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Multisource feedback (MSF) or 360 assessment forms are when non-anesthesiologists assess our anesthesia residents. They are people we work with on a regular basis and their perspectives are valuable for the clinically competent anesthesiologist to work effectively in a team setting.
MSF forms can be completed by surgeons, OR nurses, PACU nurses, PAC nurses, ICU nurses, anesthesia assistants (AAs), respiratory therapists (RTs), and pharmacists.
Residents will inform the allied health care worker about a request for an MSF. The assessment forms below can be printed and given to the assessor. The assessor will write their names on the form and submit to Lori Dengler, but results will be anonymous when given to the resident.
Providing perioperative anesthetic management for adult ASA 1 or 2 patients undergoing scheduled, uncomplicated surgery
Observers: OR nurse, PACU nurse, RT/AA, surgeon
Collect feedback on 1 occasion from at least 10 observers.
Anes Found EPA 9 Part C fillable form OR nurses - MSF.pdfAssessment form - OR nurses
Anes Found EPA 9 Part C fillable form PACU nurses - MSF.pdfAssessment form - PACU nurses
Managing common complications of labour analgesia
Observers: labour & delivery nurse, OB nurse
Collect feedback on one occasion from at least 6 observers
Anes Found EPA 20 Part B fillable form L&D nurses- MSF.pdfEPA 3.6 *elective
EPA 3.6 *elective
Performing as an integral member of the patient care team on daily ICU rounds by recommending management decisions consistent with best practice standards and guidelines (elective)
Observers: ICU nurse, RT, pharmacists, other
Collect feedback on one occasion at the end of a clinical experience of at least 4 weeks in an intensive care unit
- At least one of each observer role
- At least 8 observers
Anes Core EPA 6 Part B fillable form - elective MSF.pdfProviding perioperative anesthetic management for adult patients with complex medical issues undergoing scheduled or emergent surgical procedures
Observers: OR nurse, PACU nurse, RT/AA, surgeon
Collect feedback on 2 occasions at least 12 months apart
- At least one from each observer role
- At least 10 observers at each time point
Anes Core EPA 11 Part C fillable form - MSF.pdfProviding labour analgesia and peripartum anesthetic management for high-risk parturients having a non-surgical delivery
Observers: OB nurse, obstetrician
Collect feedback on one occasion from at least 10 observers
- At least one of each observer role
- At least 10 observers
Anes Core EPA 20 Part B fillable form - MSF.pdfManaging all aspects of patient care for a scheduled day list, including the organizational aspects related to the management of the operating room case load
Observers: OR nurse, PACU nurse, RT/AA, surgeon
Collect feedback from 8 observers
- At least 2 surgeons
- At least 2 OR nurses
- At least 2 PACU nurses
- At least 2 anesthesia assistant/respiratory therapist
Anes TTP EPA 3 Part B fillable form - MSF.pdfGoogle Sites
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