MCSO/OSU-CHS
UROLOGY
NAME OF RESIDENT
Kristen Battles, DO
John Brand, DO
Lynn Jestis,DO
Eric Lee, DO
Gina Madole,DO
Eric Mills, DO
Ryan Shaffer, DO
Scott Glover, DO
Tiffany Pinkerton,DO
Monica Woodall, DO
Michael Roach, DO
Scott Evans, 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
involved physician
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/Resident 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
Knowledge of congenital urologic problems
Understands the differential of testicular pain
Identifies scrotal and testicular abnormalities
Understands diagnosis and treatment of obstructive uropathy
Hematuria and its differential
Renal stones, differential and treatment
Proper management of UTI
Incontinence, types and treatment
Urologic malignancies, recognition
Hernias and hydrocoeles, recognition and management
ROTATION SPECIFIC COMMENTS
Comments
Signature of Evaluator
UPIN
SSN
MCSO ID
Date:
Indicates Response Required