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Medical Education
Resident Competencies Evaluation
Resident Competencies Evaluation Form
Please complete the following questions. All items with a red star
*
are required fields. When complete, scroll down and click the submit button.
*
Your Name (Evaluator)
*
Housestaff Name:
*
Program and Level of Practice:
Rotation Start Date:
MM/DD/YYYY
Rotation End Date:
MM/DD/YYYY
*
Rotation Campus:
Minneapolis
St Paul
Evaluation
A.
Patient Care
*
History/Gathering Data
Consistently Exceeds Expectations
Sometimes Exceeds Expectations
Consistently Meets Expectations
Sometimes Below Expectations
Consistently Below Expectations
N/A
*
Assessment / Clinical Judgement
Consistently Exceeds Expectations
Sometimes Exceeds Expectations
Consistently Meets Expectations
Sometimes Below Expectations
Consistently Below Expectations
N/A
*
Management Plan and Follow-Up
Consistently Exceeds Expectations
Sometimes Exceeds Expectations
Consistently Meets Expectations
Sometimes Below Expectations
Consistently Below Expectations
N/A
*
Patient/Family Counseling
Consistently Exceeds Expectations
Sometimes Exceeds Expectations
Consistently Meets Expectations
Sometimes Below Expectations
Consistently Below Expectations
N/A
*
Use of Tech. to Support Decisions
Consistently Exceeds Expectations
Sometimes Exceeds Expectations
Consistently Meets Expectations
Sometimes Below Expectations
Consistently Below Expectations
N/A
*
Procedure Competence
Consistently Exceeds Expectations
Sometimes Exceeds Expectations
Consistently Meets Expectations
Sometimes Below Expectations
Consistently Below Expectations
N/A
*
Provides Preventative Care
Consistently Exceeds Expectations
Sometimes Exceeds Expectations
Consistently Meets Expectations
Sometimes Below Expectations
Consistently Below Expectations
N/A
*
Multi-disciplinary Approach
Consistently Exceeds Expectations
Sometimes Exceeds Expectations
Consistently Meets Expectations
Sometimes Below Expectations
Consistently Below Expectations
N/A
Patient Care Comments
(500 Characters)
B.
Medical Knowledge
*
Fund of Knowledge
Consistently Exceeds Expectations
Sometimes Exceeds Expectations
Consistently Meets Expectations
Sometimes Below Expectations
Consistently Below Expectations
N/A
*
Investigation and Analysis
Consistently Exceeds Expectations
Sometimes Exceeds Expectations
Consistently Meets Expectations
Sometimes Below Expectations
Consistently Below Expectations
N/A
Medical Knowledge Comments
(500 Characters)
C.
Professionalism
*
Respect, Compassion, Integrity
Consistently Exceeds Expectations
Sometimes Exceeds Expectations
Consistently Meets Expectations
Sometimes Below Expectations
Consistently Below Expectations
N/A
*
Teamwork and Accountability
Consistently Exceeds Expectations
Sometimes Exceeds Expectations
Consistently Meets Expectations
Sometimes Below Expectations
Consistently Below Expectations
N/A
*
Demonstrates Ethical Practice
Consistently Exceeds Expectations
Sometimes Exceeds Expectations
Consistently Meets Expectations
Sometimes Below Expectations
Consistently Below Expectations
N/A
*
Demographic Sensitivity
Consistently Exceeds Expectations
Sometimes Exceeds Expectations
Consistently Meets Expectations
Sometimes Below Expectations
Consistently Below Expectations
N/A
Professionalism Comments
(500 Characters)
D.
Interpersonal Communication
*
Therapeutic Relationships
Consistently Exceeds Expectations
Sometimes Exceeds Expectations
Consistently Meets Expectations
Sometimes Below Expectations
Consistently Below Expectations
N/A
*
Communication Skills
Consistently Exceeds Expectations
Sometimes Exceeds Expectations
Consistently Meets Expectations
Sometimes Below Expectations
Consistently Below Expectations
N/A
*
Works Effectively with Others
Consistently Exceeds Expectations
Sometimes Exceeds Expectations
Consistently Meets Expectations
Sometimes Below Expectations
Consistently Below Expectations
N/A
*
Facilitates Learning of Others
Consistently Exceeds Expectations
Sometimes Exceeds Expectations
Consistently Meets Expectations
Sometimes Below Expectations
Consistently Below Expectations
N/A
Interpersonal Communication Comments
(500 Characters)
E.
Optional Criteria
Practice Based Learning
Consistently Exceeds Expectations
Sometimes Exceeds Expectations
Consistently Meets Expectations
Sometimes Below Expectations
Consistently Below Expectations
N/A
Systems Based Practice
Consistently Exceeds Expectations
Sometimes Exceeds Expectations
Consistently Meets Expectations
Sometimes Below Expectations
Consistently Below Expectations
N/A
Overall Comments (500 characters)
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Date Last Modified: 11/16/2009
