IN-TRAINING ASSESSMENT REPORT
Trainee Name:
Rotation: Family Medicine PGY2
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
Practices patient-centered, continuous and comprehensive care.
(FAM1)
Demonstrates an appropriate knowledge base. (FAM1)
Carries out professional duties in the face of multiple, competing
demands. (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)
Establish goals of care in collaboration with patients and their
families. (FAM2)
Establishes patient-centered management plans. (FAM2)
Integrates disease screening and health promotion seamlessly in
the ongoing care of patients. (FAM3)
Integrates behavioral modification strategies into lifestyle
counselling. (FAM3)
Selectively adapts the periodic health assessment based on a
patient’s specific circumstances. (FAM3)
Manages simultaneously multiple clinical issues, both acute and
chronic. (FAM4)
Establishes patient-centered care plans that include the patient,
their family, other health professionals and consultant physicians.
(FAM6)
Actively participates in the continuous improvement of health care
quality and 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
Establishes effective therapeutic relationships with patients and
their families, which incorporates racial, cultural, socio-economic
and gender considerations. (FAM8)
Utilizes patient centred interviewing skills effectively and
consistently. (FAM9)
Shares information and explanations that are clear, accurate and
timely while checking for patient and family understanding.
(FAM10)
Engages patients and families in plans that reflect the patient’s
health care needs and goals. (FAM11)
Communicates clearly and concisely across all domains (charting,
letters, reports) and mediums (oral, written, electronic). (FAM12)
Collaborator
Establishes and maintains positive working relationships with
physicians and other colleagues in the health professions. (FAM13)
Negotiates overlapping and shared responsibilities with colleagues.
(FAM13)
Engages in respectful shared decision making with colleagues.
(FAM13)
Demonstrates safe handover of the care of patients to other health
care professionals. (FAM14)
Leader/Manager
Contributes to a culture that promotes patient safety. (FAM15)
Integrates multiple EMR functionalities to manage and plan
individual patient care. (FAM16)
Partners with patients to consistent use resources efficiently and
cost-effectively. (FAM17)
Demonstrates leadership in professional practice. (FAM18)
Demonstrates effective strategies for time management. (FAM19)
Bills appropriately. (FAM19)
Participates in practice improvement. (FAM20)
Health Advocate
Identifies vulnerable or at-risk patients and initiates appropriate
interventions. (FAM21)
Is familiar and knows how to access community-based resources
for patients. (FAM21)
Advocates for broader social changes to address to determinants
of health. (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)
Effectively teaches others. (FAM26)
Professional
Demonstrates professional behaviour. (FAM27)
Demonstrates a commitment to excellence in all aspects of
practice. (FAM27)
Recognizes and responds to ethical issues encountered in practice.
(FAM27)
Demonstrates accountability to patients, society and the profession.
(FAM28)
Adheres to professional standards. (FAM29)
Recognizes, supports, and responds effectively to colleagues in
need. (FAM30
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
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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
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:
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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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