Operating Room: Scrub Skills Checklist

Personal Information
Name
E-Mail address

Please indicate your overall practical experience level with each skill using the key below. All fields are required.

Key
None	No experience
Limited	Requires additional training
Moderate	Have performed and able to do without supervision
Well Skilled	Very experienced and able to perform independently
Proficient	Able to teach and supervise

General Surgery	None	Limited	Moderate	Well Skilled	Proficient
Interpretation Abdominal Perineal Resection
Adrenalectomy
Bowel Resection
Cholecystectomy
Colostomy/Illeostomy
Gastrectomy
Hemicolectomy
Hepatic Resection
Hemiorrhaphy-Femoral/Inguinal
Hiatal Hemiorrhaphy-Transabdominal
Pancreatectomy
Organ Procurement
Radical Mastectomy
Saphenous Vein Ligation and Stripping
Splenectomy
Thyroidectomy
Whipple Procedure
Laparoscopic Procedures	None	Limited	Moderate	Well Skilled	Proficient
Cholecystectomy
Appendectomy
Hernia Repair
Colon Resection
Gynecology	None	Limited	Moderate	Well Skilled	Proficient
Cesarean Section
Dilation & Curettage
Hysterectomy-Vaginal
Hysterectomy-Abdominal
Laser Surgery
Radium Insertion
Salpingo Oopherectomy
Shirodkar Procedure
Termination of Pregnancy
Tubal Ligation
Vaginectomy
Vaginal Reconstruction
G.U. and CYSTO	None	Limited	Moderate	Well Skilled	Proficient
Circumcision
Cystoscopy/Cystostomy
Cystectomy
Hypospadius Repair
Kidney Transplant
Ileal Loop
Lithotripsy
Nephrectomy
Orchiectomy
Penile Implant
Prostatectomy
Ureterolithotomy
T.U.R.P./U.R.B.
Vasectomy
Orthopedic	None	Limited	Moderate	Well Skilled	Proficient
Amputation-Leg/Arm
Application of Halo Traction
Arthroscopy/Arthrotomy
Closed Pinning & Reduction of Extremities
External Compression Devices
Insertion of Finger Prosthesis
Total Joint Replacement-Knee, Hip, Shoulder
Spinal Fusion-Harrington Rods
Spica Cast Application
O.R.I.F.-Shoulder, Hip, Humerus, etc.
Repair of Dislocation
Patellectomy
Tendon Implants & Reanastomosis
Neurosurgery	None	Limited	Moderate	Well Skilled	Proficient
Anterior Cervical Fusion
Burrholes for Subdural Hematoma
Crainiotomy
Laminectomy
Meningocele Repair
Shunt Procedures-VP/VA
Plastics	None	Limited	Moderate	Well Skilled	Proficient
Abdominoplasty/Abdominal Lipectomy
Augmentation Mammoplasty
Cleft Lip/Palate Repair
Dermabrasion
Digital Flexor Tendon Repair
Liposuction
Myelomenengocele Repair
Otoplasty
Rhinoplasty
Reduction of Facial Fracture
Scar Revision
Skin Meshing
Split Thickness Skin Grafting
Eye	None	Limited	Moderate	Well Skilled	Proficient
Excision of Chalazion
Canthotomy
Correction of Ectropian/Entropian
Corneal Transplant
Enucleation
I.O.L Implants
Lacrimal Duct Probing
Refractive Keratoplasty
Repair of Retinal Detachment
Vitrectomy
E.N.T.	None	Limited	Moderate	Well Skilled	Proficient
Caldwell-Luc
Ethymoidectomy
Frontal Flap Sinus Procedure
Larynegectomy
Open Reduction Facial Fractures
Radical Neck
Tonsillectomy & Adenoidectomy
Myringotomy
Mastoidectomy
Tympanoplasty
Stapedectomy
Nasal Polypectomy
Laryngoscopy
Thoracic	None	Limited	Moderate	Well Skilled	Proficient
Chest Tube Set-Up Type
Hiatal Hernia
Pneumonectomy/Lobectomy
Sternal Splitting
Thoracotomy
Bronchoscopy
Lung/Wedge Resection
Endoscopy	None	Limited	Moderate	Well Skilled	Proficient
Bronchoscopy
Cystoscopy
Gastroscopy
Colonoscopy
Cardiovascular	None	Limited	Moderate	Well Skilled	Proficient
A-V Shunts
Aortic Aneurysm, Abdominal
Aorto-Femoral Bypass, Graft Insertion
Cardiac Valve Replacement
Coronary Artery Bypass Graft
Endarterectomy-Carotid/Femoral
Femoral-Popliteal Bypass
External Temporary Pacemaker
Internal Pacemaker Insertion
Intra-Aortic Balloon Pump Catheter
Pericardial Windows
Porta-Systemic Shunt
Repair of Septal Defects
Thrombectomy
Transplant Surgery
Vena Cava Ligation
Recovery Room/PACU	None	Limited	Moderate	Well Skilled	Proficient
Recovery Room/PACU

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