Evaluation Form
Printed on Sep 22, 2009
Faculty Evaluation of a Resident- 2009-2010
Evaluator:
Evaluation of:
Date:
Please take a moment to complete this resident evaluation.
Descriptions are available for the scale to appropriately determine a resident's performance and will
appear when you roll your mouse over the field of interest.
Evaluations indicating "Below Expectations" should be given if significant concerns merit intervention, and
a brief commentary must be provided.
This evaluation is NOT CONFIDENTIAL.. For confidential feedback, please contact the program director
at 650.497.8979.
Please indicate if you are an individual faculty member or
group of faculty evaluating this resident.
If this is a group evaluation, please list the names of faculty
who contributed to this evaluation. If known, please also
indicate the amount of time each faculty person spent with
the resident (in days).*
Individual
Group
Comments:
Best aspects of performance. Please cite specific
examples. *
Suggestions for improvement. Please cite specific
examples. *
Yes No
Do you have any concerns about the resident's
performance?
If you answer "yes" to this question, please provide
commentary.*
Comments:
Evaluation of specific resident skills
You will be prompted to provide additional feedback if the resident is performing at a level that is unsatisfactory. This feedback is critical for the professional
growth of the resident and will provide insight for areas of improvement.
Below
Meets
Exceeds
Expectations Expectations Expectations
1
2
3
4
5
6
Quality of history and physical.*
Clinical judgment.*
Procedures.*
Medical knowledge.*
Communication with patients and families.*
Communication with health care providers.*
Professionalism with patients and families.*
Professionalism with health care providers.*
Improvement in patient care over time.*
Teaching skills.*
Knowledge of how to deliver health care.*
How much time did you or your group spend with the
resident?*
Less than 4 days
4-7 days
7
8
9
Insufficient
contact
N/A
1-2 weeks
2-3 weeks
More than 3 weeks
Yes No
Have you provided verbal feedback to the resident during
the rotation?
If not, what were the barriers to giving the resident verbal
feedback?*
Comments:
Below
Meets
Exceeds
Expectations Expectations Expectations
1
What is the resident's overall performance for this
rotation?*
2
3
4
5
6
7
8
9
Insufficient
contact
N/A