IN-TRAINING ASSESSMENT REPORT
Trainee Name:
Rotation: Obstetrics
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 obstetrical knowledge base.
Gathers relevant information (e.g., through history and physical)
and uses that information to generate appropriate differential
diagnoses.
Accurately determine dates in pregnancy.
Provides comprehensive pre-pregnancy counseling.
Provides comprehensive prenatal care to low risk obstetrical
patients.
Recognizes indicators of high-risk pregnancy and manages or
refers appropriately.
Manages concurrent medical conditions in prenatal patients.
Identifies, evaluates, and manages common early prenatal medical
conditions.
Identifies, evaluates, and manages common late prenatal medical
conditions.
Confirms, monitors, and manages the obstetrical patient in labour.
Accurately interprets fetal heart rate tracings.
Recognizes failure to progress.
Manages all aspects of uncomplicated spontaneous vaginal
deliveries including aftercare of mother and baby.
Recognizes and appropriately manages obstetrical emergencies.
Demonstrates skill in episiotomy and 1st and 2nd degree perineal
repair techniques.
Recognizes indicator for assisted vaginal delivery/operative
delivery and provides assistance.
Able to perform appropriate procedures during labor and delivery.
Identifies and manages complications in post-partum period.
Promotes and supports breastfeeding.
Provides routine post-partum care including screening and
management of post-partum depression.
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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
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
Communicates the plan of care clearly and accurately to patients
and their families.
Answers questions from patients and families to facilitate decisionmaking.
Engages patients and families in developing birth plans that reflect
the patient’s health care needs and goals.
Communicates in a clear and timely way across all domains
(charting, letters, reports) and mediums (oral, written, electronic).
Collaborator
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.
Demonstrates safe handover of the care of patients to other health
care professionals.
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.
Seeks appropriate community-based resources for patients.
Scholar
Recognizes knowledge gaps and seeks appropriate resources to
address these gaps.
Integrates best available evidence into clinical decision-making.
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Professional
1*
2
3
4
5
NA
Demonstrates professional behaviour.
Demonstrates an approach to ethical issues encountered in
practice.
Attends to responsibilities and completes duties as required.
Recognizes his/her limitations and seeks assistance appropriately
Is consistently available and responds in a timely fashion when on
call
Demonstrates professional behaviour.
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)
14. Provide pre-conception and pre-natal care
15. Provide intra-partum care and perform low-risk
deliveries
16. Recognize and manage common intra-partum
emergencies
17. Provide postpartum care
* 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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