MCSO/OSU-CHS
Ophthalmology
NAME OF RESIDENT
Monica Woodall, DO
Michael Roach, DO
Mike Boger, DO
Robert Gispanski, DO
Thomas Jarvis, DO
Andrew Hamill, DO
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. Croft
other
Lichert Scale 1=poor 3=average 5=excellent
CORE COMPETENCY EVALUATION
Did the intern / resident demonstrate Osteopathic Skills during this rotation?
1
2
3
4
5
UE
Did the Intern demonstrate adequate medical knowledge during this rotation?
1
2
3
4
5
UE
Did the intern / resident demonstrate professionalism during this rotation?
1
2
3
4
5
UE
Did the Intern / Resident demonstrate adequate interpersonal and communication skills during this rotation?
1
2
3
4
5
UE
Did the Intern / Resident demonstrate adequate patient care skills for their level of training?
1
2
3
4
5
EU
Did the Intern demonstrate adequate use of resource materials during this rotation?
1
2
3
4
5
UE
Did the Intern / Resident demonstrate punctuality
1
2
3
4
5
UE
ROTATION SPECIFIC QUESTIONS
1
2
3
4
5
UE
Can the intern/resident diagnose and manage the red eye?
Is the intern/resident competent with the ophthalmoscope?
Can the intern/resident identify cataracts?
Is the intern/resident competent to suspect/diagnose diseases of the eye that merit referral?
Can the intern/resident remove a simple foreign body from the cornea or sclera?
Can the intern/resident manage a stye or chalazion?
Is the concept of visual fields understood by the intern/resident?
Can the intern/resident recognize and deal with strabismus?
Does the intern/resident recognize glaucoma?
Can the intern/resident measure intraocular pressure?
ROTATION SPECIFIC COMMENTS
Comments
Signature of Evaluator
UPIN
SSN
MCSO ID
Date:
Indicates Response Required