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. Planning of Incision Poor Fair Good Very Good Excellent 1 2 3 4 5 NA Poor incision Understands most Excellent planning principles in planning of planning incision incision (use of wire, if utilized) Substantial Some Minimal Direction Direction Direction 1 2 3 4 5 NA Margins of Excision Poor Fair Good Very Good Excellent 1 2 3 4 5 NA Inappropriate Adequate margins Excellent margins and/or of excision technique in lesion entered assuring during dissection appropriate margins of excision Substantial Some Minimal Direction Direction Direction 1 2 3 4 5 NA Sentinel Node Mapping Poor Fair Good Very Good Excellent 1 2 3 4 5 NA Poor knowledge Utilized scintigraphy and and technique in to identify SLN(s) efficient SLN SLN mapping but with some mapping inefficiencies Substantial Some Minimal Direction Direction Direction 1 2 3 4 5 NA
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. Planning of Incision Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 NA Poor incision planning Understands most principles in planning incision Excellent planning of incision (use of wire, if utilized) Substantial Direction 1 2 Some Direction 3 4 Minimal Direction 5 NA Margins of Excision Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 NA Inappropriate margins and/or lesion entered during dissection Adequate margins of excision Excellent technique in assuring appropriate margins of excision Substantial Direction 1 2 Some Direction 3 4 Minimal Direction 5 NA Sentinel Node Mapping Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 NA Poor knowledge and technique in SLN mapping Utilized scintigraphy to identify SLN(s) but with some inefficiencies and efficient SLN mapping Substantial Direction 1 2 Some Direction 3 4 Minimal Direction 5 NA
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