Cardiology Fellows Evaluation -Electrophysiology
Fellow:
[First Name] [Last Name]
Evaluation Period: [99/99/9999] to [99/99/9999]
Evaluator:
[First Name] [Last Name]
Rotation Name: [Rotation Name]
Interpersonal and Communication Skills
Does the fellow establish a highly effective therapeutic relationship with patients
and families; demonstrate excellent relationship building through listening and
narrative and nonverbal skills; provide excellent education and counseling of
patients, families, and colleagues; and is always "interpersonally" engaged?
,7541884_1
(Select one)
Practice-Based Learning and Improvement
Does the fellow constantly evaluate own performance, incorporate feedback into
improvement activities; an effectively use technology to manage information for
patient care and self-improvement?
(Select one)
Professionalism
Does the fellow always demonstrate respect, compassion, integrity, honesty;
teach/role model responsible behavior; total commitment to self-assessment;
willingly acknowledge errors; and always consider needs of patients, families,
colleagues?
,7560401_1
(Select one)
System-Based Practices
Does the fellow effectively access/utilize outside resources; effectively use
systematic approaches to reduce errors and improve patient care; and
enthusiastically assist in developing systems' improvement?
,7560402_1
Evaluation of Fellow
(Select one)
Patient Care and Procedural Skills
Does the fellow conduct superb, accurate, comprehensive medical interviews,
physical exams, review of other data; and always make diagnostic and therapeutic
decisions based on available evidence, sound judgment, and patient preferences?
(Select one)
Does the fellow demonstrate competence in performance of essential procedures
and minimizes patient's discomfort?
(Select one)
Can the fellow adequately interpret basic and complex ECG?
(Select one)
Can the fellow interpret Holter monitors or Telemetry?
(Select one)
Can the fellow interrogate and reprogram Pacemakers and defibrillators?
(Select one)
Can the fellow recognize appropriate location or dislodgment of ICD/ PPM leads
on CXR?
(Select one)
Can the fellow interpret basic intra-cardiac electrocardiograms?
(Select one)
Can the fellow appropriately manage VT and SVT including Afib?
(Select one)
Can the fellow differentiate between SVT and VT on ECG?
(Select one)
,7546553_1,7551
Medical Knowledge
Does the fellow have exceptional knowledge of basic and clinical sciences; highly
resourceful development of knowledge; and comprehensive understanding of
complex relationships, mechanisms of disease?
(Select one)
Does the fellow have adequate and uptodate knowledge about indications for
PPM and ICD?
(Select one)
,7560482_1
Overall/Summary
How would you rate the fellow's overall clinical competence as a sub-specialist?
,7560388_1
(Select one)
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Comments (Please write about Strengths, Weaknesses and Areas for Improvement)
Optional Comments Section:
* * Confidential Comments (The following comments will only be seen by the Program Director) * *
Feedback Confirmation
The following message is displayed to the attending and trainee to confirm verbal feedback to the trainee.
Evaluator Question:
Did you provide direct feedback on this evaluation?
Trainee Question:
Did the evaluator provide you with direct feedback on this evaluation?