Residency Manual

APPENDIX G : Sample Evaluation of Resident

Resident Evaluation This evaluation form should be filled out quarterly. All information will remain confidential. Response Scale: 1 = Lowest, 5 = Highest, NA = Not Applicable. Score Criteria I. Clinical Performance and Case Management Skills The resident has demonstrated proficiency in:

1 2 3 4 5 NA 1. Management of routine cases 1 2 3 4 5 NA 2. Management of difficult cases 1 2 3 4 5 NA 3. Detection and diagnosis 1 2 3 4 5 NA 4. Expansion of knowledge base throughout the quarter 1 2 3 4 5 NA 5. Patient care in area of residency training 1 2 3 4 5 NA 6. Patient care outside area of residency training 1 2 3 4 5 NA 7. Appropriate referrals (as indicated) 1 2 3 4 5 NA 8. Report writing and/or record keeping skills

1 2 3 4 5 NA 9. Interaction, attitude, cultural sensitivity, and communication with patients 1 2 3 4 5 NA 10. Cultural, race, ethnic and economic influences on diagnosis and management 1 2 3 4 5 NA 11. Independence and self-confidence in patient care II. Interpersonal Skills The resident has demonstrated proficiency in: 1 2 3 4 5 NA 1. Communication/interaction with patients 1 2 3 4 5 NA 2. Interaction with staff 1 2 3 4 5 NA 3. Interaction with other professionals 1 2 3 4 5 NA 4. Resident’s attitude toward learning 1 2 3 4 5 NA 5. Professionalism (includes but not limited to professional dress, behavior, decorum) III. Teaching and Supervisory Skills The resident: 1 2 3 4 5 NA 1. Demonstrates good communication skills with the students 1 2 3 4 5 NA 2. Regularly provides students with positive feedback and constructive suggestions 1 2 3 4 5 NA 3. Is able to suggest appropriate and current reading assignments 1 2 3 4 5 NA 4. Is a good role model IV. Scholarly Activities The resident: 1 2 3 4 5 NA 1. Regularly consults reference materials, including evidence based literature 1 2 3 4 5 NA 2. Pursues scholarly activities 1 2 3 4 5 NA 3. Regularly attends grand rounds, meetings, or conferences (other than Friday Programs)

V. Overall 1. Overall, the resident's performance this quarter compared to the previous one: ○Same as before ○Better than before ○Not as good ○This is the f irst quarter 2. Overall Impression (1=low, 10=high): ○1 ○2 ○3 ○4 ○5 ○6 ○7 ○8 ○9 ○10

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