MCSO/OSU-CHS
ENT
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. Castro
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 demonstrated 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
Does the Intern/Resident recognize pathology that needs to be referred?
Has the Intern/Resident referred to you inappropriately or appropriately?
Is the Intern/Resident competent to treat OM,OE,?
Can the Intern/Resident recognize and treat various presentations of sinusitis?
Can the Intern/Resident treat epistaxis competently?
Can the Intern/Resident deal competently with cerumen impactions?
Can the Intern/Resident recognize and treat foreign bodies of the ear or nose?
Can the Intern/Resident recognize and treat allergic and non-allergic rhinitis?
Does the Intern/Resident understand the evaluation for hoarseness?
Has the Intern/Resident recognized and evaluated hearing disorders correctly?
Does the Intern/Resident diagnose and deal with nasal polyps correctly?
Does the Intern/Resident have a good basic understanding of tinnitus and dizziness?
Can the Intern/Resident recognize and deal with basic salivary gland disorders?
ROTATION SPECIFIC COMMENTS
Comments
Signature of Evaluator
UPIN
SSN
MCSO ID
Date:
Indicates Response Required