A brief overview of the Zwisch rating scale that includes anchoring behaviors and cues to advancement.
Zwisch Rating Scale
With anchoring behaviors and cues to advancement
| Zwisch stage of guidance | Attending behaviors | Resident behaviors commensurate with this level of supervision |
| Show & Tell |
Does >50% of critical portions as the surgeon Narrates the case (i.e. thinks out loud) Demonstrates key concepts, anatomy, and skills |
Opens and closes First assists and observes |
| Cues to advancement: Begins to anticipate some next steps | ||
| Active Help |
Leads the resident (active assist) for >50% of the critical portions Optimizes the field / exposure Demonstrates the plane or structure Coaches for specific technical skills Coaches regarding the next steps Identifies key anatomy for the resident |
The above, plus: When operating as the first assistant, actively assists (i.e. anticipates surgeon’s needs) Practices all the component technical skills |
| Cues to advancement: Knows all steps and skills | ||
| Passive Help |
Follows the lead of the resident (passive assist) for >50% of the critical portions Acts as a capable first assistant Coaches for polish and refinement of skills |
The above, plus: Can "set up" and accomplish the next step for the entire case Recognizes critical transition points in the procedure |
| Cues to advancement: Can transition between all steps with passive assist from faculty | ||
| Supervision Only |
Provides no unsolicited advice for >50% of the critical portions Monitors progress and patient safety |
The above, plus: Can safely complete the case without faculty Recovers from most errors Recognizes when to seek advice/help |
