Zwisch Scale

Last Updated: 02 July 2015

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 work with an inexperienced first assistant (or as inexperienced as is reasonable given the complexity of the case)

Can safely complete the case without faculty

Recovers from most errors

Recognizes when to seek advice/help