LB359 Lennox Bell Lodge
60 Pearl Street
Winnipeg, MB R3E 1X2
Tel: (204)-787-8980
Fax: (204)-7874291
FACULTY OF MEDICINE
Department of Anesthesia
Anesthesia Clinical Assistant Program
Anesthesia Non-technical Behavioural Skills Assessment (ANTS)
ACA ______________________
Evaluation at:
Date _______________
1 month
2 months
Preceptor ____________________
4 months
10 months
Expand on this ACA’s strengths and offer suggestions for further development in the following areas:
Team Working
Works in a group context, in any role, to ensure effective joint task completion & team member satisfaction:

Collaborative, coordinates activities/works together with others

Exchanges information, confirms shared understanding, communicates relevant information

Uses authority and assertiveness when in leadership role, gives clear instructions

Able to judge own skills, calls for assistance when needed, alert to capabilities of other team members

Acknowledges concerns, provides physical, cognitive help and/or reassurance & encouragement to others
Strengths
Suggestions for further development
Rating
Decision Making
Skills for selecting a course of action or making a diagnosis, in normal conditions and in time-pressured situations:

Identifies options, generates alternative possibilities or actions, weighs factors with respect to patient & situation

Balances risks, considers advantages & disadvantages of various courses of action

Implements chosen option in a timely fashion
Strengths
Rating
4 - Excellent
Suggestions for further development
3 – Good
2 - Marginal
1 – Needs Remedial
Rating
NA- (Not observed)
Task management
Skills for organizing resources and required activities to achieve goals:

Plans & prepares, uses mental checklists, develops contingency strategies

Establishes necessary/available requirements (people, expertise, equipment, time), uses these for task completion

Reviews case plan with Anesthesiologist in light of changes

Schedules tasks & activities according to importance., avoids distraction

Follows published protocols & guidelines, maintains quality & safety standards, keeps accurate anesthesia records
Strengths
Suggestions for further development
Rating
Situation Awareness
Develops & maintains vigilance in all relevant aspects of the theatre environment (patient condition, progress of
surgery, progress of anesthesia, monitoring information, equipment, time, personnel):

Gathers information continuously, verifies data to confirm their reliability

Anticipates, thinks ahead about potential outcomes & consequences of intervention/non-intervention

Runs projections of current situation to predict what might happen next, takes action to mitigate potential problems

Recognizes the significance of a mismatch between a situation & the expected state & reacts accordingly
Strengths
Rating
4 - Excellent
3 - Good
Suggestions for further development
2 - Marginal
1 – Needs Remedial
Rating
NA – (Not observed)
Other comments:
ACA signature____________________________ Preceptor signature _______________________________