Evaluation Record
(from
to
)
Name:
First name(s) :
Date of Birth :
Date of Swiss Diploma :
Date of any other medical certificate :
FMH Member
Not FMH Member
FMH title aimed for at the moment :
Postgraduate Medical Training Center:
Division
Hospital
Head of Postgraduate Training Center
Directly Responsible Postgraduate Trainer
Medical Practice
Name of Practitioner
Capacity in which employed
full (fully-paid) medical assistant or assistant medical director
assistant physician in medical practice
deputy physician in medical practice
Assessment Period
Assessment from
__________________
Elfenstrasse 18, Postfach 170, CH-3000 Bern 15
Telefon +41 31 359 11 11, Fax +41 31 359 11 12
diplome@fmh.ch, www.siwf.ch
to
_______________________
Evaluation Record
Requirements satisfied
yes
1.
Professional skills
1.1
Learning attitude
1.2
Knowledge and its application
1.3
Problem-oriented, thought-out approach
1.4
Making contact, developing confidential relationship
1.5
Conversing with patients, patients’ relatives and others
involved
1.6
Anamnesis
1.7
Clinical examination
1.8
Diagnosis, prognosis
1.9
Therapy, management of patients
partly
no
cannot be
assessed
1.10 Emergency cases
1.11 Reporting
1.12 Specialist skills
2.
Attitude to Work
2.1
Commitment
2.2
Efficiency
2.3
Self-sufficiency, self-confidence, decision-making
ability
2.4
Endurance, capacity to withstand stress
2.5
Reliability
2.6
Conscientiousness, discipline, cleanliness
3.
Interactional behaviour in team
3.1
general
3.2
vis-à-vis colleagues
3.3
vis-à-vis members of other public health services
3.4
vis-à-vis superiors
Remarks and additional comments:
Objectives for the next assessment period:
2/6
Evaluation Record
Place, Date
Seal and Signatures:
Head of Postgraduate Educational
Institute
Directly Responsible Mentor
I hereby confirm that the Evaluation Record was discussed with me personally and that I have taken note
of its contents.
Place, Date
Signature of Candidate
3/6
Evaluation Record
Notes on the individual assessment criteria
1.
Specialist Sufficiencies
1.1
Learning attitude
–
–
–
–
comprehends what is explained and demonstrated quickly and reliably
utilises practical experience, makes noticeable progress
recognises gaps in knowledge and acquires missing specialised information independently
critically processes specialised knowledge from team members as well as from scientific articles and circulars; voices own
opinions and seeks discussion
– works systematically on the improvement of own knowledge and skills
1.2
Skills and their application
–
–
–
–
–
1.3
has an adequate background in general medicine (no serious gaps apparent in this respect when it comes to practical work
displays specific specialised knowledge commensurate with current stage of postgraduate education
able to recognise symptoms and signs and to relate the same even when not present in a purely “text-book form”
able to relate individual pieces of knowledge
able to convert knowledge into practice and to apply it
Problem-oriented, thought-out approach
– recognises problems in their context which extends beyond the specialised field; able to integrate in particular biomedical
and psychosocial information
– retains the overview
– recognises priorities and acts accordingly
– plans investigations and therapies in problem-oriented and objective-oriented manner
– aware of any risks and dangers and adopts appropriate measures
– aware of economic aspects and works in cost-conscious manner
1.4
Making contact, developing confidential relationship
–
–
–
–
–
–
1.5
Conversing with patients, patients’ relatives and others involved
–
–
–
–
–
1.6
approachable, open; readily available to others
gets through to patients and their relatives without help
respects human dignity and autonomy
empathetic; shows human sympathy
provides for a trusting atmosphere for consultations and examinations
recognises patients’ anxieties and helps overcome them
by means of frank questioning enables person opposite to formulate his problem
listens actively and reacts to what has been said
adapts to the understanding level of person opposite
expresses himself/herself in a way readily understandable
finds ways to communicate with persons speaking a foreign language
Anamnesia
–
–
–
–
takes in and evaluates information adequately
registers patients’ statements in an alert manner
explores skilfully and discretely
acquires necessary additional information from families, earlier clinical histories, family doctors, members of other
branches of the public health service
– interprets intelligently
– records details clearly, concisely, profoundly, and appropriately.
1.7
Clinical examination
–
–
–
–
–
–
1.8
in command of the necessary examination techniques
distinguishes differentially and sensitively: visual, acoustic, tactile, olfactory
interprets and emphasises findings (incl. X-ray photographs, ECG, laboratory values, etc.) correctly
continues to converse with patients during examination, explains actions
gentle with patients; shows consideration when making examinations
makes due allowance for relative suitability of available scope for conducting examination
Diagnosis, prognosis
– proceeds on basis of differential diagnostic considerations, working hypothesis
– draws adequate practical conclusions from findings: further investigations or treatment
– makes plausible prognoses
– informs patients and their relatives factually and understandably with regard to the test results and proposed intervention in
a manner appropriate to the situation of the parties concerned.
4/6
Evaluation Record
1.9
Therapy, management of patients
–
–
–
–
–
–
–
–
–
1.10
Emergency cases
–
–
–
–
1.11
applies therapeutical knowledge and skills correctly and responsibly
recognises and observes the limits of own competence to act
attends patients considerately, conscientiously; quickly registers occurrence of new changes
adequately explains any risks; explains and instructs regarding patient- specific necessary therapeutical and behavioural
measures
able to motivate and guide patients
makes due allowance for social circumstances of patients; involves patients’ relatives in suitable manner
draws up programme for progress monitoring, follow-up examinations
informs adequately and in good time those persons and authorities responsible for aftercare / home treatment
upholds the rights of patients vis-à-vis external authorities (insurance companies, social services, legal guardians, police, ...)
recognises and assesses emergency situations quickly, correctly
in command of the necessary immediate measures
gives clear instructions, able to delegate responsibility
provides or arranges for suitable subsequent treatment
Reporting
– record the important points for reports and patient descriptions
– constructs verbal and written reports meaningfully; correct emphasis and accent
– formulates clearly
2.
Attitude to Work
2.1
Commitment
–
–
–
–
2.2
resolute approach to work, zealous
is willing to make extra efforts in emergency cases
expresses ideas, suggests improvements
takes initiative
Efficiency
– works purposefully, rationally, speedily
– attends to administrative duties promptly
2.3
Self-sufficiency, self-confidence, resolution
– judges own capabilities and limits correctly and acts accordingly (takes on neither too much nor too little)
– works and takes decisions within limits of present competence on own initiative, confidently
2.4
Endurance, capacity to withstand stress
– able to continue working reasonably well under conditions of stress
– retains overview when in stress situations
– remains calm and friendly even after prolonged strain (strenuous duty) and in stress situations
2.5
Reliability
– works conscientiously, thoroughly, reliably
– attends to administrative duties reliably
– is punctual; keeps appointments
2.6
Conscientiousness, discipline, cleanliness
– exercises due care when working with apparatus and instruments
– displays orderliness in recording clinical histories and conducting correspondence – particularly with regard to legibility of
handwriting
– files clinical histories and documents so that they can be readily retrieved by others at any time
– observes regulations regarding hygiene
3.
Interactional behaviour in team
3.1
general
–
–
–
–
–
is easily approachable, social
shows generous attitude in co-operative efforts; helpful
contributes actively towards good team spirit
able to draw clear distinction between professional and personal differences
favours an open discussion of possible conflicts
5/6
Evaluation Record
3.2
vis-à-vis colleagues
– respectful towards more experienced colleagues and less experienced colleagues alike
– abstains from making disparaging remarks about the work of colleagues or institutions (and particularly so in discussions
with patients)
– is receptive to assessments, views, and opinions which differ from his/her own
– expresses and defends his/her own assessments, views, and opinions when in company of colleagues; strives to
encourage work-related discussion
– keeps interested colleagues informed of findings, current investigations, changes ....
– seeks and maintains professional contact, also with representatives of other branches of medicine
3.3
vis-à-vis members of other branches of the public health service
–
–
–
–
–
–
–
3.4
has a work-conducive relationship with members of other branches of the public health sector
makes us of the know-how of experienced persons from other branches of the public health sector
is able to appreciate their approach to certain aspects and delegate responsibility accordingly
is able to motivate nursing staff; is friendly and encouraging
able to give orders and instructions resolutely, clearly, structured.
supervises or checks the correct execution of orders and instructions
recognises good work, expresses thanks, praises, criticises constructively
vis-à-vis superiors
– receptive to suggestions, instructions, criticisms
– seeks personal discussion to clear up differences of opinion
– remains loyal
6/6