MCSO/OSU-CHS
Emergency 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
Dr. Ford
Dr. Lovelace
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 ITEMS
Understands the tenets of triage
1
2
3
4
5
UE
Understands the emergency medical response system
1
2
3
4
5
UE
Demonstrates the ability to rapidly and correctly assess the ER patient
1
2
3
4
5
UE
Understands appropriate use of the ER
1
2
3
4
5
UE
Intern/resident is competent to revise and repair several types of lacerations.
1
2
3
4
5
UE
Intern/resident is able to accurately diagnose and treat strains, sprains, and fractures seen in the ER setting
1
2
3
4
5
UE
Is able to rapidly identify and treat circulatory collapse
1
2
3
4
5
UE
Intern/Resident demonstrates competency in resuscitation of a patient and can successfully run a code
1
2
3
4
5
UE
Rapidly assesses and treats a multiple trauma victim
1
2
3
4
5
UE
Rapidly identifies and treats respiratory failure
1
2
3
4
5
UE
Demonstrates appropriate use of emergency diagnostic technology
1
2
3
4
5
UE
Disposition of patients to home, hospital or clinic is appropriate. Instructions to patients are appropriate and timely
1
2
3
4
5
UE
Comments
Signature of Evaluator
UPIN
SSN
MCSO ID
Date:
Indicates Response Required