MCSO/OSU-CHS
NEWBORN NURSERY
NAME OF RESIDENT
Monica Woodall, DO
Michael Roach, DO
Thomas Jarvis, DO
Robert Gispanski, DO
Mike Boger, 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
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
Evaluates newborns well
Evaluation of at risk or sick newborns
APGAR scoring accuracy
Newborn IV therapy ability
Stabilization of the newborn
ABG sampling ability
Dubowitz scale
O2 therapy in the newborn
Circumcision ability
Basic newborn lab and interpretation
Jaundice/Phototherapy
Newborn Intubation
Bag and Mask ventilation ability
Algo hearing screening
ROTATION SPECIFIC COMMENTS
Comments
Signature of Evaluator
UPIN
SSN
MCSO ID
Date:
Indicates Response Required