MCSO/OSU-CHS
Family Practice Evaluation for Obstetrics
Name of First Year Resident
*
Alex Roby DO
Clay Garrett DO
Robert Moody DO
Tim Newton DO
Rotation Dates
*
Month
Jan
Feb
March
April
May
June
July
August
Sept
Oct
Nov
Dec
*
Year
2010
2011
2012
2013
2014
2015
Name of Evaluator
*
Dr. Cuesta
Dr. Lee
Dr. Sureddi
Dr. Taylor
Dr. Whittington
Did the Intern demonstrate Osteopathic skills during this rotation?
*
1
2
3
4
5
UE
Did the Intern demonstrate adequate Medical/Obstetrical knowlege during this rotation?
*
1
2
3
4
5
UE
Did the Intern demonstrate professionalism during this rotation?
*
1
2
3
4
5
UE
Did the Intern demonstrate adequate interpersonal and communication skills during this rotation
*
1
2
3
4
5
UE
Did the Intern demonstrate adequate patient care skills for their level of training?
*
1
2
3
4
5
UE
Did the Intern demonstrate adequate use of resource materials during this rotation?
*
1
2
3
4
5
UE
Did the Intern demonstrate punctuality?
*
1
2
3
4
5
UE
Did the Intern demonstrate the ability to adequately stage the progression of labor including estimates of dilation and effacement?
*
1
2
3
4
5
UE
Did the Intern demonstrate the ability to deliver an uncomplicated OB commensurate with his/her level of training?
*
1
2
3
4
5
UE
Did the Intern demonstrate the ability to repair an episiotomy?
*
1
2
3
4
5
UE
Did the Intern demonstrate the ability to correctly interpret the fetal monitor?
*
1
2
3
4
5
UE
Did the Intern demonstrate the ability to place and monitor an epidural?
*
1
2
3
4
5
UE
Did the Intern demonstrate the ability to recognize and respond to pathology demonstrated by a complicated OB?
*
1
2
3
4
5
UE
Please estimate the number of vaginal deliveries attended by the intern
*
Please estimate the number of C-sections attended by the Intern
*
Please estimate the number of epidurals attended by the Intern
*
Signature of Evaluator
____________________________
Date
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*
Indicates Response Required