MCSO/OSU-CHS
Family Medicine Teaching Service Evaluation
NAME OF RESIDENT
Monica Woodall, DO
Michael Roach, 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. Dillow
Dr. Gastorf
Dr. Gordon
Dr. Harrison
Dr. Jaiswal
Dr. Mike Lee
Dr. Terry Lee
Dr. Sturch
Other
Lichert Scale 1=poor 3=average 5=excellent
CORE COMPETENCY EVALUATION
Did the intern / resident demonstrate Osteopathic Skills during this rotation? Did he/she apply OMT in the hospital and the continuity clinic setting? Was it appropriate? Did they apply osteopathic principles into their patient care activities?
1
2
3
4
5
UE
Comments
Did the Intern demonstrate adequate medical knowledge during this rotation? Did he/she show current knowledge? Was he/she current with new developments? Did the resident apply principles of clinical and behavioral medicine appropriately?
1
2
3
4
5
UE
Comments
Did the intern / resident demonstrate professionalism during this rotation? Did he/she show respect for families? Were they patient advocates? Were they honest with patients? Did they treat patients with compassion? Did they show an ethical concern for their patients? Did they show proper attention to issues of culture, age, gender, sexual orientation, mental and/or physical disabilities? Were they punctual? Were they properly attired?
1
2
3
4
5
UE
Comments
Did the Intern / Resident demonstrate adequate interpersonal and communication skills during this rotation? Did they show effectiveness in developing appropriate doctor-patient relationships? Did they demonstrate good listening skills? Did they demonstrate adequate written and oral communication skills in professional interactions with patients, families and other health care professionals?
1
2
3
4
5
UE
Comments
Did the Intern / Resident demonstrate adequate patient care skills for their level of training? Did they incorporate Osteopathic principles, patient empathy, good diagnostic and therapeutic plans? Did they show knowledge of preventative medicine measures?
1
2
3
4
5
EU
Comments
Did the Intern/Resident demonstrate adequate practice based learning and improvement skills? Did they integrate evidence based medicine into patient care? Did they show an understanding of research methods?
Can they apply outcomes based research? Did they use library resources to discover pertinent medical information?
1
2
3
4
5
UE
Comments
ROTATION SPECIFIC ITEMS
Number of Hospital OMT cases logged
Number of clinic OMT cases logged
Performs an adequate structural exam of patients
1
2
3
4
5
UE
Non procedural Goals and Objectives
Able to assume significant patient care responsibilites
Participate and direct the team process
Assumes the role of trainer with students
Has developed skills in effective utilization of available services
Has developed skills in patient evaluation
Has developed skills in treatment planning
Specific Procedural Competencies
1
2
3
4
5
UE
Resident can perform a lumbar puncture
Resident can perform a thoracentesis
Resident can perform a paracentesis
I&D
Skin biopsy
Excision of lesions
Cryo
Curettage
Laceration repair
Joint injections, specific
Casting
EKG interpretation
Spirometry or PFTs
Defibrillation
Urinary catheters
Endotracheal intubation
Central Line placement
Flexible sigmoidoscopy
Colonoscopy
Charts
1
2
3
4
5
UE
Charting is concise and complete
Charting clearly shows the level of care given to the patient
Charting is legible
Charts are presented to the supervising physician in a timely fashion
Overall Evaluation
1
2
3
4
5
UE
Unsatisfactory -------------Outstanding
Comments
Signature of Evaluator
UPIN
SSN
MCSO ID
Date:
Indicates Response Required