IN-TRAINING ASSESSMENT REPORT
Trainee Name:
Rotation: Family Medicine PGY1
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 a commitment to the holistic role of the family
physician. (FAM1)
Demonstrates an appropriate knowledge base. (FAM1)
In the face of multiple competing demands, prioritizes tasks based
on patient need. (FAM1)
Able to effectively and selectively identify, assess and prioritize the
main presenting symptoms in a patient encounter. (FAM2)
Recognizes and responds appropriately to urgent and emergent
conditions. (FAM2)
Gathers relevant information (e.g. through history and physical) and
uses that information to generate appropriate differential
diagnoses. (FAM2)
Solicits the patient’s perspective when establishing goals of care.
(FAM2)
Ensures patients and families are informed about risks and benefits
of treatment options. (FAM2)
Integrates disease prevention and health promotion into practice.
(FAM3)
Counsels patients on lifestyle changes. (FAM3)
Selectively adapts the periodic health assessment based on a
patient’s specific circumstances. (FAM3)
Applies appropriate clinical guidelines into the management of
patients with chronic conditions. (FAM4)
Accepts responsibility for coordination of a patient’s care. (FAM6)
Integrates strategies to ensure patient safety. (FAM7)
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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. (FAM8)
Utilizes patient centred interviewing techniques to gather
information and develop an understanding of the whole person.
(FAM9)
Communicates the plan of care clearly and accurately to patients
and their families. (FAM10)
Answers questions from patients and families to facilitate decisionmaking. (FAM11)
Communicates in a clear and timely way across all domains
(charting, letters, reports) and mediums (oral, written, electronic).
(FAM12)
Collaborator
Seeks and appropriately responds to feedback from colleagues in
the health professions. (FAM13)
Recognizes the role and scope of practice of other health
professionals (FAM13)
Appropriately uses referral/consultations to support patient care.
(FAM13)
Demonstrates safe handover of the care of patients to other health
care professionals. (FAM14)
Leader/Manager
Identifies opportunities to improve patient safety. (FAM15)
Effectively organizes information within the EMR, using appropriate
fields to facilitate patient care. (FAM16)
Considers costs of diagnostic and therapeutic interventions.
(FAM17)
Actively engages in activities led by others (FAM18)
Demonstrates attention and concern for time management.
(FAM19)
Describes an approach to practice improvement. (FAM20)
Health Advocate
Identifies vulnerable or at-risk patients. (FAM21)
Seeks appropriate community-based resources for patients.
(FAM21)
Identifies communities or populations experiencing health
inequities. (FAM22)
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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. (FAM24)
Integrates best available evidence into clinical decision-making.
(FAM24)
Develops an approach to teaching others. (FAM26)
Professional
Demonstrates professional behaviour. (FAM27)
Seeks feedback in order to improve his/her practice. (FAM27)
Demonstrates an approach to ethical issues encountered in
practice. (FAM27)
Attends to responsibilities and completes duties as required.
(FAM28)
Demonstrates awareness of professional standards. (FAM29)
Incorporates self-care in to personal routines. (FAM30)
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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)
1. Provide periodic health exams and
preventative health care to adults
2. Assess, manage, and follow-up patients
presenting with undifferentiated symptoms
3. Assess, manage, and follow-up adults
patients presenting with common (key)
conditions.
4. Diagnose and manage patients with
common chronic conditions and multiple comorbidities
5. Identify, diagnose, evaluate and manage
patients with common mental health issues
6. Perform common family medicine
procedures
7. Manage the elderly patient with multiple comorbidities
10. Assess and appropriately manage the
adult patient in hospital.
12. Plan and coordinate discharge of adult
patients from hospital.
13. Provide palliative end-of-life care
14. Provide pre-conception and prenatal care
18. Provide family medicine-centered care to
newborns in the first weeks of life
19. Provide periodic health exams and
preventative care to infants, children, and
adolescents
20. Assess, manage and follow-up infants,
children and adolescents presenting with
common (key) conditions
26. Provide expert advice and obtain
consultation for patients
27. Facilitate family and interdisciplinary
meetings
28. Optimize the quality and safety of health
care through the use of best practices and
application of QI
29. Provide care to vulnerable and
underserved populations
30. Provide care to First Nations, Inuit, and
Métis peoples
* must provide comment when selecting
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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:
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:
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