Residency Program: _____________________________________________
Rating Scale: 1=Poor; 2=Fair; 3=Adequate; 4=Good; 5=Excellent On the basis of your needs, rate this program’s: FEATURE Education
Program Philosophy
RATING COMMENTS
Accreditation Overall Curriculum ________ ________ ________ ____________________________________ ____________________________________ ____________________________________ Rotations/electives Rounds (educational vs. work) Conferences # & variety of patients Hospital Library Resident evaluations ________ ________ Board Certification of graduates ________
Attending Physicians/Teaching Faculty
# of full-time vs. part-time ________ Research vs. teaching responsibilities ________ Clinical vs. teaching skills Availability/approachability Preceptors in clinic Subspecialties represented ________ ________ ________ ________ ________ ________ ________ ________ Instruction in patient counseling & education
Hospital
Community or university hospital? ________ ________ Staff physicians’ support of program ________ Availability of consultation services ________ Other residency programs Types of patients ________ ________ Hospital staff (nursing, lab, path, etc) ________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________

FEATURE Current House Officers
Number per year Medical school of origin Personality Dependability Honesty Cooperation/get along together
RATING
________ ________ ________ ________ ________ ________ Compatibility/Can I work with them? ________
Work Load
Average #pts./HO (rotation, clinic) ________ Supervision: senior HO, attending Call schedule ________ ________ Rounds ________ Teaching/conference responsibility ________ “Scut” work Time for conferences ________ ________ Clinic responsibilities
Benefits
Salary Professional Dues ________ ________ ________ Meals ________ Insurance (malpractice, health, etc.) ________ Vacation Maternity/sick leave Outside conferences/books Moonlighting permitted
Surrounding Community
Size and type (urban/suburban) ________ ________ ________ ________ Geographic location Climate and weather Child care and public schools Socioeconomic/religious diversity ________ ________ ________ ________ ________ Entertainment/Recreation/Culture ________ Cost of living (housing/food/utilities ________ Housing availability & quality ________ Economy (industry/growth/recession)________
COMMENTS
____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________

Program’s strengths: Program’s Weaknesses:
Reprinted with the permission of Dr. Stokes and the Barberton Citizens Hospital Family Practice Program, Barberton, Ohio.