MCSO/OSU-CHS
Sports Medicine
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
Scott Wellman
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
Intern/Resident evaluates sports injuries competently
Intern/Resident treats sports injuries competently
Intern/Resident has a basic grasp on the rehabilitation of the athlete
Intern/Resident has a good grasp on the taping and splinting of injuries
Intern/Resident has a good grasp on those injuries that need more rapid diagnosis and treatment and/or referral
Intern/Resident has a good grasp on returning an athlete to competition
Intern/Resident knows and can use a concussion grading system to protect the athlete
Intern/Resident shows specific evaluation expertise for injuries to the cervical spine
Intern/Resident shows expertise in evaluation and treatment of injuries to the shoulder
Intern/Resident shows expertise in evaluation and treatment of injuries to the wrist and hand
Intern/Resident shows expertise in evaluation and treatment of injuries to the knee
Intern/Resident shows expertise in evaluation and treatment of injuries to the ankle
ROTATION SPECIFIC COMMENTS
Comments
Signature of Evaluator
UPIN
SSN
MCSO ID
Date:
Indicates Response Required