ANNUAL PEDIATRIC RESIDENCY PROGRAM EVALUATION
DATES:
Present Level of Training: (circle one) Peds I II III
I.
Med-Peds I II III IV
Didactic Curriculum
What is your overall impression of the didactic curriculum for this past academic year?
Ambulatory Talks
Morning Reports
Noon Conferences
Poor/Far Below
Expectations
↓
1 2 3
1 2 3
1 2 3
Meets expectations
↓
4
5 6 7 8
4
5 6 7 8
4
5 6 7 8
Superior/Far Exceeds
Expectations
↓
9 10
9 10
9 10
Please write specific comments & suggestions for improvement in the space below:
II.
Assessment of Evaluation Tools and Academic Teaching Experiences:
How useful have these items been to your training/preparation for Pediatrics?
A.
B.
C.
D.
E.
F.
G.
H.
I.
Not useful
Personal Advisor/Mentor
1 2
Faculty Evaluations
1 2
Pediatrics In-Service Exam
1 2
Pediatric Take Home Exams
1 2
Procedure Logs
1 2
Journal Club
1 2
Research Activity/Project
1 2
Quality Improvement Project (CFK) 1 2
Mini CEX evaluations
1 2
3
3
3
3
3
3
3
3
3
4
4
4
4
4
4
4
4
4
Very Useful
Comments/Suggestions:
5
______________________________________
5
______________________________________
5
______________________________________
5
______________________________________
5
______________________________________
5
______________________________________
5
______________________________________
5
______________________________________
5
______________________________________
Please write specific comments & suggestions for improvement in the space below:
III.
Assessment of Residency Leadership & Support Staff:
How effectively have these people served you?
A.
B.
C.
D.
E.
Program Director
Associate Program Director
Pediatric Chief Resident
Med-Peds Chief Resident
Residency Coordinator
Not effective
1 2
1 2
1 2
1 2
1 2
3
3
3
3
3
4
4
4
4
4
Very effective
Comments/Suggestions:
5
______________________________________
5
______________________________________
5
______________________________________
5
______________________________________
5
______________________________________
Please write specific comments & suggestions for improvement in the space below:
CONTINUED…
IV.
Global Comments:
A. List 3 Strengths & 3 Weaknesses of your overall residency training:
Strengths:
Weaknesses:
1. _________________________
1. _________________________
2. _________________________
2. _________________________
3. _________________________
3. _________________________
B. Lists 3 Strengths & 3 Weaknesses of your patient care experience here at Metro.
Strengths:
Weaknesses:
1. __________________________
1. _________________________
2. __________________________
2. _________________________
3. __________________________
3. _________________________
C. How effective are the following formats for giving and receiving information and feedback regarding the
residency program:
Housestaff Meetings
Ineffective
1
2
3
4
5
Effective
End-of-Year Retreat
Ineffective
1
2
3
4
5
Effective
Please write specific comments & suggestions for improvement in the space below:
V.
Final Impressions:
The residency experience is meeting my perceived needs and expectations for my training goals.
1
2
Poor/Far Below
Expectations
3
4
5
6
7
8
Meets expectations
9
10
Superior/Far Exceeds
Expectations
VI.
Additional Comments (feel free to include any areas/topics not already covered). Use the back
if needed.