Louisiana State University School of Medicine
Physical Medicine and Rehabilitation
360° Resident Evaluation
Resident’s Name: __________________________________________________________________________________
Evaluated by: ______________________________________________________________________________________
Evaluator’s Title: __________________________________________________________________________________
Resident’s Rotation Name/Location: __________________________________________________________
Dates of Rotation: From: ______________________________ To: _____________________________________
Note:
 To respond to each item, please select the number that represents your evaluation of the resident’s
performance.
 Mark “NA” if the question does not apply to you as the survey respondent, OR you have no
knowledge of this area as it applies to the resident being evaluated.
1 = Very Poor
5 = Superior
NA = Not Applicable
PATIENT CARE
Patient examinations, gathering of patient information and documentation are
accurate, thorough
1
2
3
4
5
Develops and carries out effective therapeutic care plans, including ongoing care
and follow-up
1
2
3
4
5
Effectively uses knowledge of each discipline’s role in a patient’s plan of care
1
2
3
4
5
Prioritizes and manages complications
1
2
3
4
5
Counsels, educates, and interacts respectfully with patients and their families
1
2
3
4
5
Acts appropriately on the above information and situations
1
2
3
4
5
Applies knowledge of third party payor regulations in patient care management
1
2
3
4
5
Comprehensive knowledge of medical and pharmacologic information
1
2
3
4
5
Comprehensive knowledge of physiatric information(i.e. rehabilitative
treatment/procedures, pharmacology, orthotics, prosthetics, modalities etc.)
1
2
3
4
5
Applies medical and physiatric knowledge to clinical practice and clinical judgment
1
2
3
4
5
Able to self-critique his/her practice & behaviors and make improvements
1
2
3
4
5
Accepts and utilizes feedback to improve patient care
1
2
3
4
5
MEDICAL KNOWLEDGE
PRACTICE-BASED LEARNING AND IMPROVEMENT
Uses on-line/information technology in the management of patient care
1
2
3
4
5
Facilitates the education of students, colleagues and other health care professionals
1
2
3
4
5
Applies his/her knowledge to larger populations appropriately and accurately
1
2
3
4
5
Verbal communication is accurate, therapeutic and delivered in a manner that
ensures understanding.
1
2
3
4
5
Written communication is legible, accurate, thorough, inclusive of all pertinent
and/or required areas.
1
2
3
4
5
Listens effectively
1
2
3
4
5
Works cooperatively with other members of the rehabilitation team and other
health care professionals
1
2
3
4
5
Provides effective leadership to the rehabilitation interdisciplinary patient care
team
1
2
3
4
5
Reliable, punctual. Demonstrates professional responsibility. Flexes to meet needs
of patient and team
1
2
3
4
5
With patients and families: Shows respect, compassion, sensitivity, integrity and
promotes a therapeutic and cooperative relationship
1
2
3
4
5
With allied health care professionals: Shows respect, compassion, sensitivity,
integrity and promotes a therapeutic and cooperative relationship
1
2
3
4
5
Demonstrates ethical behavior and accepts responsibility for own actions
1
2
3
4
5
Respects patient confidentiality
1
2
3
4
5
Puts needs of patient first
1
2
3
4
5
Understands the role of different specialists and utilizes them appropriately in
patient care management
1
2
3
4
5
Partners with health care managers/providers to improve health care
1
2
3
4
5
Evaluates risks, benefits and costs of available resources before including in an
individual patient’s plan of care
1
2
3
4
5
INTERPERSONAL AND COMMUNICATION SKILLS
PROFESSIONALISM
SYSTEMS-BASED PRACTICE
Understands how delivery systems differ in controlling health care costs and
resources
COMMENTS:
1
2
3
4
5