Fellow Assessment: Surgical Log and Milestones

This assessment should be submitted by Fellowship Training Program Directors. Forms should be submitted bi-annually, at 6 month intervals. The assessment should include a copy of the fellows surgical log report, an operative milestone assessment, and a non-operative milestone assessment. For the milestones, if you are having more than 1 faculty member assessing fellow(s) please average the assessment and send only 1 form.  








By signing my name below I am attesting that I have discussed this assessment with the fellow and there is mutual agreement of this assessment:

Please type the Evaluating Administrator or Program Directors Name

Surgical Log Report:

Please upload a copy of your fellow's surgical log report below. By uploading this document, you are attesting that you have reviewed the report and the volumes listed in the report and accurate. 

Your fellow is responsible for sending you their surgical log report from the Academic Universe, which you will then upload when you complete the form. For instructions on how fellows download this report, click here

Upload the surgical log report

Fellow Milestones:

The Fellow Operative and Non-Operative Milestone Forms should be submitted by Fellowship Training Program Directors. Forms should be submitted bi-annually, at 6 month intervals. If you are having more than 1 faculty member assessing fellow(s) please average the assessment and send only 1 form.    

These milestones are assumed to occur under the auspices of the appropriate, attending supervision.

Directions: Please fill  in the interval you are submitting the assessment for, and select only one level for each assessment. 

Operative Milestones:


Kidney Transplant Back Table Preparation


Kidney Transplant Back Table Preparation: Month of Assessment:

Kidney Transplant Back Table Preparation Assessment:






Kidney Transplant


Kidney Transplant: Month of Assessment:

Kidney Transplant Assessment:






Laparoscopic Donor Nephrectomy


Laparoscopic Donor Nephrectomy: Month of Assessment:

Laparoscopic Donor Nephrectomy Assessment:






Liver Transplant Back Table Surgery


Liver Transplant Back Table Surgery: Month of Assessment:

Liver Transplant Back Table Surgery Assessment:






Liver Transplantation


Liver Transplantation: Month of Assessment:

Liver Transplantation Assessment:






Deceased Donor Multi-organ Procurement


Deceased Donor Multi-Organ Procurement: Month of Assessment:

Deceased Donor Multi-Organ Procurement Assessment:







Non-Operative Milestones:


Patient Care:

Patient Care: month of assessment

Patient Care Assessment:





Professionalism:

Professionalism: month of assessment

Professionalism Assessment:





Interpersonal/Communication Skills:

Interpersonal/Communication Skills: month of assessment

Interpersonal/Communication Skills Assessment:







To submit this form, please click "Submit" below.