. Lateral canthal angle reformed with or without an absorbable suture. Orbicularis preserved and plicated superiorly to the orbital rim periosteum to support the lower lid. Excess skin trimmed and skin closed without undue tension on the wound. Global Indices 10 Maintaining haemostasis Poor anatomical knowledge of vasculature. Incorrect settings or usage of electrocautery resulting in burns, collateral damage or failure to adequately achieve haemostasis. Has trouble identifying source of bleeding. Cautery is applied to the area instead of the point of bleeding. Hemostasis is good overall, but has trouble managing larger bleeders. Electrocautery used effectively to achieve hemostasis during each step of the procedure allowing for clear visualization of anatomy. 11 Adequate tissue visualization Failure to adhere to surgical planes. Failure to expose tissue appropriately during dissection. Unable to consistently attain good surgical exposure. Corrects mistake(s) with instruction. Reasonable surgical exposure but not respecting surgical planes consistently. Realizes mistakes and attempts to correct. Sufficient incision size, hemostasis and retraction to allow for consistently good tissue exposure. 12 Respect of tissue/tissue handling Repeated unnecessary handling of tissue. Crush injuries through inappropriate use of forceps. Damage to tissue by repeated placement of sutures. Some unnecessary tissue handling and mild tissue damage occurs. Minimal unnecessary tissue handling without tissue damage. Good knowledge of the regional anatomy with efficient manipulation of tissues and minimal dissection required to create and plicate the strip. Demonstrated spatial awareness within the surgical field. 13 Knowledge of instruments Poor or no knowledge of instruments. Inappropriate combinations of suture holders, scissors and forceps resulting in unsafe surgery or collateral damage. Occasionally uses inappropriate instrument and doesn’t realize it. Occasionally uses an inappropriate instrument but realizes mistake and corrects it. Appropriate instruments used throughout case.