Mercy Catholic Medical Center Surgery Residency Program
Surgery Resident Evaluation Form (PGY I)
Resident:
Rotation: GENERAL SURGERY AND SURGICAL ONCOLOGY
Name of Evaluator:
Rotation Evaluation Dates:
Please evaluate the above resident on the basis of performance during this specific rotation. Rank each
resident on a 1-5 scale with 5 being the highest. In general, a “1” would be unsatisfactory, the average
resident is a “3”. If there is inadequate information, please check “not applicable”.
General:
1.
2.
3.
4.
5.
Evaluation (1-5):
Not Applicable:
Initiative, self-motivated.
Dependability, can be counted on to complete tasks.
Interacts well with patient and staff.
Self-confident but will seek help from others.
Teaching of medical students.
Please place check in appropriate box:
Knowledgeable
COGNITIVE KNOWLEDGE:
Demonstrates understanding of the
basic science foundation of the
specialty
Knowledgeable
and Able To
Teach
Learning But
Incomplete
Absent or
Inadequate
A) Physiology, fluid and electrolytes.
B) Pathology as it relates to general
surgery.
C) Anatomy of the abdomen, chest,
neck, vascular tree.
D) Pharmacology of antibiotics,
antihypertensives, diuretics,
analgesics, etc.
Please place check in appropriate box:
Knowledgeable,
CLINICAL PERFORMANCE:
Confident, and
Effective
Knowledgeable,
But Not
Independent
Learning But
Below
Expectations
Unsatisfactory
Knowledgeable,
But Not
Independent
Learning But
Below
Expectations
Unsatisfactory
E) Able to perform a comprehensive
history and physical exam.
F) Provides adequate pre- and postoperative care with good
documentation.
G) Appropriately diagnose medical and
surgical conditions.
H) Provide appropriate care for urgent
and emergent medical and surgical
conditions.
Please place check in appropriate box:
Knowledgeable,
OPERATIVE ABILITIES:
Confident, and
Effective
I) Understands the function of surgical
instruments.
J) Able to tie knots effectively.
K) Sutures a complex wound.
L) Uses scalpel, forceps, and scissors
effectively.
M) Understands the use of
electrocautery.
Please place check in appropriate box:
Based on the experience in this rotation do you think the resident would be able to:
Yes,
Independently
Yes, With
Direction
Yes With
Much
Assistance
N) Recognize appendicitis and perform a simple
appendectomy for suppurative appendicitis.
O) Diagnose and treat an uncomplicated reducible
hernia.
P) Perform a breast biopsy or remove lipoma.
Q) Perform bedside procedures (ie: IV Insertion, ABG,
NG Insertion)
R) Discuss nature of medical condition and prognosis
with family.
S) Diagnose acute abdomen and prepare for the OR.
T) Drain a subcutaneous abscess or perirectal abscess.
Please place check in appropriate box:
Overall Evaluation (Compare with the last 10 resident at this level on this rotation):
Top 20%
Middle 60%
Lower 20%
Comments (Required):
Do you think this resident should be advanced to the next clinical year?
Yes
No
Needs more
evaluation
Signed:
Date:
Please return the completed form to Program Director, MCMC General Surgery
Residency Program, 1500 Lansdowne Avenue, Darby, PA, 19023.
Thank you for your assistance.
No