FAMILY PRACTICE RESIDENCY PROGRAM EVALUATION
NEUROLOGY
Please rate the physician named below in comparison to other family physicians with whom you have worked. Circle one
rating response per item. Circle the appropriate number between 1 and 5 where 1 is unable to pass and 5 is the highest
rating. If you have had insufficient contact to evaluate this physician on a particular characteristic, circle UE (Unable to
Evaluate).
Name of Resident Physician _______________________________________ Rotation Dates ______________
Name of Evaluator _______________________________________________ Date ______________________
____________________________________________________________________________________________
RATING SCALE
1 = Unable to Pass*
2 = Learning
3 = Capable
4 = Proficient
5 = Mastery*
UE = Unable to Evaluate
* = Documentation Required
____________________________________________________________________________________________
1.
Appreciates the clinical presentation of abnormal neurologic states
1
2.
UE
2
3
4
5
UE
2
3
4
5
UE
2
3
4
5
UE
2
3
4
5
UE
2
3
4
5
UE
2
3
4
5
UE
2
3
4
5
UE
Understands management and diagnosis of myasthenia gravis
1
11.
5
Understands management and diagnosis of disorders of multiple sclerosis
1
10.
4
Understands management and diagnosis of disorders of aseptic meningitis and encephalitis
1
9.
3
Understands management and diagnosis of disorders of TIA, CVA, Cerebrovascular disease
1
8.
2
Understands management and diagnosis of disorders of peripheral neuropathies, weakness of unknown etiology
1
7.
UE
Understands radioisotope methods for evaluation of neurologic function
1
6.
5
Can identify and discuss tumors of the neurologic system
1
5.
4
Can identify the indications for neurologic surgery
1
4.
3
Understands management and diagnosis of disorders of nervous system
1
3.
2
2
3
4
5
UE
Understands management and diagnosis of disorders of meningitis, polymyositis
12.
Can distinguish between psychogenic and organic neurological disorders
1
13.
2
3
4
5
UE
Can diagnose and treat disorders of temporal arteritis, trigeminal neuralgia
1
2
3
4
5
UE
Justification for 1 or 5_________________________________________________________________________
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Comments___________________________________________________________________________________
____________________________________________________________________________________________
_________________________________________________________
Evaluators Signature
_______________________________________________________________
Program Directors Signature
_______________________________________________________________
Resident Signature