IN-TRAINING ASSESSMENT REPORT
Trainee Name:
Rotation: Care of the Elderly
Trainee Level:
Start Date:
End Date:
Block(s):
Goals & Objectives:
Considering the present level of training and, on review of training milestones, assess the
resident performance in the following areas:
1*
unsatisfactory
2
marginal
3
good
4
very good
5
excellent
well below expected
level
additional work
needed
performance at the
expected level
area of strength
exceptional
performance
* must provide comment when selecting
Medical Expert
1*
2
3
4
5
NA
Demonstrates an appropriate knowledge base in care of the
elderly.
Gathers relevant information (e.g. through history and physical) and
uses that information to generate appropriate differential
diagnoses.
Perform appropriate for screening in the older patient, including
assessment of falls, vision, hearing, and blood pressure screening,
immunizations, cancer screening (in select groups).
Perform an appropriate and adapted physical examination of
elderly patients.
Performs a comprehensive mental status exam that includes a
cognitive and mood evaluation.
Performs patient-centered clinical assessments and is able to
manage and follow-up patients presenting with common conditions
in the care of the elderly.
Recognizes and appropriately manages urgent or emergent
situations.
Identifies patients who would benefit from a palliative approach and
initiates discussions regarding advance care planning.
Develops advance care plans that reflect patient’s wishes.
Assess and manage pain by multiple modalities and delivery
systems.
Apply principles of appropriate prescribing and modify prescribing
patterns based on quality of life and life expectancy.
Manages common end-of-life symptoms.
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Plan and manage for the care of the dying patient during the last
hours of life.
Identifies risk factors for the abuse of elderly patients, recognizes
the signs and symptoms of abuse of and is able to propose a
management plan in conjunction with the clinical team.
Performs procedures appropriately.
Communicator
1*
2
3
4
5
NA
1*
2
3
4
5
NA
1*
2
3
4
5
NA
1*
2
3
4
5
NA
Optimizes the physical environment for patient comfort, privacy,
engagement and safety.
Utilizes patient centred interviewing skills and seeks corroborating
information as needed.
Adapts communication to the clinical condition and circumstances
of the elderly patient (e.g. cognitive impairment, sensory
impairment, behavioral problems).
Communicates the plan of care clearly and accurately to patients
and their families.
Answers questions from patients and families to facilitate decisionmaking.
Communicates in a clear and timely way across all domains
(charting, letters, reports) and mediums (oral, written, electronic).
Collaborator
Works effectively with other members of the of the personal care
home/geriatric care team.
Seeks and appropriately responds to feedback from colleagues in
the health professions.
Recognizes the role and scope of practice of other health
professionals.
Appropriately uses referral/consultations to support patient care.
Leader/Manager
Considers costs of diagnostic and therapeutic interventions.
Completes patient related paperwork effectively and in a timely
fashion.
Health Advocate
Identifies vulnerable or at-risk patients and initiates appropriate
interventions.
Is familiar and knows how to access community-based resources
for patients.
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Scholar
1*
2
3
4
5
NA
1*
2
3
4
5
NA
Recognizes knowledge gaps and seeks appropriate resources to
address these gaps.
Integrates best available evidence into clinical decision-making.
Professional
Demonstrates professional behaviour.
Demonstrates an approach to ethical issues encountered in
practice.
Attends to responsibilities and completes duties as required
Practice.
Recognizes his/her limitations and seeks assistance appropriately.
Entrustable Professional Activities (EPAs)
Please provide an opinion as to this resident’s ability to perform the following EPAs:
5: can supervise
others *
4: “unsupervised”
practice
3: practice with
supervision on
demand
2: practice with full
supervision
1: cannot practice
the EPA *
(Note: final decisions regarding ‘entrustability’ will be made by the program)
3. Assess, manage, and follow-up adults
presenting with common (key) conditions.
4. Diagnose and manage patients with
common chronic conditions and multiple comorbidities
7. Manage the elderly patient with multiple comorbidities.
* must provide comment when selecting
DATA SOURCES:
Number of field notes used for this evaluation: ____
Procedure log reviewed for this rotation: ___
OVERALL COMMENTS:
Please give examples and elaborate on strengths and areas for improvement identified.
* There MUST be a comment for any rating indicated by an asterisk
STRENGTHS:
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AREAS FOR IMPROVEMENT:
OVERALL ASSESSMENT OF RESIDENT’S PERFORMANCE
Major lapses and/or
multiple minor lapses
precluding independent
performance of goals
and objectives of this
rotation
Minor lapses but not
impairing overall safety
or patient outcomes
Consistently performs
the objectives
competently and safely
Frequently functions at a
level beyond that
described in the goals
and objectives and
expected of a successful
resident in this rotation
Fail
Routinely functions at a
level beyond that
described in the goals
and objectives and
expected of a successful
resident in this rotation
Borderline Pass
Pass
Vacation/Conference/Sick Time: ___________________
This assessment was completed by:
One individual (please name):
A group: (list members):
Other:
Name of rotation coordinator:
ITAR completed by:
ITAR discussed with resident by:
Date discussed:
Not discussed (state reason):
Resident’s comment:
I agree with this evaluation
I disagree with this evaluation
Resident’s signature: _____________________________ Date: __________
Any concerns about the above assessment should be addressed by completing the Request for Review of Assessment
Form available in the Program Office and returned by the resident within one week of the date of the evaluation.
Date reviewed by the Site Education Director:
Comments:
PEC approved_Nov. 27 2015
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