ANNUAL FACULTY EVALUATION
SCHOOL OF MEDICINE
Evaluation Period
(Month/Year – Month/Year)
Faculty Member
Years in Rank
Percent Effort: Scholarship
Academic Rank
Date of Hire
% + Teaching
% + Service
% = 100%
Faculty Preparation prior to your Annual Review Meeting:
1. Submit an updated version of your SOM-formatted CV including the SOM Educator’s Portfolio with this
evaluation.
These documents can be found on the SOM Faculty Affairs pages under the Promotion and Tenure Resources
tab at:
http://www.ohsu.edu/xd/education/schools/school-of-medicine/faculty/faculty-affairs/index.cfm
2. Complete the FACULTY SELF-ASSESSMENT in the areas of Scholarship, Teaching, Service, Citizenship and
Leadership.
3. Complete the Goals Section.
4. Submit CV and this Evaluation form to your Evaluator prior to your Annual Review Meeting.
Evaluator Preparation prior to the Annual Review Meeting:
1. Review the faculty member’s CV, Self-Assessment of Performance and Goals.
2. Review any other department performance metrics such as summaries of teaching performance and clinical
performance/productivity reports for the faculty member.
Evaluator tasks for the Annual Review Meeting:
1. Discuss your assessment of the faculty member’s performance in the areas of Scholarship, Teaching, Service,
Citizenship and Leadership and complete the EVALUATOR ASSESSMENT under each of these areas.
2. Discuss the faculty member’s progress on last year’s goals and new proposed goals and revise as necessary to come
to agreement about goals for the next evaluation period.
3. Complete your assessment of the faculty member’s progress towards promotion.
4. Provide a written summary of this evaluation to the faculty member for his or her signature, return a signed copy to
the faculty member and place original in the faculty member’s personnel file.
1
SCHOLARSHIP
FACULTY SELF ASSESSMENT
(Choose a rating for yourself by placing an “X” before the appropriate number)
1
2
3
4
activities, quality and
minimal or no scholarly
some research or scholarly
depth of projects meet
work; activity considerably work; activity somewhat
current standards and as
below that expected for
below that expected for
expected for current
current level of experience current level of experience
level of experience and
and scholarly FTE
and scholarly FTE
scholarly FTE
5
activity, quality and
depth of projects
somewhat above that
expected; pattern of
ongoing activities
activity considerably
above that expected;
ongoing extensive
research activity;
expands lines of
research
List two of your most significant accomplishments in Scholarship during this evaluation period or highlight these
accomplishments on your current CV.
1.
2.
EVALUATOR ASSESSMENT OF SCHOLARSHIP
I agree with faculty member’s self rating of performance (place an “X”): YES
If NO, complete your rating of the faculty member’s performance (place an “X”): 1
NO
2
3
4
5
Comments:
TEACHING
Use information from the Educator’s Portfolio for this section
FACULTY SELF ASSESSMENT
(Choose a rating for yourself by placing an “X” before the appropriate number)
1
Instruction
Ineffective;
poor content
knowledge
1
Range of
Activities
activities
considerably
below that
expected
2
lacks enthusiasm;
mixed evaluations;
limited content
knowledge
2
activities somewhat
below that expected
3
satisfactory;
evaluations usually
favorable; covers
content; engages
some adequately
3
activities as
expected in
departmental role
4
effective; evaluations
favorable; motivated and
enthusiastic; department
teaching awards
4
5
highly effective and engaging;
outstanding evaluations;
presents content in innovative
ways; institutional teaching
awards
5
activities somewhat above activity considerably above
that expected;
that expected;
in-depth activities with one in-depth activities with one or
group (students, residents
more groups (students,
2
or faculty)
residents or faculty)
List two of your most significant accomplishments in Teaching during this evaluation period or highlight these
accomplishments on your current Educator’s Portfolio.
1.
2.
EVALUATOR ASSESSMENT OF TEACHING
I agree with faculty member’s self rating of performance (place an “X”): YES
If NO, complete your rating of the faculty member’s performance (place an “X”):
Instruction
1
2
3
4
5
Range of Activities 1
2
3
4
5
NO
Comments:
SERVICE
FACULTY SELF ASSESSMENT
(Choose a rating for yourself by placing an “X” before the appropriate number)
1
2
3
activities, quality and
minimal or no service;
some service; activity
depth of projects meet
activity considerably below
somewhat below that
current standards and as
that expected for current expected for current level of
expected for current
level of experience
experience
level of experience
4
5
activity, quality and
depth of projects
somewhat above that
expected; pattern of
ongoing activities
activity considerably
above that expected;
ongoing extensive
service activity
List two of your most significant accomplishments in Service during this evaluation period or highlight these
accomplishments on your current CV.
1.
2.
EVALUATOR ASSESSMENT OF SERVICE
I agree with faculty member’s self rating of performance (place an “X”): YES
If NO, complete your rating of the faculty member’s performance (place an “X”): 1
NO
2
3
4
5
3
Comments:
List honors or awards in Scholarship, Teaching or Service that you have received during this evaluation period.
1.
2.
3.
CITIZENSHIP & LEADERSHIP
Rating Scale:
1 = Inconsistent in performance and requires excessive supervision and support. Improvement plan is needed.
2 = Results are usually on target. May need occasional support. Still learning to perform responsibilities independently.
3 = Results are fully and consistently on target. Makes a valuable contribution. Is fully competent. This level describes performance of
most faculty members.
4 = Results consistently exceed expectations. Makes significant contributions well beyond requirements. Outpaces most peers
FACULTY SELF ASSESSMENT
Choose a rating for yourself by placing an “X” before the appropriate number
in the following Citizenship categories:
Communication
• Open to feedback
• Listens to and respects the views of others
Accountability
• Takes personal responsibility to deliver agreedupon results
• Accomplishes goals with little supervisory
intervention
Collaboration
• Shares success with others
• Resolves conflict directly & constructively
Diversity
• Understands and utilizes cross-cultural
perspectives to strengthen quality of interaction
with others.
• Actively participates in the development and
implementation of a diversity strategy plan/effort.
EVALUATOR ASSESSMENT
 place an “X” for Citizenship
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Choose a rating for yourself by placing an “X” before the appropriate number
in the following Leadership categories:
EVALUATOR ASSESSMENT
 place an “X” for Leadership
Program Management
• Delegates work effectively
• Sets priorities and establishes timelines
• Manages change
1
2
3
4
1
2
3
4
Program Vision & Development
• Develops viable initiatives
• Builds sustainable programs/manages resources
effectively
1
2
3
4
1
2
3
4
Leading Others
• Empowers and mentors others
• Demonstrates a balanced and flexible approach
1
2
3
4
1
2
3
4
4
Evaluator Comments:
GOAL SETTING
Comment on your progress on last year’s goals (cut and paste last year’s goal into this document if available):
List your proposed goals for the next evaluation period:
1.
2.
3.
4.
5.
Please give suggestions for specific support that could facilitate the fulfillment of your career goals within the
Division/Department.
EVALUATOR ASSESSMENT
PROGRESS TOWARD PROMOTION (place an “X” in the appropriate designation):
Faculty Member is a Full Professor
Faculty Member is satisfied with current rank and not working towards promotion
Faculty member is a candidate for promotion in the next promotion cycle.
Academic Rank
Faculty member is working towards promotion but is not a candidate for promotion in the next promotion cycle.
Next steps toward promotion
1.
2.
3.
The document was reviewed together by the Faculty member and the Evaluator on
Written summary sent to the faculty member on
Faculty Member Signature*
(dd/mm/yy)
(dd/mm/yy)
Evaluator Signature
*The faculty member’s signature is an acknowledgement of the completed annual review process and does not necessarily
signify agreement with the evaluator’s ratings or evaluation comments.
5
Faculty Comments:
6