Ether Resources for Anesthesia Research and Education

Self-Assessment and Feedback

Dr. Chu's Self-Assesment and Feedback Form

Please consider using this form as a self-assessment tool and way to solicit structured feedback from your attendings during your first month of anesthesia. I have developed this form over the past two years and tested it on several CA-1 residents and we think that it is fairly effective if used correctly.

You can download the form here and print out a copy for each day in the OR.

Please follow these important steps if you like to use this card:

  1. Give the front of the card to your attending in the AM and ask him/her to write down some goals and learning objectives for the day. This will help focus your learning and serve as a reminder to both you and your attending throughout the workday.
  2. After each case is started (but before you finish the case), ask your attending for 5-10 minutes of quiet reflection time to complete the self-assessment form. DO NOT give the form to your attending to fill out. This form is for you as a self-assessment of your own performance. Simply check Yes or No to reflect your self-assessment of your ability to complete a task adequately.
  3. Next. share the form comments with your attending. Together, discuss your self-assessment and any areas where you feel you might need some improvement. Your attending can share some advice or helpful pointers to guide your improvement.
  4. Keep your cards for the month.
  5. At the end of the month, review them and see how much progress you have made and note the useful advice and pointers you have received along the way!

I hope you enjoy this feedback card!



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