There are three scales routinely incorporated into a SIMPL evaluation. They are used by both faculty and trainee raters to assess the trainee's educational experience and demonstrated performance during an operation.
Zwisch Rating
Prompt
What is the resident’s Zwisch level for the majority of the critical portion of this procedure?
Scale
Zwisch Scale | Attending behaviors | Resident behaviors |
Show & Tell | Does >50% of critical portion - Demonstrates key concepts, anatomy, and skills
- Explains case (ie. narrates)
| - Opens and closes
- Passively first assists & observes
|
Active Help | Leads the resident (active assist) for >50% of the critical portion - Optimizes the field/exposure
- Demonstrates plane/structure
- Coaches technical skills
- Coaches next steps
- Identifies key anatomy
| The above, plus: - Practices component technical skills
- Practices active assisting (i.e. anticipating surgeon’s needs)
|
Passive Help | Follows the lead of the resident (passive assist) for >50% of the critical portion - Acts as a capable first assistant
- Coaches for polish, refinement of skills, and safety
| The above, plus: - Can "set up" and accomplish next steps
- Learns to recognize critical transition points
|
Supervision Only | Provides no unsolicited advice for >50% of the critical portion - Monitors progress and patient safety
| The above, plus: - Mimics independence
- Works with a less experienced assistant
- Safely completes the case without faculty guidance
- Recovers from most errors
- Recognizes when to seek advice/help
|
Performance Scale
Prompt
What is this resident’s performance for the majority of the critical portion of this procedure?
Scale
Performance Scale | Training Descriptor | ACGME Milestone Mapping |
Unprepared / Critical Deficiency | - Poorly prepared to perform this procedure and/or included critical performance errors that endangered the safety of the patient or the outcome of the procedure.
| Level 0: Critical Deficiencies |
Inexperienced w/ Procedure | - Resident appears inexperienced in performing this procedure.
- Frequent problems regarding technique, execution, smoothness, efficiency, and forward planning.
| Level 1: Incoming resident |
Intermediate Performance | - Performance reflects an intermediate stage of development.
- Performance of procedural elements is variable but acceptable for the amount of experience with this procedure.
- Not yet at the level expected for graduating residents.
| Level 2: Advancing but not yet mid-level - and - Level 3: Hits majority of targets |
Practice- Ready Performance | - Resident is ready to perform this operation safely, effectively and independently assuming resident consistently performs procedure in this manner
| Level 4: Graduation target |
Exceptional Performance | - One of the best performances I have ever seen. Above the level expected of graduating residents
| N/A |
Complexity Scale
Prompt
What is the relative complexity of this procedure compared to procedures of a similar type?
Scale
Level |
Easiest 1/3 |
Average |
Hardest 1/3 |
